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Eating Disorders
Eating Disorders include healthy weight control as well as anorexia, bulimia, and binge eating disorder.
There are three formally recognized eating disorders, and many more symptoms of eating disordered behavior. A fairly common eating disorder (especially among women in late adolescence and early adulthood) is bulimia nervosa. Although a person with bulimia may maintain an average weight, she or he struggles with preoccupation with body image and with loss of control around food, often overeating and then purging the calories out of guilt. "Purging" can include self-induced vomiting, laxative abuse, or over-exercise. Sometimes diuretics, diet pills, and fasting or severe food restriction can also be misused as weight control strategies. Bulimia can be accompanied by intense feelings of shame and fear that others might be shocked or revolted by the bingeing and purging behaviors; these negative feelings prevent many sufferers from seeking treatment. People struggling with this disorder should rest assured that therapists who treat eating disorders have been exposed to many very severe symptoms. Therapists are quite unlikely to be shocked, and very likely to be empathic and supportive.
In anorexia nervosa, people also struggle with preoccupation with body image and body weight, and will restrict eating until an underweight physique is achieved. Sometimes there can be mild cycles of bingeing and purging in anorexia, but more commonly the sufferer places many rules and regulations on eating (e.g., certain foods cannot be consumed under any circumstances, or food needs to be chewed a specific number of times before swallowing, etc.). Over-exercise is common. Females with anorexia will eventually lose even the minimal body fat required to support menstruation, so periods will stop. Weight loss goals will continue despite the distress of family and friends, and of the sufferer herself (or himself).
In binge eating disorder, people experience a loss of control around food. People will tend to eat rapidly and will eat when not hungry and when uncomfortably full. Overeating in binges will occur regularly and will be accompanied by guilt and self-criticism. Some sufferers describe using food as "emotional self-medication." For instance, eating binges may occur in response to feelings of loneliness or sadness. Generally, purgative strategies are not used, even though people may feel guilty about weight gain and possible ill health consequences.
All three eating disorders can be treated by strategies that decrease emotional chaos and increase self-monitoring (and ultimately, self-control). Food intake and exercise can be examined in a more systematic way, and changed a little at a time to be more adaptive. For instance, for those who binge, food restriction can be a compensatory strategy-but the low blood sugar associated with restriction leaves one physiologically vulnerable to the next binge. Planning balanced meals and avoiding self-punishment can help people regain control and end the binge-purge cycle. In addition, negative thoughts that maintain problematic eating can be examined and challenged. Ways to deal more effectively with stress, crisis, and everyday negative emotion can be explored and regularly implemented. In addition, the client and therapist can work together to more evenly distribute the client's self-esteem across domains in order to avoid over-investment in body image.
Weight Control
Over half of Americans are overweight, in part because of our fast food culture and our relatively sedentary lifestyles. Despite so many of us struggling with our weight, society can be harsh and critical, expressing prejudice toward those with excess weight. This reality can make it especially hard to deal with one's weight in a healthy manner. Most people have tried countless diets and other weight loss strategies with limited or no success, and many folks come to therapy very discouraged about their ability to achieve and maintain a healthy weight.
Therapy can be used to help regain control over a weight problem in reasonable steps by helping people monitor diet and exercise in a structured way. Self-defeating beliefs can be challenged and replaced with more adaptive, self-supportive thinking. In addition, for those who may tend to overeat for emotional reasons, these underlying reasons and needs can be addressed in a way that doesn't involve food. Alternative behaviors and methods of coping can be substituted.