“This deadly cycle has to end. Okay, I have an eating disorder – I need help! But I have no idea as to what works!”
In this final piece of our eating disorder series we’re going to chat treatment.
“Where do I start?”
Actually, you already got started when you declared you have an eating disorder. Ownership is job-one.
The best way to begin an “I’m serious” eating disorder treatment program is by finding a therapist. Not just any therapist – one who’s comfortable, and knowledgeable in, treating the eating disorders.
In addition to facilitating therapy, she/he can be the point-person in your overall recovery strategy. Don’t forget, you may need the services of other healthcare professionals – psychiatrist, other physicians, dentist, nutrition professional.
Need some help finding a therapist? Why not use the “Find a Therapist” service on Psychology Today? Click here and you’ll find it at the top right.
Huge point of order! If you’re severely malnourished, therapy actually isn’t the place to start. Under these circumstances, it’s all about securing medical and nutritional help to establish medical stability.
Then it’s on to therapy.
“So what works?”
Well, a combination of medical and psychotherapeutic work seems to be the best approach. So let’s cut to the chase…
Ongoing medical and nutritional stabilization and maintenance is crucial. Psychotropic medications may be indicated, as well. Don’t forget – an eating disorder can coexist with a mood or anxiety disorder.
For example – in anorexia, an antidepressant may be prescribed following weight gain; given starvation may exacerbate depressive symptoms. An antidepressant may work well for relapse prevention for those who have restored their weight, or who continue to present with depressive and anxious (perhaps obsessive/compulsive) symptoms.
Antidepressants are also known to assist with the emotional issues involved with the binge/purge cycle.
- Cognitive Behavioral Therapy (CBT): The plus here is it’s directive and has a set time-frame within which the work is accomplished. You and your therapist work together to ID your irrational beliefs and thinking patterns – body image, weight, food, and – yes – perfectionism. And then it’s on to changing behaviors – binge eating, purging, dieting, and ritualistic exercise. CBT is often considered the treatment of choice for bulimics.
- Psychodynamic Therapy: It’s about achieving greater insight into the psychological forces that motivate your actions. The journey introduces the potential for change in both personality and behavior. The underlying assumption here is, who you are today is shaped by your past.
- Feminist Psychodynamic Psychotherapy: The foundation here is the assumption that social conditioning of women results in repression of certain needs and aspects. The importance of interpersonal relationships and intimacy are a focus. You’ll engage in dialogue with your therapist that encourages you to find your own truths – and your own voice.
- Interpersonal Therapy: Designed for the treatment of depression, it’s been modified to help with the eating disorders. You’ll be taught how to evaluate your interactions with others. The idea is your interpersonal conflicts may not have caused your eating disorder, but can sure as heck be sustaining it. The focus is in the here and now, with less attention paid to your eating disorder behaviors and symptoms.
- Dialectical Behavior Therapy (DBT): Actually, DBT is a CBT (how’s that?). But it’s different in that there’s a focus on helping you observe and label your emotional reactions to trauma. And then it’s on to validation, and acquiring a balance between acceptance and change. This is a fairly new approach, which is being modified for the treatment of bulimia and binge eating disorder. Here’s a link to a chipur article on DBT.
- Addiction Work: There is much debate as to whether eating disorders are true addictions. However, there’s a high prevalence of substance abuse among persons with eating disorders. And that means it’s likely either condition may precipitate the other. The fact is, the presence of a substance abuse issue has implications for eating disorder treatment.
- Expressive Therapy: When it’s difficult to put feelings into words, self-expression through the arts is helpful. Be it dance, movement, art, drama, drawing, painting, etc. – the opportunity is there for communication that might otherwise remain repressed.
- Light Therapy: Many individuals with SAD (seasonal affective disorder) also have dysfunctional eating. Recent studies have shown that light therapy has improved mood and decreased bingeing and purging. The positive effects can last for about 4 weeks.
- Internal Family Systems Model (IFS): This is an integrative approach to individual psychotherapy with the view that your mind is made up of relatively discrete subpersonalities – each with its own viewpoint and qualities. The dynamics of your family relationships are used in understanding how these collections of subpersonalities are organized.
Well, that’ll do it for our three-part need-to-know series on the eating disorders. Absolutely vital and hopeful information, don’t you think?
Want to help yourself and others? If you have personal experiences with any of the eating disorders, please be sure to share in a comment (or two)…
Much of this information was gathered at the National Association of Anorexia Nervosa and Associated Disorders (ANAD) website. You gotta’ pay a visit. And be sure to check out the National Eating Disorders Association NEDA.
image credit bidorbuy.co.za
Would you like to learn more about the biology of the mood and anxiety disorders? Here’s a list of the chipur articles.