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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.
What are the major kinds
of eating disorders?
Who suffers from eating disorders?
What causes eating disorders?
Why is it
important to seek treatment for these disorders?
How can a psychologist
help someone recover?
Does treatment really work?
What are the major kinds
of eating disorders?
There are three major types of eating disorders.
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. 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.
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.
Who suffers from eating
disorders?
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.
What causes eating disorders?
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.
Why is it
important to seek treatment for these disorders?
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.
How can a psychologist
help someone recover?
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.
Does treatment really work?
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.
Therapists 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.
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 therapists such as licensed psychologists
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.
October 1998
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