From my understanding, Overeaters Anonymous embraces those with any type of eating disorder. I appreciate the willingness of group members to understand that it is the addictive, compulsive nature of the behavior that is the problem and not the specific manifestation. Along this line of thought, one member of the group noted his addiction to drugs as well as to food. Crossover addictions are extraordinarily common. One member indicated being a former anorexic who starved herself regularly; that was ten years ago and now she can be considered overweight. Whether or not there is a proven "addictive personality," certainly there are people for whom any pattern of behavior can become a potential problem. From a clinician's perspective, I appreciate the formula the Twelve Steps offer. The group provides a social network. This may be the most important function of the Twelve Step group; certainly it is one of the most important. Members come here and find they are not alone in their suffering. This knowledge alleviates the pain considerably. Sharing means caring. The newcomer to an Overeaters Anonymous meeting is told that when they are ready to commit to the program they shall also find a sponsor. The sponsor is a mentor, a more senior member (although not necessarily a veteran) who can guide a newcomer through the Twelve Steps. The sponsee is expected to phone the sponsor when trouble arises, such as the urge to binge eat.

Newcomers seem tentative at the meeting. They share but they ramble, not yet understanding the connection between their eating disorder, their emotions, and the Twelve Steps. Indeed, one of the hardest things to grasp about the Twelve Steps is their unabashed abstraction. They are steps, but they are not concentrate ones. Rather, they are psychological -- although many group members would say "spiritual" -- steps. The person first "admits powerlessness." Essentially, the first step is admitting one has a problem. By the time the person is willing to do something about the problem, the next major psychological hurdle is the spiritual one in Step Three.

The spiritual nature of the Twelve Step group is one that clinicians struggle with, as it raises ethical...

How is a counselor supposed to encourage an atheist to attend a group meeting that is so overtly about spiritual matters? Thankfully, meetings like the one I attended temper the spiritual content of the Twelve Step group with language that secular humanists understand. Surrendering to a "higher power" is a psychological step. It marks a major shift in consciousness. No matter what a person believes about the creation of the universe, anyone suffering from an eating disorder knows pain and suffering first hand and can at the very least allow the emotional catharsis that comes from surrender. The group actually urges skeptical newcomers to "make the group your higher power." I appreciated this. This showed that the group was not a cult after all, but a genuine outlet for those who need help.
One of things I struggled with was the notion of finality, or lack thereof. For the veteran member of OA, you "keep coming back" forever. Veteran members believe that the key to long-term success and "abstinence" is to attend meetings regularly for the rest of the person's life. This finality tends to scare off newcomers to the Twelve Steps. No one wants to be forever labeled "an overeater." The lack of finality raises questions about the pertinence of labeling theory and possibly self-fulfilling prophesies. Also, the group discourse suggests that there is no possible way a person who suffers from an addiction or eating disorder can ever heal.

I disagree. Although I value and support the Twelve Step group like Overeaters Anonymous, I would counsel my clients in tandem. I would encourage clients to "keep going back" and that the steps indeed "work if you work them." However, I would want to help my client keep in mind the ultimate goals of the Twelve Steps: healing. If clients believe that the only way to achieve liberation from an eating disorder is to become chained to a series of weekly meetings then I would have failed. Perhaps some clients can only benefit from the structure and regular social interaction, but many will be better off weaning themselves off the program once the steps have set in and the work of daily life without addiction begins.