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Eating Disorders

Eating Disorders | Bulimia Nervosa | Binge Eating | Anorexia
Weight Control & Obesity | Body Dysmorphic Disorder
Nutritional Counseling
Psychological Evaluations for Bariatric Surgery


Eating Disorders

Eating disorders are the result of the interplay between biological, psychological, and societal factors. Genetics, societal pressure for thinness and beauty, low self-esteem, and life stress may all contribute to the development of an eating disorder. The extreme dieting associated with eating disorders begins as a way to gain control and improve self-confidence, but ultimately results in adoption of rigid and tiring rules, obsessive thoughts about food and shape/weight, and disrupted relationships.

Eating disorders are associated with psychological consequences that can precipitate seeking treatment, such as depression, anxiety, impulsivity, perfectionism, and low self-esteem. Individuals with an eating disorder may also seek treatment because they are ashamed of their binges, are concerned about the financial strain of binge eating, have experienced negative medical or dental effects, or because their eating disorder interferes with relationships, work, and hobbies.

What are the symptoms of an eating disorder?

There are three major categories of eating disorders, Anorexia Nervosa, Bulimia Nervosa, and Eating Disorder Not Otherwise Specified (including Binge-Eating Disorder).

Anorexia Nervosa

  • Significantly underweight:
    • Body Mass Index* less than 17.5 or
    • Weight less than 85% of normal
  • Intense fear of weight gain
  • Absence of menstrual periods
  • Self-starvation; try to go as long as possible without eating
  • Extremely rigid dieting; many “forbidden” foods
  • May include binges/ purges Medical complications of AN include: cardiac problems, low blood pressure, severe constipation, soft hair (lanugo) on body, osteoporosis/osteopenia, thyroid problems, loss of menstrual period, drop in body temperature (constant feelings of coldness)

Who is Affected?

Lifetime prevalence rates indicate that roughly 0.9 - 2.2% of women and 0.2 - 0.3% of men will meet criteria for Anorexia Nervosa at some point in their lives.

* Body Mass Index is a relationship between weight and height that is associated with body fat and health risk.

Click Here To Calculate Body Mass Index

Bulimia Nervosa

  • Preoccupied with shape and weightBinge eating: Consuming an objectively large quantity of food while feeling a loss of control
  • Purging: Vomit, laxative abuse, and/or excessive exercise after meals or binges
  • Have many “forbidden” foods
  • Try to go as long as possible without eating; skip meals; try  “fad diets” to lose weight
  • Eat in secret; hide food
  • Feel disgusted about your body
  • Check shape/weight with frequent  weighing, pinch body fat, try on “skinny” clothes
  • Disrupted social life because you avoid eating with others
  • Medical complications of Bulimia Nervosa include: imbalance in electrolytes, erosion of tooth enamel due to repeated vomiting, inflamed throat, swollen glands, GI distress from laxative abuse, kidney problems from diuretic abuse, acid reflux
Who is Affected?

Lifetime prevalence rates indicate that roughly 1.5 – 2% of women and 0.5% of men will meet criteria for Bulimia Nervosa at some point in their lives.
Typical age of onset for Bulimia Nervosa is in late adolescence or early adulthood.

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Eating Disorder Not Otherwise Specified (ED-NOS):

This is a broad category encompassing individuals who have problems with eating, but do not meet criteria for Anorexia or Bulimia. For example, this might include: someone who has symptoms of Anorexia but still gets a monthly menstrual period; someone who purges after eating a normal amount of food, rather than after binge eating; or someone who binge eats and purges, but not frequently enough to meet criteria for Bulimia.
  • While ED-NOS is not a well-known diagnosis, it is believed that 50-60% of individuals who seek outpatient treatment for eating disorders meet criteria for ED-NOS. Therefore, ED-NOS is a more common diagnosis than Anorexia Nervosa or Bulimia Nervosa.

Binge Eating Disorder (BED) has been identified as one type of ED-NOS

  • Preoccupied with shape and weight
  • Binge eating: Consuming an objectively large quantity of food while feeling a loss of control
  • Have many “forbidden” foods
  • Try to go as long as possible without eating; skip meals; try “fad diets” to lose weight
  • Eat in secret; hide food
  • Feel disgusted about your body
  • Check shape/weight with frequent weighing, pinch body fat, try on “skinny” clothes
  • Disrupted social life because you avoid eating with others
  • Feel ashamed about your eating and want to be more “in control”
Who is Affected?

Lifetime prevalence rates indicate that roughly 3.5% of women and 2% of men will meet criteria for BED at some point in their lives.
Typical age of onset for BED is in middle age.

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What causes eating disorders to develop?

The simple answer is: we don’t know for sure. Most likely, eating disorders arise from a combination of factors, including: genetics, stressful life experiences, cultural emphasis on thinness, perfectionism, and low self-esteem.

What we know a bit more about, thanks to the work of Chris Fairburn at Oxford University and others, is how eating disorder symptoms are maintained once they’ve started. Fairburn and colleagues have found that most individuals with eating problems, regardless of what form these problems take, tend to display similar types of thinking about themselves. They place an excessive emphasis on the importance of their bodies, believing that the key to their self-worth lies in their ability to reach an ideal shape and weight. In order to achieve their ideal (and usually unattainable) shape and weight, they set exceedingly strict dietary rules for themselves. Unfortunately, it is impossible to adhere to such strict rules, which causes people to feel that they have “failed” in their efforts and cannot control themselves. Such feelings of “failure,” often combined with life stress, negative emotions, and poor self-image, can lead to binge eating and purging, excessive exercising, and/or to renewed attempts at strict dieting. These behaviors (binge eating, purging, excessive exercising, restricting) reinforce a person’s focus on his/her shape and weight, which then causes the cycle of problematic dieting and eating behaviors to continue.

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How does Cognitive-Behavior Therapy for eating disorders work?

Eating disorders are chronic without treatment. In some cases, hospitalization may be required during the first phase of treatment for Anorexia Nervosa, to restore the patient to healthy weight and monitor medical health. As noted above, cardiac problems, low blood pressure, severe constipation, soft hair (lanugo) on body, osteoporosis/osteopenia, thyroid problems, loss of menstrual period, and drop in body temperature (constant feelings of coldness) are among the serious medical consequences of Anorexia . Once the patient achieves a medically-stable weight, cognitivebehavioral therapy can be effective and beneficial for preventing relapse.

The results of numerous research studies indicate that CBT is the most effective form of treatment for Bulimia Nervosa, Binge Eating Disorder, and other forms of disordered eating. BULIMIA NERVOSAIt is superior to a variety of other therapies and is regarded as the first line of treatment. Cognitive-behavioral therapy addresses the psychological, familial, and societal factors associated with eating disorders and  directly targets the problematic thinking and behaviors that maintain eating disorder symptoms.

Treatment strategies include:

  • Education about eating disorders, including nutritional information
  • Establishing a regular pattern of eating through self-monitoring of eating patterns
  • Challenging rigid rules about eating and reintroducing “forbidden foods” back into one’s diet
  • Exploring the triggers for episodes of binge eating, and finding alternative methods for coping with these triggers
  • Discussing the origins of one’s overemphasis on shape and weight, and finding alternative ways to evaluate oneself
  • Addressing problematic thinking patterns that often characterize eating disorders, such as perfectionism and “all-or-nothing” thinking.
  • Eliminating frequent checking of one’s body shape or one’s tendency to avoid looking at one’s body
  • Targeting interpersonal problems, low self-esteem, and/or perfectionism, if any of these factors appear to be maintaining eating disordered behaviors

A final phase of treatment is relapse prevention, during which the therapist and patient together develop and practice strategies to maintain progress and to prevent a relapse of binge eating, purging, and unhealthy eating habits.

What about weight loss?

The vast majority of individuals with Bulimia Nervosa are within a normal weight range, whereas many patients with Binge Eating Disorder are overweight. For overweight individuals with problematic eating, treatment often targets two goals--ending problematic eating behaviors, and weight management/weight loss. Research has shown that behavioral weight loss treatment is currently the most effective method of weight loss. Behavioral treatment stresses the importance of gradual weight loss, achieved by setting realistic dietary and exercise goals and following flexible guidelines (rather than rigid rules). Patients will learn new strategies for healthy eating, meal planning, and portion control, as well as methods for effectively coping with cravings and triggers. A Registered Dietitian can do a food analysis and recommend dietary changes individualized to your needs.

What about Surgical Weight Loss Methods?

Surgical weight loss, commonly known as bariatric surgery, may be recommended by your medical doctor when non-surgical weight loss efforts (diet, exercise, behavior modification) have been unsuccessful.

Typically individual’s who weigh at least 100 lbs. above his/her ideal body weight, have a BMI greater than 40, or with one or more co-existing medical problems and a BMI between 30-39.9 may also be considered candidates for surgery. These methods, which can include Roux-en -Y gastric bypass, laparoscopic adjustable gastric band (LAP BAND), or laparoscopic sleeve gastrectomy, can result in significant and sustained weight reduction, improved medical conditions, and enhanced quality of life. 

Prospective candidates for bariatric surgery are required to undergo several pre-surgical evaluations including a psychological evaluation. The purpose of the psychological evaluation is to assess the factors contributing to obesity and barriers to long – term successful weight loss.

At AICT, we offer psychological evaluations for bariatric surgery. Please call to set up a consultation.*

*AICT is not affiliated with an interdisciplinary Bariatric Group nor do we provide referrals to Bariatric Surgery Programs

How long will I be in treatment?

Cognitive-behavioral treatment for Bulimia Nervosa, Binge Eating Disorder, and other types of problematic eating typically lasts for approximately 20 weeks. CBT for relapse prevention in individuals with Anorexia Nervosa varies in length according to need. Treatment sessions are held weekly. You and your therapist will decide on an appropriate length of treatment based on your symptoms.

What do I need to do?

Cognitive-behavioral treatment for eating disorders may initially be anxiety-provoking for patients, yet they typically become more comfortable with the therapy once they observe how quickly it disrupts the cycle of dieting and problematic eating behaviors.. Patients are asked to give the therapy an honest try and to practice skills learned between sessions. If you would like further information about cognitive-behavioral treatment for an eating disorder, or if you would like to schedule an appointment for an eating disorder assessment, please call the American Institute for Cognitive Therapy at 212-308-2440.

Do Low Fat Diets Really Make a Difference?

Read what the Chicago Tribune had to say about the issue here.

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To learn more about body dysmorphic disorder see Dr. Veale's website.
For more information on bulimia, see facetheissue.com.

Other helpful links include:

Recommended Reading:

To download more information on obesity and weight control please click on the chapters below:

The DBT Solution for Emotional Eating
-Debra L. Safer, Sarah Adler, and Philip C. Masson.

Eating Disorders and Obesity
-Edited by Kelly D. Brownell and B. Timothy Walsh

Handbook of Obesity Treatment
-Edited by Thomas A. Wadden and Albert J. Stunkard

Cognitive Behavioral Treatment of Obesity - A Clinician's Guide
-Zafra Cooper, Christopher G. Fairburn and Deborah M. Hawker

Weight Bias: Nature, Consequenses, and Remedies
-Kelly D. Brownell, Rebecca M. Puhl, Marlene B. Schwartz and Leslie Rudd.

Help Your Teenager Beat an Eating Disorder
-James Lock and Daniel Le Grange

"I'm, Like, SO Fat!", Helping Your Teen Make Healthy Choices about Eating and Exercise in a Weight-Obsessed World
-Dianne Neumark-Sztainer

Assessment of Eating Disorders
-James E. Mitchell and Carol B. Peterson, Eds

Binge-Eating Disorder: Clinical Foundations and Treatment
-James E. Mitchell, Michael J. Devlin, Martina de Zwaan, Scott J. Crow, and Carol B. Peterson

Body Image: A Handbook of Science, Practice, and Prevention, Second Edition
-Edited by Thomas F. Cash and Linda Smolak

Cognitive Behavior Therapy and Eating Disorders
-Christopher G. Fairburn

Dialectical Behavior Therapy for Binge Eating and Bulimia
-Debra L. Safer, Christy F. Telch, and Eunice Y. Chen

Eating Disorders in Children and Adolescents: A Clinical Handbook
-Edited by Daniel Le Grange and James Lock

Feeling Good about the Way You Look: A Program for Overcoming Body Image Problems
-Sabine Wilhelm

Night Eating Syndrome: Research, Assessment, and Treatment
-Edited by Jennifer D. Lundgren, Kelly C. Allison, and Albert J. Stunkard

Overcoming Binge Eating
-Christopher G. Fairburn

Self-Help Approaches for Obesity and Eating Disorders: Research and Practice
-Janet D. Latner and G. Terence Wilson

Treating Bulimia in Adolescents: A Family-Based Approach
-Daniel le Grange and James Lock

Treatment Manual for Anorexia Nervosa: A Family-Based Approach, Second Edition
-James Lock and Daniel Le Grange

Treatment Plans and Interventions for Bulimia and Binge-Eating Disorder
-Rene D. Zweig and Robert L. Leahy

These excerpts are posted with permission of Guilford Publications, Inc. and are subject to copyright law and restricted from further use. No part of these excerpts may be reproduced, stored in a retrieval system or transmitted in any form or by any means (electronic, photocopying, recording or otherwise) without prior written permission of the publisher. To obtain permission please contact Guilford Publications, Inc. at the address below or e-mail: permissions@guilford.com This book may be ordered directly from Guilford Publishing at http://www.Guilford.com

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Keywords: weight loss, body fat, eating disorders, overweight, body image, thin, diet, exercise, binge,obesity, weight

All Content on this website is copyrighted © Robert L. Leahy, PhD. All Rights Reserved.