Ask Your Therapist Today: Psychotherapy for Eating Disorders
Eating Disorders (ED) are categorized as mental illnesses that involve maladaptive eating patterns. Those diagnosed with an eating disorder are likely to consume excessive or very insufficient amount of food which taxes their physical health, immunity and mental health, coupled with the deep fear of becoming fat.
This unhealthy relationship with food lowers quality of life and also taxes social functionality a person hopes to have.
A study conducted in the US reported that 20 million females and 10 million males are diagnosed with a clinically significant ED at one point in their lifetime (Hudson et al., 2007).
Let’s have a look at the various types of eating disorders as identified by the DSM-V.
Characterized by persistent restriction of food, leading body weight lower than what is expected for that age, gender, development trajectory and physical health guidelines.
Individual must display recurrent episodes of binge eating followed by excessive purging. A sense of lack of control is felt during the eating episodes, and very low esteem is also persistent. Individual will also be abusing weight loss medication and performing compensatory behavior to prevent weight gain.
Binge Eating Disorder
Individual will feel a lack of control when eating, and will be uncomfortably full. Some people may also eat alone, eat when not hungry, and feel excessive depression or guilt post-eating.
This is diagnosed in individuals who consume non-nutritious substances which are not culturally or normally done – for example, glue, mud, etc. This is usually seen in those with the Autistic Spectrum Disorder.
Characterized as a pathological obsession with “healthy” nutrition, patients will subjectively consume food they feel is healthy and omit food groups they consider unhealthy or impure. Patients will spend unlimited time debating over the quality of food they are consuming and are overly conscious of nutrient value.
It’s usually seen in patients with diagnosed OCD, Anxiety and OCD Personality disorders.
Avoidant/Restrictive Food Intake Disorder
Initially referred to as the Selective ED, individuals will limit or restrict certain food groups/types because of the fear of becoming fat. It stems from the sensory characteristics of food and results in lowered physical health, nutritional levels and lowered psychosocial functioning.
Other Specified EDs
The following disorders are characterized by non-normative eating behavior, but don’t fully meet the criteria of the conditions written above. Have a look at them nonetheless.
Atypical Anorexia Nervosa
All criteria is met except for the weight loss – individual may be of normal body weight
Low Frequency Binge Eating Disorder
All symptoms are met and prevalent for the expected time duration, but behavior occurs at low frequency
Recurrent purging to keep weight and calorie intake in check
Night Eating Syndrome
Characterized by recurrent episodes of excessive food intake at night – usually after sleeping or after evening meals.
Eating disorders under this category cause distress and impairment in development and cognitive functioning, but cannot be fully diagnosed as specific disorder.
The various kinds of eating disorders share common symptoms. However, these symptoms have to be a cause for distress; they have to inhibit daily functioning and be persistent for a long period of time:
- Strict dieting – restrictive/avoidant eating
- Secret binging
- Hoarding food
- Increase in use of diet pills, laxatives and diuretics
- Exercising excessively
- Using appetite suppressants – prescriptive medication and stimulant drugs
- Constant fluctuation in weight and energy levels
- Gastrointestinal complaints
- Digestive problems
- Hair loss/thinking
- Unhealthy skin and nails
- Feeling cold
- Weak muscles
- Sleep problems
- Russel’s sign
- Swollen salivary glands
- Esophagus lining tears
Comorbidity refers to the presence of more than one illness at a given time; in the case of mental illness, one disorder paves way for another to develop.
Eating disorders exist alongside other mental illnesses. The onset of an ED is brought about because of an existing mental condition, or an ED facilitates the symptoms of another mental illness. EDs also arise due to impaired cognitive functioning resulting from birth defects, developmental delays or accidents. Here are some illnesses EDs share comorbidity with:
- Bipolar Disorder
- Obsessive Compulsive Disorder
- Obsessive Compulsive Personality Disorder
- Borderline Personality Disorder
- Panic and Anxiety Disorder
- Sleep Disorder
- Addiction – substance abuse
Psychotherapies for Eating Disorder
Psychotherapies are breakthrough therapies used alongside psychiatric medication or on their own, to encourage patients to address their thoughts, feelings and behaviors that have led to their diagnosis.
The aim of psychotherapy for EDs is to identify psychological stressors that brought the onset of the disorders/symptoms. Patients learn to identify and use resources to improve their functionality, quality of life and delay the onset of recurrent symptoms.
Since eating is a very important part of being human, psychotherapies eating disorders cause devastation to the body. Physical deficiencies have spill-over effects on the brain, and improper nutrition can bring about impairment in various areas – motor skills, memory, learning, habituation, etc. For example, in depressed patients, lower levels of vitamin D were noted.
Cognitive Behavioral Therapy
Probably one of the most popular and effective psychotherapies out there, the premise of CBT is to deal with thoughts and feelings as interdependent components of the human psyche. CBT aims to change the way patients feel about food and themselves by identifying thoughts that reinforce disordered eating and curbing them with alternate ones.
Psychotherapists also use CBT to correct errors in attribution which patients may display towards food, weight gain and body image – basically, identifying, addressing and amending adaptive thoughts that feed the disordered eating pattern.
It also helps to simultaneously modify symptoms arising from comorbid disorders like anxiety or depression.
Enhanced Cognitive Behavioral Therapy is often used for dire cases. It treats the psychopathology instead of the diagnosis. It uses a combination of novel strategies and interventions to address external obstacles the patient’s are facing – low self-esteem, interpersonal troubles, etc.
There are two forms of CBT-E. The focused form of CBT-E is primarily used to treat psychopathology, and the broad form of CBT-E treats obstacles to change and psychopathology of the ED.
Focusing on interpersonal difficulties that brought the onset of the ED, IPT is divided into three parts:
- Identifying difficulties
2. A treatment plan to target the difficulties
The history of the eating disorder will be excavated alongside interpersonal relationships, and significant life events which may have caused the ED to manifest will be treated by equipping the patient with effective coping skills.
Importance is given to life events life grief, role transitions and disputes, and interpersonal skills. Success has been seen with bulimics and binge eaters.
Dialectical Behavioral Therapy
DBT is based on emotional regulation and is offered to patients who use disordered eating habits to cope with emotional ups and down. It’s a way to identify process and manage emotional challenges in alternate ways to improve eating habits.
Clients and practitioners come up with an individualized treatment plan of achieving goals to ensure great recovery.
Intensive Short Term Dynamic Psychotherapy
ISTDP involves interactive approaches to help patients. It brings to focus how an individual experiences emotions which dictate disordered eating habits. Clients and practitioners identify unhelpful defenses and emotional triggers that bring the onset of disordered eating episodes, and encourage patients to practice skills to curb later episodes.
The Maudsley Method
This treatment is imparted to younger patients, where families are involved in the treatment process. Caretakers are given guidelines about healthy eating behavior and information on purging, binging and other weight compensatory habits.
Divided into three parts, the treatment begins with:
Step 1 : Weight restoration and normalizing,
Step 2: Returning control of eating decisions to the patient – usually after 87% of their ideal body weight has been achieved
Step 3: Helping the patient establish a healthy identity
Exposure and Response Prevention Therapy
As the name suggests, this therapy aims to expose patients to feared objects or circumstances to desensitize their fears. Practitioners use ERP to assist patients to resist compulsive behaviors performed in the advent of anxiety or fear – in other words, patients are made to identify and deal with their triggers by facing them and processing the emotions the exposure illicit.
Usually used for those diagnosed with Pica or Anorexia Nervosa, the lessening of fear reduces the compulsion to indulge in disordered eating. Depending on the extremity of symptoms, a practitioner may use one of the following techniques:
- Gradual Exposure Therapy: Increasing exposure to threatening stimuli gradually
- Prolonged Exposure: Extended periods of sustained exposure to threatening stimuli
- Exposure Therapy Social Anxiety: Treating anxiety brought on by social events/activities
For individuals who have ED comorbidity with panic disorders, anxiety and fear, this therapy aims to equip them with techniques of being aware and increasing acceptance. It inculcates mindful eating habits and mindful meditation to employ when the onset of symptoms are near.
The aim of mindfulness is to inhibit and disengage with negative thoughts, disregarding them entirely.
Therapies tried under this bracket are:
- Acceptance and Commitment Therapy (ACT)
- Mindfulness Based Stress Reduction Therapy (MBSR)
- Mindfulness Based Cognitive Therapy (MBCT)
- Mindfulness Based Eating Awareness (MB-EAT)
Success of Psychotherapy with Eating Disorders
Treating disorders physically simply controls the symptoms. Medications may lower the reoccurrence of symptoms, improve brain functioning, better gastrointestinal health and hair and skin devastation. But mental illnesses need to be targeted at the root – as the word “mental” suggests; modification of thought patterns, emotional triggers and responses are important to improve overall quality of life.
Psychotherapy has reported numerous successes with treating eating disorders.
Those diagnosed with Anorexia Nervosa have shown through a long term study that 49% of the times, patients show minimal to no symptoms after prolonged periods of Cognitive Behavioral Therapy, and 41% of the times they remain stable. Using Interpersonal Psychotherapy treatment has shown 64% improvement, and consistent improvement is promised with patient-centered psychotherapy.
Using Interpersonal Psychotherapy and Cognitive Behavioral therapy measures on bulimics has shown better results when paired with psychiatric medication (Fluoxetine). Dialectical Behavioral Therapy, although novel, has shown reduced symptoms and shown abstinence in a number of bulimics; when conducted as group therapy, it shows long term (12-months) consistency in abstaining from disordered eating habits.
Exposure and Response therapy has shown improvement in patients who express fear of weight gain, guilt due to eating episodes, depression and lack of control during their disordered eating. For patients who share comorbidity with Obsessive Compulsive Disorders, this treatment has shown a reduction in the emotional devastation they feel which feeds the disordered eating.
The Maudley model works significantly well with young children and adolescents. Treating the disorder with a marked support group (family and caretakers) shows high remission rates and a chance at living a healthy and normal life.
However, no matter how successful a treatment or medication is, a patient’s willingness towards treatment is a primary factor in their road to recovery.
Unhealthy or inconsistent eating habits are a normal part of daily life. We have schedules and commitments that take up time, and attending events and plans don’t guarantee a correct and timely diet all the time.
But when eating habits begin to affect the daily functioning of an individual, create distressing thought and behavioral patterns to maintain a specific waistline, and show deteriorating health, it’s the time to act.
If you or your loved ones are showing symptoms of an eating disorder, speak to a trusted individual and visit a therapist to understand your condition better.