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?
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.
This information was prepared by the American Psychological Association.
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.
Julia Berkman, Ph.D.
is our eating disorders specialists.
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