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Eating Disorders

How To Treat Bulimia Through Therapy

woman with bulimia standing on a scale with tape around her ankles

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) lists bulimia nervosa under the Disorder Class: Feeding and Eating Disorders as a complex brain disorder. Bulimia nervosa, also referred to as bulimia, is one of the three most commonly diagnosed eating disorders in America. The Mayo Clinic defines bulimia as a “serious eating disorder marked by binging, followed by methods to avoid weight gain.” Hence, bulimia is essentially characterized by episodes of uncontrolled binging (extreme overeating), typically followed by purging (making oneself vomit). An individual struggling with bulimia may also purge via the misuse of various medications related to weight loss, such as laxatives, diuretics, enemas, and/ or excessive exercise. The episodes of binging and purging is often referred to as a binge-purge cycle. Depending on the individual, eating binges can range from occurring twice a week to several times a day. Bulimia is not solely about one’s weight, but also revolves around one’s self-image. The psychological nuances and physical consequences that can arise from bulimia are what makes it such a complex disorder. The damage that occurs from prolonged malnutrition and the unhealthy cycle of binging and purging can lead to significant short and long-term physiological complications. While bulimia is a chronic disorder, with proper treatment an individual can learn the tools and skills needed to develop a healthy and sustainable relationship with food.

Treatment

Every individual is different and will require some form of customized treatment when it comes to bulimia. There are many different mental health treatment options and distinct forms of therapies used to treat bulimia. The nuanced needs of a person diagnosed with bulimia will greatly inform which psychotherapeutic methods are included in one’s treatment plan. In order to treat bulimia through therapy, a person’s treatment plan could comprise of one or more of the following types of therapy:

  • Cognitive behavioral therapy (CBT) is based off of the notion that one’s thoughts govern one’s feelings, which in turn affects one’s behaviors. According to the Society of Clinical Psychology, “In CBT, the therapist works collaboratively with the patient to disrupt the factors maintaining the binge-purge cycle with the goal to achieve abstinence from these behaviors.”
  • Interpersonal therapy (IPT) is a therapeutic modality that is most often used to treat individuals who suffer from anxiety disorders, eating disorders, depression, as well as other psychiatric disorders, including bulimia nervosa. Interpersonal therapy focuses on how a person’s communications and interactions with other people affect his or her own mental health. Through interpersonal therapy an individual will learn to resolve and adjust unhealthy interpersonal complications, resulting in a symptomatic recovery.
  • Dialectical behavior therapy (DBT) is a type of cognitive behavioral therapy that places greater emphasis on the psychosocial aspect of therapy. DBT can benefit an individual diagnosed with bulimia by helping to foster self-management skills, lower stress, reduce anxiety, and learn to control destructive eating behaviors. The goals of DBT are to help an individual learn to establish healthy coping mechanisms that can be applied to environments that would have otherwise provoke destructive eating behaviors. It helps individuals learn how to reduce emotional reactivity and improve their interactions with others. DBT promotes acceptance and teaches skills to enable an individual to live in the moment and cope with emotional triggers that may otherwise perpetuate the binge-purge cycle and other unhealthy symptoms and behaviors associated with bulimia. 

A treatment plan for bulimia will be carefully tailored so as to effectively accommodate all of the individual’s mental health needs. 

Disclaimer: 

The information above is provided for the use of informational purposes only. The above content is not to be substituted for professional advice, diagnosis, or treatment, as in no way is it intended as an attempt to practice medicine, give specific medical advice, including, without limitation, advice concerning the topic of mental health.  As such, please do not use any material provided above as a means to disregard professional advice or delay seeking treatment. 

How To Treat Anorexia

anorexia spelled out

Anorexia nervosa, often referred to as anorexia, is listed in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) as an eating disorder. According to the Mayo Clinic, anorexia is “characterized by an abnormally low body weight, an intense fear of gaining weight and a distorted perception of weight.” Though anorexia can manifest at any age, research suggests it most commonly develops during adolescence. Individuals that struggle with anorexia engage in a cycle of self-starvation that often results in malnutrition including a lack of essential minerals and nutrients. The list of adverse short and long-term effects of anorexia is extensive, and without proper treatment anorexia can lead to life-threatening consequences. 

Diagnostic Criteria

Obtaining an accurate diagnosis is essential to the recovery process for any mental health illness. Though the symptoms of anorexia can become visibly evident, a diagnosis of anorexia nervosa is reached through a thorough physical and psychological exam. Further, the evaluating provider considers the diagnostic criteria for anorexia, provided by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). To be diagnosed with anorexia nervosa, according to the DSM-5, the following criteria must be met:

  • Restriction of energy intake relative to requirements, leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health. Significantly low body weight is defined as a weight that is less than minimally normal, or for children and adolescents, less than that minimally expected. 
  • Intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain, even though at a significantly low weight.
  • Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight. 

Atypical anorexia is diagnosed when an individual meets the above criteria but despite significant weight loss, is not medically considered underweight. It is important to note that an individual may still be struggling with a serious eating disorder even if all of the DSM-5 criteria for anorexia are unmet. 

Treatment

Every individual is different and will require a tailored treatment plan when it comes to recovering from anorexia. Treatment plans often include a multidisciplinary approach. According to the Mayo Clinic a clinical treatment team for an individual diagnosed with anorexia could include doctors, mental health professionals and dietitians. Depending on the nuanced needs of the individual, the treatment process could include any combination of the following components:

  • Inpatient treatment: intensive, inpatient treatment can help address severe malnutrition and other physical health complications that have developed from one’s eating disorder, settings could include:
    • Hospitalization
    • Inpatient facility
  • Psychotherapy: there are a variety of therapeutic modalities used to help treat individuals with anorexia, such as cognitive behavioral therapy (CBT), dialectical behavior therapy (DBT), interpersonal psychotherapy, psychodynamic psychotherapy, creative arts therapies, and more. 
  • Medications: certain medications (e.g. antipsychotic: Zyprexa) can be prescribed to help with weight gain
  • Nutrition counseling: used to help individuals learn how to restore normal eating patterns and teach a healthy approach to weight and food

The Mayo Clinic asserts, “One of the biggest challenges in treating anorexia is that people may not want treatment.” Although anorexia is a considered to be a chronic disorder, with proper treatment an individual can learn how to effectively manage its symptoms and go to on lead a healthy and fulfilling life. 

Disclaimer: 

The information above is provided for the use of informational purposes only. The above content is not to be substituted for professional advice, diagnosis, or treatment, as in no way is it intended as an attempt to practice medicine, give specific medical advice, including, without limitation, advice concerning the topic of mental health.  As such, please do not use any material provided above as a means to disregard professional advice or delay seeking treatment. 

How To Treat Binge Eating Disorder

woman in dbt session

Binge eating disorder (BED) is a mental health illness that is classified as an eating disorder, and is listed as such in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Binge eating disorder is currently known to be the most common eating disorder in America. The National Eating Disorder Association (NIDA) define binge eating disorder as “severe, life-threatening, and treatable eating disorder characterized by recurrent episodes of eating large quantities of food (often very quickly and to the point of discomfort); a feeling of a loss of control during the binge; experiencing shame, distress or guilt afterwards; and not regularly using unhealthy compensatory measures (e.g. purging) to counter the binge eating.” If left untreated, binge eating disorder and its associated symptoms could result in an individual developing severe short and long-term physiological consequences. 

Signs and Symptoms

There are a variety of signs and symptoms that could manifest in an individual struggling with binge eating disorder. Examples of common signs and symptoms could include any combination of the following, as provided by the Mayo Clinic:

  • Eating until uncomfortably full
  • Eating in secret
  • Eating alone
  • Eating when not hungry
  • Feeling ashamed, depressed, disgusted, and/ or guilty about eating
  • Frequent dieting, possibly without weight loss
  • Feeling out of control with regard to one’s eating behaviors

While most individuals diagnosed with binge eating disorder are overweight or obese, an individual could remain in the normal weight-range and still struggle with BED. 

Treatment

The first step in treating binge eating disorder is to obtain a proper diagnosis from a qualified medical and/ or mental healthcare provider. However, it can be helpful to understand the general diagnostic criteria of BED, which according to the DSM-5 include:

  • Recurrent episodes of binge eating, which is characterized by both:
    • A sense of lack of control over eating during the episode
    • Excessively overeating (an amount that is greater than the norm) in a short period of time (e.g. within a two hour period)
  • Binge eating episodes include three (or more) of the following:
    • Eating large amounts of food when not hungry
    • Eating far more rapidly than normal
    • Eating until feeling uncomfortably full
    • Feeling ashamed, depressed, guilty and/ or disgusted with oneself after eating
    • Eating alone due to embarrassment related to the quantity of food consumed
  • Marked distress regarding binge eating behavior
  • Binge eating episodes occur (on average) at least once a week for three months
  • No engagement of unhealthy compensatory behaviors after binge eating (e.g. purging)

Every individual is different and will be faced with nuanced challenges and unique needs when it comes to treating BED. Hence, it is common practice for binge eating disorder treatment plans to be tailored and include customized combinations of various therapeutic approaches so as to ensure all of the individual’s specific needs a fully accommodated. Treatment plans could comprise of any combination of the following components:

Depending on one’s specific needs it is not uncommon to emphasize establishing healthy daily habits, such as obtaining ample nightly sleep, practicing regular mindfulness techniques (i.e. yoga, meditation, etc.), and engaging in health daily exercise. Recovering from binge eating disorder will be a life-long journey, but with the proper guidance, continued commitment, and support, an individual diagnosed with BED can go on to live a healthy and fulfilling life.

Treatment For Eating Disorders

hope for treatment

A common misconception surrounding eating disorders is that they are a lifestyle choice. However, eating disorders are considered serious mental health illnesses, and when left untreated can result in severe short and long-term consequences. Though there are several different types of eating disorders listed in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), in a very broad sense, eating disorders are characterized by severe disturbances in people’s eating behaviors and related thoughts and emotions. The different types of eating disorders, according to the Mayo Clinic include: 

    • Anorexia nervosa: is an eating disorder characterized by weight loss and/ or lack of appropriate wait gain in growing children, an inability to maintain an appropriate body weight for one’s age, height, stature, intense fear of gaining weight and a distorted perception of body image (weight and/ or shape). People struggling with anorexia will employ extreme efforts to control their weight and/ or shape, which can significantly interfere with their ability to properly function in their daily life. 
    • Bulimia nervosa: is an eating disorder characterized by a cycle of overeating (bingeing) and compensatory behaviors (purging) in attempts to undo the effects of the binge eating episodes. Purging could include self-induced vomiting, excessively over exercising, and/ or abusing diuretics. 
    • Binge-eating disorder (BED): is an eating disorder characterized by recurrent episodes of compulsively eating abnormally large quantities of food (often quickly) to the point of physical discomfort, without engaging in compensatory behaviors. Often binge episodes are followed with emotions of embarrassment, shame, guilt, and/ or distress. 
    • Rumination disorder: is an eating disorder characterized by repeatedly and unintentionally regurgitating (spitting up) undigested or partially digested food from the stomach, chewing it again and either swallowing it or spitting it out. 
  • Avoidant/ restrictive food intake disorder (ARFID): is an eating disorder characterized by restricting food intake (i.e. eating smaller amounts) and/ or eliminating certain groups to the point of infringing on one’s exposure to and ability to absorb needed nutrients coming from food. 

Each disorder has its own set of signs and symptoms, short and long-term effects, and most effective methods of treatment, respectively. 

Treatment

The treatment for an eating disorder will depend on several contributing factors, some of which include one’s exact diagnosis, how long he or she has been actively engaging in unhealthy eating habits, his or her personal health history, and the presence of any co-morbid disorders. The nuanced needs of a person diagnosed with an eating disorder will greatly inform his or her treatment plan. Most treatment plans for eating disorders will be customized and tailored so as to effectively accommodate all of his or her mental health needs. Depending on the needs of the individual treatment plans could include any combination of the following:

  • Individual psychotherapy
  • Group therapy
  • Family therapy
  • Creative arts therapies
  • Medical care and/ or medical monitoring
  • Medications
  • Nutritional counseling

Additionally, depending on one’s needs, some treatment plans will include practicing and incorporating healthy activities into one’s daily schedule, such as mindfulness techniques (i.e. meditation, yoga, etc.) and/ or encouraging regular and ample sleep habits. Every person is different and will respond distinctly to the various therapeutic options available. Although there is currently no cure for eating disorders, effective treatment will help to provide an individual with healthy coping mechanisms and emotional strategies to enable a person to go on to live a meaningful and fulfilling life. It is, however, important to note, that the recovery process from an eating disorder will require a life-long, steadfast commitment.