Eating Disorders:
Psychotherapy's Role in Effective Treatment
In a society that continues to prize
thinness even as Americans become heavier than ever before, almost
everyone worries about their weight at least occasionally. People with
eating disorders take such concerns to extremes, developing abnormal
eating habits that threaten their well-being and even their lives. This
question-and-answer fact sheet explains how psychotherapy can help
people recover from these increasingly common disorders.
There are three major types of eating disorders.
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People with anorexia nervosa have a distorted
body image that causes them to see themselves as overweight even when
they're dangerously thin. Often refusing to eat, exercising
compulsively, and developing unusual habits such as refusing to eat in
front of others, they lose large amounts of weight and may even starve
to death.
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Individuals with bulimia nervosa eat excessive
quantities of food, then purge their bodies of the food and calories
they fear by using laxatives, enemas, or diuretics, vomiting and/or
exercising. Often acting in secrecy, they feel disgusted and ashamed as
they binge, yet relieved of tension and negative emotions once their
stomachs are empty again.
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Like people with bulimia, those with binge eating disorder
experience frequent episodes of out-of-control eating. The difference
is that binge eaters don't purge their bodies of excess calories.
It's important to prevent problematic behaviors from evolving
into full-fledged eating disorders. Anorexia and bulimia, for example,
usually are preceded by very strict dieting and weight loss. Binge
eating disorder can begin with occasional binging. Whenever eating
behaviors start having a destructive impact on someone's functioning or
self-image, it's time to see a highly trained mental health
professional, such as a licensed psychologist experienced in treating
people with eating disorders.
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According to the National Institute of Mental Health,
adolescent and young women account for 90 percent of cases. But eating
disorders aren't just a problem for the teenage women so often depicted
in the media. Older women, men and boys can also develop disorders. And
an increasing number of ethnic minorities are falling prey to these
devastating illnesses.
People sometimes have eating disorders without their families
or friends ever suspecting that they have a problem. Aware that their
behavior is abnormal, people with eating disorders may withdraw from
social contact, hide their behavior and deny that their eating patterns
are problematic. Making an accurate diagnosis requires the involvement
of a licensed psychologist or other appropriate mental health expert.
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Certain psychological factors predispose people to developing
eating disorders. Dysfunctional families or relationships are one
factor. Personality traits also may contribute to these disorders. Most
people with eating disorders suffer from low self-esteem, feelings of
helplessness and intense dissatisfaction with the way they look.
Specific traits are linked to each of the disorders. People
with anorexia tend to be perfectionist, for instance, while people with
bulimia are often impulsive. Physical factors such as genetics also may
play a role in putting people at risk.
A wide range of situations can precipitate eating disorders in
susceptible individuals. Family members or friends may repeatedly tease
people about their bodies. Individuals may be participating in
gymnastics or other sports that emphasize low weight or a certain body
image. Negative emotions or traumas such as rape, abuse or the death of
a loved one can also trigger disorders. Even a happy event, such as
giving birth, can lead to disorders because of the stressful impact of
the event on an individual's new role and body image.
Once people start engaging in abnormal eating behaviors, the
problem can perpetuate itself. Binging can set a vicious cycle in
motion, as individuals purge to rid themselves of excess calories and
psychic pain, then binge again to escape problems in their day-to-day
lives.
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Research indicates that eating disorders are one of the
psychological problems least likely to be treated. But eating disorders
often don't go away on their own. And leaving them untreated can have
serious consequences. In fact, the National Institute of Mental Health
estimates that one in ten anorexia cases ends in death from starvation,
suicide or medical complications like heart attacks or kidney failure.
Eating disorders can devastate the body. Physical problems
associated with eating disorders include anemia, palpitations, hair and
bone loss, tooth decay, esophagitis and the cessation of menstruation.
People with binge eating disorder may develop high blood pressure,
diabetes and other problems associated with obesity.
Eating disorders are also associated with other mental
disorders like depression. Researchers don't yet know whether eating
disorders are symptoms of such problems or whether the problems develop
because of the isolation, stigma and physiological changes wrought by
the eating disorders themselves. What is clear is that people with
eating disorders suffer higher rates of other mental disorders --
including depression, anxiety disorders and substance abuse -- than
other people.
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Psychologists play a vital role in the successful treatment of
eating disorders and are integral members of the multidisciplinary team
that may be required to provide patient care. As part of this
treatment, a physician may be called on to rule out medical illnesses
and determine that the patient is not in immediate physical danger. A
nutritionist may be asked to help assess and improve nutritional
intake.
Once the psychologist has identified important issues that
need attention and developed a treatment plan, he or she helps the
patient replace destructive thoughts and behaviors with more positive
ones. A psychologist and patient might work together to focus on health
rather than weight, for example. Or a patient might keep a food diary
as a way of becoming more aware of the types of situations that trigger
binging.
Simply changing patients' thoughts and behaviors is not
enough, however. To ensure lasting improvement, psychologists and
patients must work together to explore the psychological issues
underlying the eating disorder. Psychotherapy may need to focus on
improving patients' personal relationships. And it may involve helping
patients get beyond an event or situation that triggered the disorder
in the first place. Group therapy also may be helpful.
Some patients, especially those with bulimia, may benefit from
medication. It's important to remember, however, that medication should
be used in combination with psychotherapy, not as a replacement for it.
Patients who are advised to take medication should be aware of possible
side effects and the need for close supervision by a physician.
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Yes. Most cases of eating disorder can be treated successfully
by appropriately trained health and mental health care professionals.
But treatments do not work instantly. For many patients, treatment may
need to be long-term.
Incorporating family or marital therapy into patient care may
help prevent relapses by resolving interpersonal issues related to the
eating disorder. Psychotherapists can guide family members in
understanding the patient's disorder and learning new techniques for
coping with problems. Support groups can also help.
Remember: the sooner treatment starts the better. The longer
abnormal eating patterns continue, the more deeply ingrained they
become and the more difficult they are to treat.
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Eating disorders can severely impair
people's functioning and health. But the prospects for long-term
recovery are good for most people who seek help from appropriate
professionals. Qualified psychotherapists with experience in this area
can help those who suffer from eating disorders regain control of their
eating behaviors and their lives.
The American Psychological Association Practice Directorate
gratefully acknowledges the assistance of Kelly D. Brownell, Ph.D.;
Kathy J. Hotelling, Ph.D.; Michael R. Lowe, Ph.D.; and Gina E.
Rayfield, Ph.D., in developing this fact sheet.
September 1997
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