As you spend more time discussing goals and challenges with your Talkspace therapist, you may have questions or are interested in learning more about specific mental health topics and conditions. The Talkspace Bookshelf offers up-to-date mental health information directly from our behavioral health team to provide a better understanding of condition origins, diagnoses, various forms a condition may take, and different treatment options. Feel free to use this resource as a starting point to open up a dialogue and pose questions for your Talkspace therapist.
Eating disorders make up a classification of conditions that reference a troubling and disruptive relationship with food and nutrition. It is estimated that in the United States as many as 30 million people (20 million women and 10 million men) have an eating disorder in their lifetime.
Some of the most prevalent eating disorders are: Anorexia Nervosa (Anorexia), Bulimia Nervosa (Bulimia), Binge-Eating Disorder, Avoidant/Restrictive Food Intake Disorder, and Pica.
Anorexia Nervosa
Anorexia Nervosa, or anorexia as it is more commonly known, is one of the most widely known eating disorders. Typically, individuals with anorexia have a persistent and intense fear of gaining weight or becoming “fat.” This fear manifests in both behaviors that limit weight gain (such as only eating very little) and in preoccupying thoughts about weight, weight gain, appearance, and food intake. Often, individuals with anorexia may have some disturbance or distortion in the way they see their bodies or how their bodies are perceived by others.
Individuals may only engage in nutrition restriction (as defined by medical guidelines) or may also engage in binging/purging behaviors (such as misuse of laxatives, diuretics, enemas, or by self-induced vomiting).
Bulimia Nervosa
In contrast with anorexia, Bulimia Nervosa (or more simply Bulimia) is characterized by periods of binging that is then followed by behavior to correct or make up for binging behavior, referred to as compensatory behaviors. These behaviors can include practices similar to those of anorexia and exist in an effort to prevent weight gain. Examples of behaviors include: fasting, vomiting (purging), using diuretics, laxatives or other medications, or excessive exercise.Similarly to anorexia, individuals living with bulimia also experience their shape or bodies as being a significant influence on their overall sense of self and self-worth.
Binges are characterized by intense and often short periods (of a couple of hours) of time in which an individual eats an amount of food that is unusual for that time frame. That is, individuals consume an amount of food that most average people would not consume in that time. In practice, sometimes individuals may consume a significant portion of a day’s worth of calories (per average medical guidelines).
Binge-Eating Disorder
Binge-Eating Disorder is a condition in which individuals engage in binge eating behaviors, such as those in Bulimia Nervosa. The binge eating episodes are relatively brief, but intense periods of excessive consumption and are often later experienced with guilt, shame or regret. During the bingeing period, individuals may experience a feeling of a lack of control. These binging periods are typically experienced when the individual does not feel physically hungry.
Avoidant/Restrictive Food Intake Disorder
By contrast, people living with Avoidant/Restrictive Food Intake Disorder engage in the avoidance of food. This can be due to an apparent lack of interest and can also be due to the desire to avoid the food due to its sight, color, taste, or other sensory experiences. In some instances, the individual may also depend on nutritional supplements or obtain nutrition through means other than by eating food.
Pica
Pica is condition in which people eat non-nutritive (i.e. not food) items that are not a specific cultural practice and not represented by developmental (age appropriate) behavior (e.g. little children who may explore eating dirt). The condition may or may not have a specific onset, but is often soothing for clients who live with the condition.
Treatment
Crisis Intervention
Acute treatment of some eating disorders such as anorexia nervosa may include crisis intervention, such as hospitalization. Due to the risks of low body weight, such as heart attacks and organ failure, those struggling with anorexia are at a particular risk for hospitalization.
It should also be noted that the other eating disorders may produce medical concerns that require immediate medical intervention as well. Nutritional deficiencies can cause a variety of medical concerns and individuals with eating disorders may, at times, also experience severe anxiety, depression, cognitive impairment or suicidal, thoughts.
Therapy
CBT, or Cognitive Behavioral Therapy, is widely used in the treatment of eating disorders. Often, those who live with anorexia, bulimia, or binge eating disorder experience ongoing rumination and self-critical thoughts of themselves and their bodies. Past research has indicated that many clients who experience disordered eating also demonstrate high levels of perfectionism which can disrupt balanced thinking. Cognitive therapy will help clients identify perfectionism and other thought patterns which cause daily disruption and rumination. The development of alternative, or more balanced, thinking skills is often a hallmark of treatment.
Behavioral based strategies in the treatment of eating disorders will help clients structure their days to maximize function and promote healthy, regular eating patterns. Ongoing nutritional counseling with a nutritionist or dietician is often recommended for sustained progress in the treatment of eating disorders.
Dialectical Behavioral Therapy
Some therapists are also trained in Dialectical Behavioral Therapy, commonly referred to as DBT, which is known as a blend of traditional western therapies such as Cognitive Behavior Therapy (CBT) and eastern-based skills such as mindfulness. With its four modules (mindfulness, distress tolerance, emotional regulation, and interpersonal), you will learn a wide range of skills to address the emotions that impact problem eating behavior.
With both CBT and DBT, these skills can be used in perpetuity after being practiced regularly with the supervision and support of a mental health professional.
Nutritional Counseling
Ongoing assessment and counseling from a nutrition professional is often a recommended course of treatment for those living with eating disorders. As an adjunct to therapy or medication, nutritional counseling can be helpful in assisting clients in learning more fact-based information about nutrition and one’s own individual dietary needs. Often, your therapist can work with your nutritional counselor or dietitian to provide an optimal level of support that reinforces a healthier, and more balanced relationship with food.Support Groups
In addition to individual therapy, support groups are often indicated for individuals who live with eating disorders, in either inpatient or outpatient treatment settings. Support groups can be quite helpful in finding much-needed support and camaraderie. They can provide an opportunity for individuals to share both challenges and healthy strategies to move forward.
Community-level support groups are often offered after initial treatment when clients enter the maintenance phase. Groups may be held and organized by peers (people who have lived, or are living, with eating disorders), while some may be held and organized by professional therapists and mental health professionals. An example of peer-led group is Overeaters Anonymous.
Medication
Treatment for eating disorders may also include medication or pharmacotherapy. Mood stabilizers or antidepressants are often prescribed to help clients maintain an even mood. This can often be helpful as a critical addition to talk therapy, which may include many cognitive and behaviorally based strategies.
In addition, some treatments designed to improve or restrict appetite may be considered depending on the nature of the condition and an individual’s needs. However, it should also be noted that some medications may have side effects that inherently impact appetite and other behaviors.
Therapeutic Note
Remember your therapist is here to help you figure out the best way to address your concerns. Therapy works best when it is a collaboration between you and your therapist. It is important to be open, honest, and an active participant in this process. Talk to your therapist about your goals for therapy so that together you can come up with the best plan to achieve your goals.
Questions You Might Have For Your Talkspace Therapist
- What are the medical conditions that happen with an eating disorder?
- I have some fine hair that grows all over my body, what is that?
- Just because I want to be thin, why is that considered an eating disorder?
- I don’t want to talk about my condition in a support group but how would it help?
Sources
Association, A.P.. "Feeding and Eating Disorders." Desk Reference to the Diagnostic Criteria From DSM-5®. Washington: American Psychiatric Publishing, 2014. 169-176.
Get The Facts On Eating Disorders. (n.d.). Retrieved April 27, 2017
National Institute of Mental Health (2013). Eating Disorders. Retrieved April 12, 2017