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
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
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
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
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
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
How can a psychotherapist
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
he 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
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
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
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.
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.; an" Gina E. Rayfield. Ph.D., in developing
this fact sheet.
This document may be reprinted in its entirety without
A Publication of the American Psychological
Association Practice Directorate