Psychotherapy for Eating Disorders

Eating disorders are abnormal and unhealthy attitudes and behaviors toward food and eating. People with eating disorders have distorted views of themselves and of their bodies. Although eating disorders can affect anyone, they most often occur in teenage girls and young women. In addition to their adverse health affects, eating disorders are both caused by and lead to emotional and psychological turmoil. Therefore, psychotherapy is often the treatment of choice for eating disorders.

Psychotherapy for eating disorders is “talk therapy.” It is based on open and honest communication between the patient and the psychotherapist that can lead to changes in thought processes, emotions, and behaviors. The relationship between the psychotherapist and the patient must be based on trust, which often develops gradually over time.

How Does Psychotherapy Treat Eating Disorders?

Psychotherapy, or psychological therapy, is the treatment of a disease or condition by addressing the patient’s mental and emotional processes. People with eating disorders often have irrational or illogical ideas, thoughts, and fears that lead to inappropriate eating behaviors.

There are four main types of eating disorders:

• Anorexia nervosa is a form of self-starvation, characterized by the dread and avoidance of food or preventing food from being absorbed by the body; for example, by vomiting after eating. Anorexia causes severe weight loss and, left unchecked, can lead to the malfunction of the body’s organs and even death.

• Bulimia nervosa is a condition in which food can be neither enjoyed nor avoided. Extreme overeating followed by purging—vomiting or the use of laxatives or diuretics—or a period of fasting or excessive exercising characterizes bulimia.

• Binge eating is characterized by repeated episodes of overeating or bingeing without vomiting, purging, or fasting.

• Not-otherwise-specified eating disorders include all other abnormal eating behaviors and attitudes toward food.

Psychotherapy for eating disorders can help the patient recognize and change the emotional and mental processes behind the disorder.

Psychotherapy can help patients:

• Determine whether they have an eating disorder and, if so, of what type
• Identify irrational thoughts, perceptions, assumptions, and fears that contribute to the eating disorder
• Identify unhealthy thinking processes that may contribute to the disorder
• Identify other contributing problems, such as depression or anxiety
• Identify contributing stresses, such as personal relationships or situations
• Recognize triggers for unhealthy attitudes and behaviors.

A psychotherapist treats eating disorders by:

• Listening to and validating a patient’s experiences and emotions
• Acting as a role model or mentor
• Helping patients focus their energy in positive ways
• Instilling optimism and hope
• Improving self-esteem.

The duration of psychotherapy varies. In general, the longer the duration and severity of the eating disorder, the longer the period of recovery. Psychotherapy may continue after resolution of the eating disorder to address underlying emotional problems that led to the disorder.

What Types of Psychotherapy Are Used to Treat Eating Disorders?

Although there are many types of psychotherapies, only a few have been adapted to the treatment of eating disorders. The most common type of psychotherapy for eating disorders is cognitive behavioral therapy (CBT). CBT was initially adapted as a specific short-term treatment for bulimia. More recently it has been adapted to the treatment of binge eating. Cognition refers to thoughts, perceptions, and reasoning.

Cognitive aspects that are addressed during treatment of eating disorders include:

• Undo concerns about weight and body shape
• Perfectionism
• All-or-nothing types of thinking
• Low self-esteem.

The behavioral aspects of CBT focus on abnormal eating and purging.

Cognitive Behavioral Therapy (CBT) has three stages.
Stage one involves:

• Recording in detail all eating and related thoughts and feelings as they occur
• Introducing a regular eating regimen
• Developing alternative behaviors to resist the urge to binge
• Education about food, eating, weight, and body shape.

Stage two includes:

• Reintroducing avoided foods and eliminating other forms of dieting
• Developing skills to deal with situations that trigger binges
• Identifying and changing problematic thinking patterns
• Identifying the origins of the eating disorder.

Stage three involves developing realistic strategies and expectations for the future.

Other types of psychotherapy are also used to treat eating disorders:

• Psychodynamically oriented, supportive psychotherapy focuses on the patient’s inner psychological experience. It is probably the most common psychotherapy for adolescents with eating disorders, providing a safe one-on-one environment for insecure teenagers with low self-esteem.
• Interpersonal psychotherapy (IPT) focuses on social interactions that may lead to eating disorders.
• Group therapy led by a mental health professional is less expensive and involves the help and support of others who are dealing with eating disorders.
• Family therapy can identify family problems and strengths and address misunderstandings that may contribute to the eating disorder. The Maudsley method of family therapy was developed specifically for treating adolescents with anorexia nervosa.

Is Psychotherapy an Effective Treatment for Eating Disorders?

Although psychotherapy is generally very helpful in treating eating disorders, individual responses vary greatly. Some individuals respond immediately and positively to psychotherapy; whereas for others initiating psychotherapy is merely the beginning of a long and slow process. Furthermore, different types of psychotherapy are more effective for some individuals than for others.

Finding a Psychotherapist

Patients with a suspected eating disorder should first consult a general practitioner or family doctor to assess their overall physical condition and determine whether hospitalization may be required. A psychotherapist who treats eating disorders may be a medical doctor, such as a psychiatrist, who can also prescribe medication and address other medical conditions that may contribute to or result from the eating disorder. The psychotherapist can also be a trained social worker or psychologist. Sometimes eating disorders are treated by a team of professionals. In severe cases, psychotherapy may occur in a specialized eating-disorder unit of a hospital.

Psychotherapists have different styles, methods, and personalities and it is essential to find one with whom the patient can work productively. Some psychotherapists are very directive, whereas others may expect the patient to take the initiative in changing eating behaviors. It is often necessary to visit several psychotherapists before finding a good fit. Interviews with potential psychotherapists should include questions about the therapist’s credentials and experience in and approaches toward the treatment of eating disorders.

Additional Resources
National Eating Disorders Association