Typically, recovery from eating and food issues is a long and difficult process. Behavioral health therapy is usually an important part of recovery. Some therapies are short term, requiring about four months. Others can last years.
Typical treatment goals include:
- Stop harmful behaviors like purging
- Build good eating habits
- Bring weight to a healthy level
- Treat associated mental health conditions like anxiety or PTSD
- Develop healthy coping skills
Recovery isn’t only about physical well-being. Recovery involves reclaiming your identity and creating a healthy relationship with your body. In therapy, you can develop a sense of self that doesn’t revolve around diet or appearance.
Just as there are many types of eating and food issues, there are many types of therapies to treat them. One person may try group therapy, seeking support from others with their condition. Another person may prefer talking with a therapist one-on-one in psychotherapy. Some therapies may focus on changing harmful behaviors or thought patterns; others might address the feelings underneath.
When you meet with a therapist to get help for disordered eating, they will conduct a confidential intake assessment. They will ask you questions about your eating habits and symptoms, as well as about your family, relationships, and emotions. The therapist may diagnose your condition and will work with you to create treatment goals and a treatment plan.
According to Deborah Klinger, MA, LMFT, CEDS, “Psychotherapists who treat eating disorders in outpatient practice usually recognize the importance of [complementary] therapies…[They] utilize resources such as…expressive arts therapies, yoga classes, and self-help programs.” It is unlikely these strategies will treat eating and food issues by themselves. Yet they can be helpful when used under the guidance of a mental health practitioner.
Sometimes psychoactive drugs may be a part of treatment. For example, a person with binge-eating behaviors may take an antidepressant to lower anxiety. Medications are almost always used in tandem with psychotherapy, if they are used at all. Generally, food and professional support are the most important medicines.
Some eating disorders are too complex to treat with outpatient therapy alone. In these cases, a residential treatment center or inpatient hospital may be the best option. A person may live at the facility for one month or longer, getting full-time treatment and support.
There are a wide range of rehab programs for eating disorders. Residential centers often include mental health therapy and alternative therapies in their programs. These could include tai chi, equine-assisted therapy, or art therapy. Other centers build their programs around specific models of psychotherapy, like Internal Family Systems (IFS) or dialectical behavior therapy.
Eating disorders can often cause dangerous medical complications. A person who’s experiencing medical symptoms should seek the help of a doctor right away.
- Binge eating can cause high blood pressure, diabetes, obesity, and other long-term health issues.
- Bulimia is linked to dehydration, abdominal pain, and bowel problems. If someone purges through vomiting, they can cause serious damage to their teeth, and their esophagus may eventually rupture.
- Anorexia often goes hand in hand with malnutrition. A lack of nutrition can cause osteoporosis, hypothermia, and even death. If someone eats too quickly after a period of fasting, they could also die from refeeding syndrome. Refeeding syndrome is when the sudden increase in nutrients causes an electrolyte imbalance in the body, leading to cardiac arrest.
- ARFID may cause weight loss, malnutrition, and stunted growth. People with ARFID often require nutritional supplements to function.
- Pica can cause serious harm depending on what the person eats. Certain objects can block the intestines and prevent proper digestion. Other substances like paint may cause acute poisoning. In some cases, pica can be fatal.
- Rumination has been linked to malnutrition in children and infants.
Klinger advises, “Patients whose disordered relationship with food is putting them in medical danger should have a treatment team that includes a primary care physician, a psychiatrist for overseeing medication, and a dietician who is skilled in treating eating disorders, as well as a psychotherapist.”
Eating disorders are complicated conditions. Yet with help and hard work, they are treatable. Here are two case studies of therapy for people who got help for their eating issues and began their road to recovery.
- Disordered Eating and Perfectionism: Cathy, a 25-year-old medical student, came to therapy to address her eating habits. Fellow students have told Cathy they are concerned about her weight loss and lack of a social life. Cathy claims she is simply stressed about school, putting grades ahead of socializing. She has recently lost about 15 pounds. At 5’4” and 96 pounds, her body is underweight. Further questioning reveals Cathy was teased for being chubby in middle school. She had forced herself to vomit after meals for a few years afterward. More recently, she has been cutting back on food portions, eliminating fats from her diet, and avoiding social events that include food. The therapist refers Cathy to a physician for medical monitoring and a dietician to make a meal plan. The therapist also helps Cathy challenge the distorted, anorexia-driven thinking about her body. As Cathy’s eating improves and her brain is better nourished, she acknowledges her fear of being less than perfect. This fear stems in part from her parents' pressure to succeed in school. Cathy says her parents focused more on her academic achievements than her emotions. The therapist helps Cathy access her repressed feelings. Cathy learns to manage painful emotions rather than starving them away. Over time, Cathy grows more comfortable in her body.
- Overeating, Stress, and Self-Hatred: Yvonne, 38, is an elementary school teacher who has always been overweight. Whenever her former husband insulted her looks, Yvonne soothed herself with food. After such a binge, she experienced shame from her perceived lack of willpower. She would vow to be strong and disciplined from then on. Yet the next time she was stressed, she would find herself binge eating again. Yvonne enters therapy because she wants help stopping the cycle. Her therapist explains how food can be misused as an antidote for painful emotions. He provides Yvonne with tools for tuning in to her body’s hunger and fullness signals. Yvonne learns to let her body's needs dictate her eating rather than following a diet. Through therapy, Yvonne recognizes how her father’s alcoholism affected her. As a child, Yvonne formed the habit of reaching for food to comfort herself when her father was drunk and angry. She had learned from her father to stuff painful feelings down. Over many sessions, Yvonne learns to eat according to her body's needs. She also develops greater emotional self-care skills. Eventually her body drops much of the excess weight.
If you’re wondering how to get help for an eating disorder or other food-related issue, meeting with a doctor or counselor is a good first step. You can find a therapist near you by searching online, contacting your insurance provider, and/or asking other people for a recommendation.
If you have health insurance, it may cover some aspects of your treatment for eating disorders. The best way to find out if outpatient therapy or inpatient residential treatment is covered is to contact your insurance provider.
When you meet with a doctor or counselor, they can refer you to others who may be able to help you in your recovery process, like a nutritionist or a support group. It may be helpful to share your recovery goals with supportive people or family members you trust. Asking for help from others is often an important step to healing.
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- Eating disorder treatment: Know your options. (2017, July 14). Mayo Clinic. Retrieved from https://www.mayoclinic.org/diseases-conditions/eating-disorders/in-depth/eating-disorder-treatment/art-20046234
- Fawcett, J., M.D. (2012). Eating disorders and the DSM-5. Psychiatric Annals, 42(11), 394-395. doi:http://dx.doi.org/10.3928/00485713-20121105-01
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