When people speak of eating disorders they are referring to anorexia nervosa, bulimia nervosa, and binge or compulsive overeating.  Eating disorders can be accompanied by anxiety and mood disorders, struggles with substance abuse, sometimes with a history of trauma or sexual abuse, and frequently with significant medical complications. 

Eating disorders are clearly complex, affecting the individual on many levels—physical, emotional, interpersonal, and spiritual.  Emotional, relational, biological, and societal factors all play a part in the etiology of an eating disorder.  Though complicated, eating disorders are nevertheless treatable, requiring a comprehensive approach that takes the whole person into account.

The treatment of choice for eating disorders involves a team approach.  The patient’s medical stability and safety are essential in order for outpatient therapy to proceed.  Collaboration with the primary care physician is central given the medical complications that can accompany an eating disorder.  Nutritional counseling, group treatment, medication evaluation and management can also be highly beneficial.  At times,  hospitalization or residential treatment is necessary.  A thorough assessment at the outset will help tailor the therapy to the specific needs of the individual.

      Overall, individual psychotherapy for eating disorders uses a combination of cognitive-behavioral strategies and psychodynamic exploration to address behaviors and reduce symptoms and to examine underlying conflicts and issues, including the feelings that fuel the disorder.  Concrete behavioral interventions may include keeping a log of eating and emotions, journaling, and identifying positive coping strategies to replace problematic behaviors.  Therapy may also focus on modifying problematic patterns of thought that produce a distorted view of the self and the body and that lead to chaotic or restrictive eating behaviors.  Psychodynamic exploration helps to address inner conflicts that fuel feelings of inadequacy and self-loathing, and attends to troubled interpersonal relationships that are often at the heart of the eating disorder.  Psychoeducation and skill building are also important components of treatment.  Throughout, it is important to keep in mind that eating disorders are not actually about food, but rather about the feelings that food is used to help regulate and manage, and they are not just about body image or external appearance, but rather about how the individual experiences and feels about him/her self on the inside.  As self-esteem and self-efficacy improve, as relationships become more connected and satisfying, and as feelings become more manageable, food is more likely to find its place as a source of energy, sustenance, and pleasure, and the body is less likely to be used as the arena upon which internal and interpersonal conflicts are played out.

Without treatment and support, an eating disorder can become entrenched, taking on a life of its own, and placing the individual’s health, and at times his or her life, at risk.  While recovery from an eating disorder can be a difficult and slow process, most people respond well to treatment, and in time eating disorder symptoms begin to diminish. Recognizing the warning signs and acting quickly to get help does make a difference.  Studies have shown that early detection of an eating disorder helps to contribute to a successful outcome in treatment.