Eating Disorders: Anorexia and Bulimia

Description

Alternative Names

Therapy

Eating disorders are nearly always treated with some form of psychiatric or psychologic treatment. Depending on the problem, different psychologic approaches may work better than others.

Cognitive-Behavioral Therapy

Cognitive-behavioral therapy (CBT) works on the principle that a pattern of false thinking and belief about one's body can be recognized objectively and altered, thereby changing the response and eliminating the unhealthy reaction to food. One approach for bulimia is the following:

• Over a period of four to six months the patient builds up to three meals a day, including foods that the patient has previously avoided.
• During this period, the patient monitors and records the daily dietary intake along with any habitual unhealthy reactions and negative thoughts toward eating while they are occurring.
• The patient also records any relapses (binges or purging). Such lapses are reported objectively and without self-criticism and judgment.
• The patient discusses the responses with a cognitive therapist at regular sessions. Eventually the patient is able to discover the false attitudes about body image and the unattainable perfectionism that underlies the opposition to food and health.
• Once these habits are recognized, food choices are broadened and the patient begins to challenge any entrenched and automatic ideas and responses. The patient then replaces them with a set of realistic beliefs along with actions based on reasonable self-expectations.

An interesting Swedish study reported significant success in a small group of patients with anorexia and bulimia using specific behavioral techniques that were based on the premises that dieting and exercise stimulate regions in the brain to produce feelings of pleasure and reward. In the study, patients were initially severely restricted from physical activity (anorexic patients were in wheelchairs and bulimic patients could only walk slowly). Meals were monitored using a scale connected to a computer to measure the amount of food taken off the plate and to match intake against a scale. The patients were then trained to eat more by watching their progress on the screen. After each meal, they rested for an hour in a warm room to restore body temperature (which is low in anorexia). A higher percentage of patients remained in remission than those who did not have this treatment. This approach warrants more research.

Interpersonal Therapy

Interpersonal therapy deals with depression or anxiety that might underlie the eating disorders along with social factors that influence eating behavior. This therapy does not deal with weight, food, or body image at all.

The goals are the following:

• To express feelings.
• To discover how to tolerate uncertainty and change.
• To develop a strong sense of individuality and independence.
• To address any relevant sexual issues or traumatic or abusive event in the past that might be a contributor of the eating disorder.

Studies generally report that it is not as effective as cognitive therapy for bulimia and binge eating, but may be useful for some patients with anorexia. The skill of the therapist plays a strong role in its success.

Family Therapy

Because of the major role family attitudes play in eating disorders, one of the first steps in treating the patient with early-onset anorexia is to also treat the family. Family therapy is certainly useful for both younger and older patients.

If the patient is hospitalized, experts recommend that family therapy start after the patient has gained weight, but before discharge. It should usually continue after the patient has left the hospital.

The feelings of intense guilt and anxiety that caregivers experience are probably similar to those produced by living with a person who is suicidal. An over-involved parent may even support the patient's eating disorder for various reasons:

• Some parents may be afraid of releasing some underlying anger or grief directed at the patient.
• Other parents may identify with the goal of thinness and not even perceive that their child is unhealthily underweight.

In such cases, it is extremely important that the family fully understand the danger of this disorder and that they are collaborating in their child's illness, or even death, by encouraging this state.