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Introduction
Learn About Eating Disorders
● Eating disorders: Recovery
Almost everyone worries about their weight occasionally. People with eating disorders take such concerns to
extremes. Learn more about eating disorders and how psychologists treat them.

Getting Help
● Treatment for anorexia and bulimia
Therapy can help restore a healthy attitude toward eating.
● Treatment for binge eating
Experts agree that binge eating treatment must tackle the obesity that comes with binge eating and the
psychological problems that underlie the disorder. But they’re still debating which aspect to treat first.

Introduction:
Eating disorders are abnormal eating habits that can threaten your health or even your life. They include:

● Anorexia nervosa: Individuals believe they’re fat even when they’re dangerously thin and restrict their
eating to the point of starvation.
● Bulimia nervosa: Individuals eat excessive amounts of food, then purge by making themselves vomit or
using laxatives.
● Binge eating: Individuals have out-of-control eating patterns, but don’t purge.

Learn About Eating Disorders:

 ● Eating disorders:
Recovery
This fact sheet explains how psychotherapy can help people recover from
these dangerous disorders.
It’s estimated that 20 million women and 10 million men will experience an eating disorder at some
point in their lives.1 People with eating disorders take such concerns to extremes, developing
abnormal eating habits that threaten their well-being and even their lives. This fact sheet explains how
psychotherapy can help people recover from these dangerous disorders.

What are the major kinds 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, then purge their bodies of the food and
calories they fear by using laxatives, enemas, or diuretics; vomiting; or exercising. Often acting in
secrecy, or feeling a lack of control 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.
Another category of eating disorders is “other specified feed or eating disorders,” in which individuals
have eating-related problems, but don’t meet the official criteria for anorexia, bulimia or binge eating.2
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 bingeing. Whenever eating behaviors start having a
destructive impact on sCertain psychological factors and personality traits may predispose people to
developing eating disorders. Many people with eating disorders may 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 perfectionistic, for
instance, while people with bulimia are often impulsive. Physical factors such as genetics may also
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. Bingeing
can set a vicious cycle in motion, for instance, as individuals purge to rid themselves of excess
calories and psychic pain, then binge again to escape problems in their day-to-day lives.

omeone’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, eating disorders are most common in teenagers
or young adults, but can also affect almost anyone.3 People of all ages, backgrounds, body weights,
and ethnicities can be affected by eating disorders. Although common in teenage women, men and
boys can also be vulnerable. 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 mental variables and character qualities may incline individuals to creating dietary problems. Numerous individuals
with dietary issues may experience the ill effects of low confidence, sensations of weakness, and serious disappointment with
the manner in which they look.
Explicit attributes are connected to every one of the problems. Individuals with anorexia will in general be perfectionistic, for
example, while individuals with bulimia are regularly rash. Actual factors, for example, hereditary qualities may likewise
assume a part in putting individuals in danger.

A wide scope of circumstances can hasten dietary problems in defenseless people. Relatives or companions may over and
over prod individuals about their bodies. People might be partaking in aerobatic or different games that stress low weight or a
specific self-perception. Negative feelings or injuries like assault, misuse, or the demise of a friend or family member can
likewise trigger problems. Indeed, even a glad occasion, like conceiving an offspring, can prompt problems in view of the
distressing effect of the occasion on a person's new job and self-perception.

When individuals begin taking part in unusual eating practices, the issue can propagate itself. Gorging can get an endless
loop rolling, for example, as people cleanse to free themselves of overabundance calories and mystic agony, at that point
gorge again to get away from issues in their everyday lives.

Why is it important to seek treatment

for these disorders?
Research indicates that eating disorders very often go untreated. In one study, for example, less than
13% of adolescents with eating disorders received treatment.

But leaving eating disorders untreated can have serious consequences. Research has found that
individuals with anorexia have a mortality rate 18 times higher than peers who don’t have eating
disorders, for example.5

Eating disorders can devastate the body. Physical problems associated with anorexia, for instance,
include anemia, constipation, osteoporosis, even damage to the heart and brain. Bulimia can result in
a sore throat, worn-away tooth enamel, acid reflux, severe dehydration, and intestinal distress. People
with binge eating disorder may develop high blood pressure, cardiovascular disease, 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 from the research is that people with eating disorders suffer higher rates of
other mental disorders—including depression, anxiety disorders, and substance abuse—than other
people.6
How can a psychologist help
someone recover?
It’s important to remember that there is not a one-size-fits-all approach to the treatment of eating
disorders. Psychologists can play a vital role in the 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.

A psychologist can help to identify the underlying issues and develop a treatment plan to help a
patient work through some of the destructive thoughts and behaviors and replace them with more
positive ones. For example, the focus may be on overall health and well-being, rather than weight. Or
a patient might be asked to keep a food diary as a way of becoming more aware of the types of
situations that trigger bingeing.

Simply changing one’s thoughts and behaviors may not be enough, however. A psychologist may
recommend evidence-based treatments such as psychotherapy to help address the underlying
psychological issues of the eating disorder, or it may be used to focus on improving one’s personal
relationships. It may involve helping one get beyond an event or situation that triggered the disorder in
the first place. Group therapy may also be helpful in the treatment of an eating disorder.

Some patients may be prescribed medications as part of their treatment plan, but it’s important to
follow the instructions of your health care or mental health professional about taking medications and
the possible side effects.

Does treatment really work?

In most cases, eating disorders can be treated successfully by appropriately trained health and mental
health care professionals. But treatments do not work instantly and for many, treatment may be long-
term.

Incorporating family or marital therapy into one’s care may help to prevent relapses by resolving
interpersonal issues related to the eating disorder. Therapists can guide family members in
understanding the disorder and learning new techniques for coping with problems. Support groups can
also help in overcoming an eating disorder.

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 one’s functioning and health. But the prospects for long-term
recovery are good for those 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.

Getting Help:

Treatment for anorexia

and bulimia
Psychologists are finding effective ways to treat these dangerous disorders.
Family therapy, cognitive-behavioral therapy and interpersonal psychotherapy can help individuals
overcome two common eating disorders.

Anorexia treatment
Families can play a key role in treating anorexia, according to clinicians using a treatment known as
the Maudsley approach.
The treatment is a form of family therapy that enlists parents’ aid in getting their children to eat again.
Early in the treatment, clinicians invite the family to share a picnic meal. That gives them a sense of
family meal patterns. It also allows them to suggest ways parents can get the child to eat more.
In weekly sessions, the parents then describe what they’ve fed their child and what’s working well.
The approach also helps to strengthen the childrens’ feelings of independence by gradually letting
them take control of their eating. Clinicians also help the family learn how to help the child cope with
the challenges of adolescence.
In contrast to current treatment, this approach is relative short-term. It relies mostly on outpatient
treatment. And it’s successful over the long term, say researchers.
One study found that two-thirds of patients regained normal weight without hospitalization. Most
showed big improvements in psychological functioning. And parents became less critical of each other
and their children.

Bulimia treatment
The largest controlled study on bulimia so far shows that two types of psychotherapy can help
individuals stop bingeing and purging:

● Cognitive-behavioral therapy helps individuals change the unrealistically negative thoughts they
have about their appearance and change their eating behaviors.
● Interpersonal psychotherapy helps individuals improve the quality of their relationships, learn
how to address conflicts head-on and expand their social networks.

Family-based Treatment of Adolescent

Anorexia Nervosa:
The Maudsley Approach
Even though anorexia nervosa (AN) was first recognized more than 125 years ago, this disorder still
bewilders patients and their families and perplexes clinicians and researchers. Our understanding of
the medical features of AN has advanced, increasing our success at weight restoration in specialist
inpatient settings. Inpatient and day hospital treatments are generally effective in weight restoration,
however, they are disruptive to the adolescent’s family, social and educational life, and relapse is
common. Moreover, weight restoration alone is not sufficient for recovery. The Maudsley family-based
outpatient treatment for AN is a promising alternative model to costly inpatient or day hospital
programs. This model, which strives to bring about weight restoration and restore the adolescent’s
developmental trajectory, is explored in this article.
Research into treatment of anorexia in adolescents

Few controlled clinical trials have been conducted to explore efficacious outpatient treatments for
adolescents with anorexia (1). While research has not been extensive, recent published reports of the
treatment for adolescent AN have been more encouraging.

This handful of treatment trials (2) all investigated a particular type of family-based treatment which is
designed to:

Prevent hospitalization of the adolescent by assisting the parents in their efforts to help their
adolescent in his/her recovery from AN, and; to return him/her to normal adolescent development
unencumbered by the eating disorder. This treatment was conceived by a team of child and
adolescent psychiatrists and psychologists at the Maudsley Hospital in London and has come to be
known as the Maudsley Approach or Family-based Treatment (FBT) for AN.

These studies have all demonstrated the efficacy of this treatment – that is, approximately two thirds
of adolescent AN patients are recovered at the end of FBT while 75 - 90% are fully weight recovered
at five-year follow-up(3). Similar improvements in terms of psychological factors were also noted for
these patients. Clinical and research endeavors by The University of Chicago and Stanford University
have shown promising results in their FBT studies, which are comparable to the positive outcomes
that were initially established in the Maudsley studies. These researchers have shown that most
young patients with AN require on average no more than 20 treatment sessions over the course of 6-
12 months, and that about 80% of patients are weight restored with a start or resumption of menses at
the conclusion of treatment(4).

The Maudsley Approach

The Maudsley approach can mostly be construed as an intensive outpatient treatment where parents
play an active and positive role in order to: Help restore their child’s weight to normal levels expected
given their adolescent’s age and height; hand the control over eating back to the adolescent, and;
encourage normal adolescent development through an in-depth discussion of these crucial
developmental issues as they pertain to their child.

More ‘traditional’ treatment of AN suggests that the clinician’s efforts should be individually based.
Strict adherents to the perspective of only individual treatment will insist that the participation of
parents, whatever the format, is at best unnecessary, but worse still interference in the recovery
process. In fact, many proponents of this approach would consider ‘family problems’ as part of the
etiology of the AN. No doubt, this view might contribute to parents feeling themselves to blame for
their child’s illness. The Maudsley Approach opposes the notion that families are pathological or
should be blamed for the development of AN. On the contrary, the Maudsley Approach considers the
parents as a resource and essential in successful treatment for AN.

Phase I: Weight restoration

The Maudsley Approach proceeds through three clearly defined phases, and is usually conducted
within 15-20 treatment sessions over a period of about 12 months. In Phase I, also referred to as the
weight restoration phase, the therapist focuses on the dangers of severe malnutrition associated with
AN, such as hypothermia, growth hormone changes, cardiac dysfunction, and cognitive and emotional
changes to name but a few, assessing the family’s typical interaction pattern and eating habits, and
assisting parents in re-feeding their daughter or son. The therapist will make every effort to help the
parents in their joint attempt to restore their adolescent’s weight. At the same time, the therapist will
endeavor to align the patient with her/his siblings. A family meal is typically conducted during this
phase, which serves at least two functions:

It allows the therapist to observe the family’s typical interaction patterns around eating, and it provides
the therapist with an opportunity to assist the parents in their endeavor to encourage their adolescent
to eat a little more than she was prepared to.

The way in which the parents go about this difficult but delicate task does not differ much in terms of
the key principles and steps that a competent inpatient nursing team would follow. That is, an
expression of sympathy and understanding by the parents with their adolescent’s predicament of
being ambivalent about this debilitating eating disorder, while at the same time being verbally
persistent in their expectation that starvation is not an option. Most of this first phase of treatment is
taken up by coaching the parents toward success in the weight restoration of their offspring,
expressing support and empathy toward the adolescent given her dire predicament of entanglement
with the illness, and realigning her with her siblings and peers. Realignment with one’s siblings or
peers means helping the adolescent to form stronger and more age appropriate relationships as
opposed to being ‘taken up’ into a parental relationship.

Throughout, the role of the therapist is to model to the parents an uncritical stance toward the
adolescent – the Maudsley Approach adheres to the tenet that the adolescent is not to blame for the
challenging eating disorder behaviors, but rather that these symptoms are mostly outside of the
adolescent’s control (externalizing the illness). At no point should this phase of treatment be
interpreted as a ‘green light’ for parents to be critical of their child. Quite the contrary, the therapist will
work hard to address any parental criticism or hostility toward the adolescent.

Phase II: Returning control over eating to the adolescent

The patient’s acceptance of parental demand for increased food intake, steady weight gain, as well as
a change in the mood of the family (i.e., relief at having taken charge of the eating disorder), all signal
the start of Phase II of treatment.

This phase of treatment focuses on encouraging the parents to help their child to take more control
over eating once again. The therapist advises the parents to accept that the main task here is the
return of their child to physical health, and that this now happens mostly in a way that is in keeping
with their child’s age and their parenting style. Although symptoms remain central in the discussions
between the therapist and the family, weight gain with minimum tension is encouraged. In addition, all
other general family relationship issues or difficulties in terms of day-to-day adolescent or parenting
concerns that the family has had to postpone can now be brought forward for review. This, however,
occurs only in relationship to the effect these issues have on the parents in their task of assuring
steady weight gain. For example, the patient may want to go out with her friends to have dinner and a
movie. However, while the parents are still unsure whether their child would eat entirely on her own
accord, she might be required to have dinner with her parents and then be allowed to join friends for a
movie.

Phase III: Establishing healthy adolescent identity

Phase III is initiated when the adolescent is able to maintain weight above 95% of ideal weight on
her/his own and self-starvation has abated.

Treatment focus starts to shift to the impact AN has had on the individual establishing a healthy
adolescent identity. This entails a review of central issues of adolescence and includes supporting
increased personal autonomy for the adolescent, the development of appropriate parental boundaries,
as well as the need for the parents to reorganize their life together after their children’s prospective
departure.

Sites that practice the Maudsley Approach

In addition to the Maudsley Hospital and other centers in London, this family-based approach to
treatment is implemented by programs in the United States, including Columbia University and Mt.
Sinai School of Medicine, New York, NY, Duke University, Durham, NC, The University of Chicago,
Chicago, IL, Stanford University, Stanford, CA, the University of California at San Diego, CA and the
Eating and Weight Disorders Center of Seattle (part of the Evidence Based Treatment Centers of
Seattle), Seattle, WA. Dissemination of the Maudsley Approach has also been successful in Canada,
e.g., Eastern Ontario Children’s Hospital in Ottawa, North York General Hospital and the Hospital for
Sick Children in Toronto, and McMaster University in Hamilton, ON. The adolescent eating disorders
program at the Westmead Children’s Hospital in Sydney, and the eating disorders program at the
Royal Children’s Hospital in Melbourne, Australia, have well established FBT programs.

The promise of the Maudsley Approach

In summary, the Maudsley Approach holds great promise for most adolescents who have been ill for a
relatively short period of time (i.e., less than 3 years). This family-based treatment can prevent
hospitalization and assist the adolescent in her/his recovery, provided that parents are seen as a
resource and that they are allowed to play an active role in treatment. A detailed clinician’s manual
that spells out how parents should be involved in this treatment approach has recently been
developed (5). These authors have also published a parent handbook that clearly spells out the
positive role that parents can play in their child’s recovery (6). Drs. Le Grange and Lock have founded
the Training Institute for Child and Adolescent Eating Disorders as a vehicle to conduct regular
workshops for clinicians who wish to become certified FBT therapists.
Treatment for binge
eating
Experts agree that binge eating treatment must tackle obesity and psychological problems. However, they’re still debating
which aspect to treat first.
People with binge eating disorder have distorted attitudes about eating, weight and shape. They also
have mood-related symptoms, such as depression and personality disorders.
Not surprisingly, experts on eating disorders say the best treatment focuses on the eating disorder.
Their goal is to help patients reduce or eliminate bingeing, improve their self-esteem and acceptance
of their bodies and treat underlying problems such as depression and anxiety.
Advocates of this approach say addressing the psychological problems that cause the condition will
eliminate binge eating and help patients feel better about themselves.
They call for treatments like cognitive-behavioral therapy, which addresses a person’s eating-related
thoughts and behaviors, and interpersonal psychotherapy, which helps a person develop healthier
relationships.
Weight loss, these experts say, will follow.
In contrast, obesity experts say it’s best to tackle the weight problem first. Treatment that targets
obesity directly is typically less expensive and shorter in duration than psychological treatment, they
say.
The best treatment approaches combine both psychological and weight-loss components, say other
researchers.

-Psych2Go