ED Specialization Reflection: Why Are You Specializing in EDs?

Sandra Wartski, Psy.D., CEDS

Many of us in the Eating Disorder (ED) field likely often get asked what sparked interest in this particular field of concentration.  I generally give a variety of answers depending on the week, my energy level or the particular person querying; however, I forced myself to dig a bit deeper from a longer term perspective when a newer clinician embarking into the field recently asked about why I chose this specialization.  Rather than give a quick or simplified retort as I sometimes have done, I chose to reflect a bit more thoughtfully about my personal journey into this field – something I hadn’t really done in quite some time.  It is unclear whether it was the pandemic fatigue that prompted me to spend the additional time on something other than intensive client care or maybe the fact that this young, motivated newbie in the field seemed genuinely interested, but the process of reflecting and writing this down proved to be helpful not just to our discussions but also, of course, for my own self-awareness.  I am sharing my reflection here as a means to possibly encourage others to maybe explore significant features from the past and to create a vision moving forward in this complex, rich, and incredibly satisfying field of work.

My specialization in Eating Disorders (EDs) has foundational roots in my childhood, was strengthened with concentrated exposure, responded to a geographical need, and has now come full circle back to prevention.

My formative pre-teen and teen years were in the late 1970s and early 1980s, the time of big hair, Jane Fonda aerobics, MTV, consumerism, materialism, and the explosion of body objectification. Many of my friends embarked on what now sound like silly diets—the cabbage soup diet, the cottage cheese diet, the Beverly Hills diet, the Elizabeth Taylor diet—and, I now realize in retrospect, that some of them likely were struggling with bona fide eating disorders. One of the protective factors for me may have actually been related to the fact that my mother, an immigrant trying hard to fit in with the American lifestyle, seemed to be caught up in some of the body over-focus; I was hurt and confused when she would attempt to push this onto me but mostly saddened by the seemingly misguided emphasis on the external. These early years, unbeknownst to me at the time, formed the foundation of what would later become an area of passion for me.

Fast forward almost a decade later, deep into a clinical psychology graduate school program, I received my first choice internship placement at a residential treatment center for Eating Disorders. I was intrigued with the notion of spending a year focused on a domain about which I thought I knew very little, though it turns out that growing up as a female in America and my years learning about mental health more generally served as helpful underpinning. My interest in EDs was solidified as I trained amidst talented clinicians working with smart, sensitive clients stuck in scary spirals. This intensive setting not only provided an excellent source of data for my doctoral dissertation but, more importantly, exposed me to the hard work involved in addressing this serious illness. I worked with individuals deeply entrenched in patterns of restricting, purging, binging – and came to see how the symptoms were only the outward manifestation of the deep hurt, trauma, unexpressed emotions, unmet needs and struggles which lay beneath the surface. Even more importantly, I was able to see how individuals really could get better. My sense of hope for recovery was strengthened.

When I moved to a new city to start my career as a newly minted psychologist, I had no intention of specializing in Eating Disorders; however, the practice owner who hired me said almost immediately, “Great! You can be our ED clinician!” I didn’t believe I really could be that specialist, but there were very few therapists in the area concentrating on this work at that time, and soon my caseload filled with teens, children and adults struggling with disordered eating patterns. I had to get past my imposter syndrome struggles and get busy. The desperation of so many families, pediatricians, or other therapists struggling to help individuals tackle this overwhelming disease inspired me to keep learning. I applied my knowledge from my training but found significant differences in the outpatient work. No longer was there 24/7 supervision and reinforcement of healing, healthful messages with daily staff strategizing sessions; this forced me to develop treatment teams in the community, provide educative coaching for families, guide physicians in ways of approaching medical follow-up, join an ED supervision group and continue my own ongoing instruction at every opportunity. And, just as importantly, much of my professional development came from the experience of working with brave clients who shared their vulnerabilities as we tackled the slow but steady ascent to healing.

Fortunately, there are now many more clinicians, as well as treatment centers, treating EDs in my community and across the nation. I continue to treat individuals with EDs but have been able to diversity my caseload some. I still feel passionate about the work, but I have moved now more consistently into the role of attempting to work with families, schools, PTAs, girl scout troops, pediatricians, and other clinicians on the prevention of disordered eating patterns and body image negativity. Like Desmond Tutu wisely affirmed, “There comes a point where we need to stop just pulling people out of the river. We need to go upstream and find out why they’re falling in.” I am eager to keep walking upstream, and I am hopeful that we can help make some of the formative years for today’s generations better.

What has your journey been?  Are there specific events and formative years occurrences that influenced your interest in this field? And how would you like to see your work impacting future generations of ED clinicians and researchers to come? Reflecting on this might prove valuable to others such as mentees, supervisees, coworkers or supervision group members but perhaps, most importantly, to yourself.


Sandra Wartski, Psy.D. completed her undergraduate degree at the University of Rochester and received her Doctorate in Psychology from Widener University.  After interning at Media Child Guidance Clinic and The Renfrew Center, Dr. Wartski moved to Raleigh and joined Silber Psychological Services in 1993. As a licensed psychologist in North Carolina, Dr. Wartski has been conducting individual, family and group therapy, as well as psychoeducational evaluations, with special interests in mood disorders, anxiety, eating disorders, relationship issues and crisis intervention.  She is also a Certified Eating Disorder Specialist (CEDS).    One of her favorite parts of being a therapist is the opportunity to build relationships allowing room for positive growth and change. Dr. Wartski also enjoys providing presentations and writing articles on a variety of mental health topics for both community groups and other professionals.  Her primary professional volunteer activities have related to disaster mental health responding, serving as Disaster Response Network Coordinator for North Carolina and as Mental Health Lead at the Triangle Red Cross; more recently, she has served as President of the North Carolina Psychological Association (NCPA) and is now serving as President of the North Carolina Psychological Foundation.   Dr. Wartski has been honored to have received the North Carolina Psychological Foundation President’s Award, The Exceptional Volunteer Service Award from the American Red Cross and the “Heroes in the Fight” Award from the Coalition for Persons Disabled by Mental Illness.

Comments: sandra.wartski@silberpsych.com. Visit website: http://silberpsych.com/

*The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders and not intended as endorsement by iaedp™ Foundation, Inc. or its Board of Directors.*

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