Department of Psychiatry
Penn Behavioral Health

PAH Outpatient Behavioral Health Clinic

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Newsletter: February 2010

Evaluation and Treatment of Eating Disorders

Nell Manning, MA


Have you been feeling as if your eating or dieting were beyond your control?  Do you feel that your sense of self-worth is inseparable from your weight or shape?  Has anyone close to you expressed concern that you might have an eating disorder? Eating disorders are marked by disturbances in a person’s eating behavior that may not only cause physical harm, but are also related to severe emotional turmoil and distress.  They involve profound misperceptions of one’s body shape or weight.  Often, people suffering from eating disorders believe they are doing something healthy for their body, while others are concerned they are hurting themselves.  This can add tension to an already stressful situation.  Approximately 90% of people who suffer from eating disorders are female, and many (but not all) begin to struggle with these difficulties between ages 14 and 18.

There are several types of eating disorders.  One is focused on restricting one’s eating in a way that makes it impossible to maintain a normal body weight.  This is called Anorexia Nervosa.  In addition to having a body weight significantly below normal for one’s age and height, a person suffering from this kind of disorder has a strong fear of gaining weight or becoming fat, a fear that is not relieved as she loses weight.  Furthermore, someone suffering from anorexia nervosa often denies the serious medical implications of their malnourishment, implications which include the absence of several cycles of menstruation.

Another type of eating disorder, called Bulimia Nervosa, is characterized by binge eating (during which one feels one cannot control one’s eating) and then compensating (also called “purging”) by inappropriate or unhealthy methods: fasting, making oneself vomit, misusing laxatives, or exercising excessively.  An individual suffering from this disorder places a great deal of emphasis on her weight or shape when she evaluates herself, and she has a great fear of gaining weight, a strong desire to lose weight, and a sense of discontent with her body.

One of the most difficult aspects of having one of these eating disorders, or struggling with some of their symptoms, is the interpersonal strain that often accompanies them.  Often people struggling with these issues find themselves entangled in conflict with others they are close to.  Sometimes this conflict or tension is about the eating behaviors per se, but not necessarily.  A parent, for instance, may express concern for the welfare of their child suffering from an eating disturbance, but may do so in a way that is difficult to receive, makes her feel guilty, embarrassed, angry, or hurt, even if it is kindly meant.  Or perhaps a loved one has been distant, and an eating disorder may serve as a way to try to draw them nearer.  Sometimes multiple tensions are present.  Some people may focus on their eating because it is an area they feel they can attempt to control when relationships or other events in their lives are out of control.  Others may feel the lack of control they exhibit when they eat is reflective or typical of how they feel about other areas of their lives, too.  Addressing interpersonal relationships and patterns is often an important aspect of treatment for eating disorders.

What can you do to combat an eating disorder or troubling symptoms of one?  First, seek help.  It can be difficult or even anxiety-producing to change some of these patterns on your own, so if you have tried to change what you’re doing but have had difficulty, do not give up.  A therapist can help and support you as you learn to take care of yourself in new, healthier ways, and in a different way than people already known to you might offer.    

Several kinds of psychotherapy have been found to be effective in treating these disorders.  One type is cognitive-behavioral therapy, which focuses on cycles of thoughts, feelings, and behaviors related to eating and helps one learn to change one’s thoughts to interrupt those unhealthy cycles.  Another type of psychotherapy that research has indicated to be equally effective in treating eating disorders is interpersonal therapy.  In this, thoughts and actions about food are not explicitly the focus of treatment, but by focusing and working on understanding and changing patterns in current interpersonal relationships, one is also able to change one’s relationship with eating, purging, weight, and shape.  Both types of treatment have repeatedly been found to be effective in research studies, particularly with people who suffer from bulimia nervosa.  People who enter psychotherapy often make improvements on all aspects of their eating disorder: their eating and compensating (purging) behaviors; their anxiety and other feelings about their weight, body shape, and overall self-worth; and feelings of tension or withdrawal in their close relationships.


References:

American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR).  Washington, DC: Author.

Wilson, G.T. & Pike, K.M., (2001). Eating Disorders.  In D. H. Barlow (Ed.), Clinical Handbook of Psychological Disorders, Third Edition (pp. 332-375). New York: Guilford.