28 Jun Eating Disorders
Eat, Purge, Crave Repeat?
Isn’t food a part of our existence? We either eat to live or live to eat. But what happens when we do neither? What happens when food makes us feel… guilty? And not the I’ll compensate by working out tomorrow guilty. This feeling of guilt tends to give rise to an eating disorder. An eating disorder as defined by the Diagnostic and Statistical Manual-5 is a condition in which an individual has a persistent disturbance in eating-related behaviours which leads to an altered consumption or absorption of food. This results in a significant impairment in psychosocial functioning and/or physical health.
These cause severe distress and affect attitudes, thoughts and emotions. Obsessions with body weight, food and appearance may be signs of an eating disorder. Due to the medical and even fatal implications; they are considered dangerous, making it extremely crucial for them
to be identified and treated in their early stages. Eating disorders affect people of all ages and genders, they usually develop during the teen years or young adulthood and are more common in females. They may also develop during childhood. It is important to realise that people with an eating disorder may appear healthy on the outside.
What causes Eating Disorders?
Research suggests that there is no one single cause for eating disorders. An interplay of several biological, social, and psychological factors are likely to play a role in the causation of Eating Disorders. A few likely causes are listed below:
• There is a high genetic predisposition of eating disorders that is, they tend to run in families. Identical twins have a higher likelihood of developing eating disorders compared to fraternal twins.
• The hypothalamus in the brain plays an important role in the development of Eating disorders. Lesions or tumours in the hypothalamus inhibit or increase food consumption.
• Neurotransmitters like serotonin are associated with food consumption behaviors. Lower levels of serotonin are related to anorexia nervosa and higher levels are related to binge eating.
• Having a low self-esteem of feelings of worthlessness and doubt
• Having irrational beliefs about an ideal body shape
• Having dysfunctional family interaction patterns
• Being part of a culture where thinness is associated with beauty
• Being part of events, professions or activities in which body image is a concern
for example, athletics, gymnastics or the fashion or acting industry.
• Living in an environment or having health concerns related to leanness or obesity.
• Experiences of stressful life changes like the break up of an important relationship, loss of a loved one, leaving home for a job or further studies, etc.
• Experience of trauma like physical, sexual or emotional abuse.
Types of Eating Disorders and Symptoms
The DSM-5 identifies 6 types of eating disorders. The most common ones are Anorexia Nervosa, Bulimia Nervosa and Binge-eating Disorder. The symptoms of these are discussed in the next section.
• Anorexia Nervosa
This is the most well-known eating disorder, developed in adolescence it usually affects women more than men. Individuals having this disorder consider themselves as overweight despite being dangerously underweight. As a result, they continually avoid eating particular types of food, closely monitor their weight and drastically reduce their calorie consumption. A few common symptoms include an intense fear of gaining weight, persistent behaviours to reduce gaining weight, a distorted body-image, denial of being underweight, very restricted eating patterns, excessive dieting or exercise and a pursuit of thinness.
• Bulimia Nervosa
In this disorder, a person experiences a binge-purge cycle. They binge till they are full to a painful extent and then an attempt to compensate the calorie intake, they purge, induce vomiting, fast, take laxatives or over-exercise. A few common symptoms include a fear of weight gain despite having a normal weight, recurrent cycles of binging and purging, feeling a lack of control over eating and an overemphasis on body shape and weight.
• Avoidant/restrictive food intake disorder
This disorder usually develops during childhood and is characterised by restricted intake of food, preventing the individual from sufficient nutrients. The eating habits interfere with social functioning, there is a poor development of the person with respect to age and height,
deficiencies and weight loss are common symptoms.
• Binge-eating Disorder
This is one of the most common disorders, in which individuals tend to consume large amounts of food in short time intervals until uncomfortable. Lack of control, feelings of shame, guilt and distress when thinking about binging behaviour, and absence of attempts of purging are the key symptoms of this disorder.
This disorder involves eating inedible things like chalk, ice, dirt, soil, soap, hair, paper, etc. This is most common among children but is seen in adults and adolescents as well. They are at a risk of infections, injuries and could even be life-threatening based on the substance
• Rumination disorder
In this disorder, an individual regurgitates the food they previously ingested and re-chew it, reswallow it or spit it out. This is a voluntary act and usually occurs within 30 minutes of a meal. While this is common in infants, if not resolved, it can lead to malnutrition and severe weight loss.
Types of therapy
Several therapies have proved to be effective in working with eating disorders. A few considerations like which stage of recovery the client
is in and the associated potential risks have to be kept in mind while choosing the therapy. A few of them are described in more detail below:
• Acceptance and Commitment Therapy (ACT)
This therapy focuses on changing the client’s actions and feelings rather than focusing on thoughts. The clients learn to accept their emotions and life experiences. It helps in recovery as the individual develops a healthier relationship with their intellect, emotions and the self. ACT also helps the clients to recognise the urges associated with the eating disorder and helps understand these impulses. This therapy is effective in working with comorbid anxiety or depression as well.
• Cognitive Behavioural Therapy (CBT)
CBT as a therapy works on the premise that one’s thoughts, feelings and behaviours are connected. Usually CBT is a short-term therapy, comprising of 15-20 sessions but they may be extended to more depending on the severity of the disorder. CBT for eating disorders can be
done in group or individual sessions. This therapy helps the client identify the connection between their thoughts and feelings. They further evaluate the thoughts and later beliefs about body weight, body image and shape which helps reduce harmful behaviours like binge eating,
strict dieting or induced vomiting. CBT is an active form of therapy which give the client homework like maintaining a thought dairy, trying certain behaviours and evaluating their feelings and several other activities. The thoughts and feelings are then tactfully challenged or
• Dialectic Behavioural Therapy
DBT is supported by empirical evidence to be effective in the treatment of Bulimia Nervosa and Anorexia nervosa. This therapy focuses on developing skills to replace maladaptive eating behaviours with more adaptive ones. The skills taught are practicing mindfulness, distress
tolerance, enhancing interpersonal relationships, emotional regulation and relaxation. This thus makes the client aware of their feelings and control their reactions by recognising situations which may be triggers to their behaviours. The skills taught are a coping mechanism for the
triggering situations. This can occur in individual or group set-ups.
• Family-Based Therapy (FBT)
This approach is usually used with teenagers having an eating disorder. Parents play an active role in helping their child recover. The parent gradually takes control over the child’s food intake by monitoring their body needs and help them get back to healthy weight. This therapy
is successful only when all members of the family participate in the joint sessions, share their ways of coping and feel supported. Communication patterns, issues related to adolescent independence, family arguments or transitions of life are addressed.
• Expressive Arts Therapy
Art-based therapy and dance movement therapy have also proved to be effective for Eating disorders. They work on the premise of healing through expression. Through art therapy, a creative outlet for emotional expression through the medium of clay, colours, sculpting or drawing is provided while through movement or dance therapy; an alternate for coping and self-expression can be provided.
What happens in therapy and why is it needed?
While the course of therapy and the nature of a therapy session depends on the kind of therapeutic frame the therapist follows, the initial sessions are spent building the relation with the client, establishing trust and nurturing the new relationship built where the client will be
disclosing his/her vulnerabilities. Time is also spent trying to explore the client’s past experiences and bring the root cause of the disorder to light. More specific questions about eating habits are asked like what does a typical day’s eating schedule look like, the kind of foods consumed, any ritualistic behaviours around eating, what happens after eating, is there any feeing of guilt or shame, any kind of compensating strategies like over-exercising or inducing vomit, pills or laxative taken after eating, the client’s exercise schedule is asked, their sense of body image is assessed, any changes in weight are inquired about, how much time is invested in thinking about food, weight and appearance.
Several other areas like childhood experiences, family interactions, any kind of major life changes and the client’s beliefs related to weight, food habits and appearance are asked about over the next few sessions and goals are established in a collaborative manner. Strategies
are then developed keeping the goals set with the client in mind, the client agrees to engage in them and practices them. The goals of therapy for any eating disorder are largely understanding the gap in the client’s current and required nutritional intake and facilitate physical rehabilitation; foster change and modification in the client’s dysfunctional attitudes and behaviours related to their eating disorder, help in improving interpersonal and social skills and address any comorbid psychological conditions or conflicts reinforcing the faulty eating habits.
The client’s motivation to change or engage in the process of change, the severity of their disorder and the collateral damage caused is
assessed. Based on the goals, assessments and interactions with the client, a suitable treatment plan is chalked out which may include
initiating a more nutritional diet, more favourable exercise conditions and even medication alongside therapy. It is likely that the treatment may include experts from the field of diet with consent of the client. Other comorbid conditions like suicide ideation, depression or anxiety if any would also be tended to.
Online therapy can add the convenience of scheduling the therapy session at your personal time of ease, it could be from any venue, like during a free day in office, while travelling or even when multitasking. If it is your first ever time in therapy, through a virtual session, it would feel safer to be in a space you are comfortable in and less intimidating to talk about your eating disorder to a ‘stranger.’ It could also help the client identify a safe space at home which can be used to ventilate any emotions even without a therapy appointment.
Takeaways from the session?
According to me, the biggest takeaway from any therapy session is to know that there is someone who without a bias or conditions wants to help you feel better. In addition to this, each session has different takeaways be it learning something new about yourself or overcoming a fear, be identifying insecurities or accepting your past and the scars along with it. You learn new skills and techniques like relaxation and healthy coping. Most importantly, you look at situations from a new perspective, shed the old maladaptive ways and eventually with tears and effort, become a better version of yourself.
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