WHAT ARE EATING DISORDERS?

Eating Disorders (EDs) are serious illnesses comprised of physical and cognitive symptoms that can have profound consequences for an individual's overall health and quality of life. The eating disorders include bulimia nervosa, anorexia nervosa, and eating disorder not otherwise specified. Eating disorders affect both men and women but are mostly diagnosed in women. They often develop during adolescence but may emerge at any point across the lifespan. Bulimia nervosa occurs in 1% to 8% and anorexia nervosa in 0.4% to 1% of Canadians. According to the Public Health Agency of Canada, approximately 3% of women will be affected by an eating disorder in their lifetime.

Bulimia nervosa is characterized by a cyclical pattern of bingeing and use of compensatory strategies. Bingeing means eating a large amount of food in a brief period and experiencing a sense of loss of control. Compensatory behaviours are strategies to get rid of unwanted calories and include self-induced vomiting, abuse of laxatives, diuretics, excessive exercise, and/or fasting. Individuals with bulimia also experience shape and weight as core determinants of self-esteem.

Anorexia nervosa is characterized by significant weight loss due to restriction of food intake, an extreme fear of gaining weight or becoming fat, feelings of 'fatness', and experience body shape and weight as a core determinant of self-esteem. In females, loss of menstruation also occurs. Some individuals with anorexia nervosa also experience episodes of bingeing and/or use of compensatory behaviours.

Eating Disorders Not Otherwise Specified (EDNOS) is a final category of the eating disorders that includes individuals who do not meet the strict criteria for anorexia or bulimia nervosa, yet still exhibit serious symptoms. Binge eating disorder is an example of an EDNOS and is characterized by episodes of binge eating in the absence of compensatory behaviours.

WHAT PSYCHOLOGICAL APPROACHES ARE USED TO TREAT THE EATING DISORDERS?

Eating disorder behaviours typically occur when an underlying struggle (e.g., emotional, interpersonal, or life challenge) exceeds an individual's capacity to cope. As such, despite severe health consequences, ED behaviours can serve a valued function in the individual's life; they may enhance self-esteem, be a means of communication, address a need for control, or provide a way to avoid painful emotions. As a result, ambivalence regarding change is common in this group. It is therefore essential that the treatment approach explores the underpinnings of the illness and is matched to the individual's readiness.

Eating disorder treatment is multifaceted and may be delivered by health professionals from various fields (e.g., physician, psychiatrist, psychologist/clinical counselor, dietician, recreational or occupational therapist, and nurses). Treatment may be individual or group-based and can occur in outpatient or inpatient/residential settings.

A variety of psychological approaches may be used to treat the EDs, however, Cognitive Behavioural Therapy (CBT) is most common. In CBT, individuals learn to self-monitor in order to increase awareness of the relationships among their thoughts, feelings, and behaviours. They learn to challenge unhelpful thoughts that trigger or maintain eating disorder symptoms, and learn strategies to eliminate ED behaviours.

Interpersonal Therapy (IPT) is also used to treat EDs. IPT focuses on understanding links between eating disorder episodes and relationship issues. For instance, therapy might focus on difficulties in forming or maintaining relationships, unresolved grief, and disputes with friends or relatives.

Psychoeducation is typically offered in the early stages of treatment. It is delivered in a group format and provides factual information about the causes of eating disorders as well as strategies for overcoming an eating disorder.

Family therapy is recommended for children and adolescents with an ED and may also be useful in adult populations. Family approaches focus on assisting the family to work together in overcoming the eating disorder. Multi-family therapy groups can increase, support the sense of community among families struggling with the illnesses.

Motivational approaches are increasingly being integrated into eating disorder treatments in order to address readiness for change. These approaches focus on exploring ambivalence, examining the costs and benefits/pros and cons of change, exploring the role of the ED in the individual's life, and identifying higher values.

HOW EFFECTIVE ARE PSYCHOLOGICAL METHODS OF TREATING EATING DISORDERS?

Research has shown that psychoeducation is a useful first line of treatment for individuals with mild to moderate bulimia nervosa. For individuals with more severe bulimia symptoms, interpersonal therapy and cognitive behaviour therapy have been shown to be highly effective, and identified as the treatments of choice.

Although research is still investigating the best treatments for anorexia nervosa, a comprehensive approach that addresses motivational issues, weight restoration, and underlying psychological issues is recommended. Family therapy has been shown to be a critical treatment component for younger clients.

You can consult with a registered psychologist to find out if psychological interventions might be of help to you. Provincial, territorial and some municipal associations of psychology often maintain referral services. For the names and coordinates of provincial and territorial associations of psychology, visit http://www.cpa.ca/public/provincialandterritorialassociations. The Canadian Register of Health Service Providers in Psychology also has a listing service and can be reached through http://www.crhspp.ca.

This fact sheet has been prepared for the Canadian Psychological Association by Dr. Josie Geller, Director of Research, Eating Disorder Program; Associate Professor, Department of Psychiatry, UBC; Senior Scholar, Michael Smith Foundation for Health Research.

Revised: March 2009