Understanding Eating Disorders and how CBT can help

The standards of the ideal body size for women has been greatly influenced by the media. Models seen on TV generally range from thin to extremely thin, affecting what we perceive as the desired body size. Efforts to reach this perceived ideal can be damaging to one’s physical and mental health and lead to development of eating disorders.

Eating disorders are characterized by irregular eating habits and severe concern about body weight or shape. It is important to note that while eating disorders involve a preoccupation with body image they are often the result of a desire for control. Approximately 1 in 3 women in Canada develop bulimia nervosa in their lifetime. Additionally anorexia nervosa is one of the most common psychiatric conditions in young women. While eating disorders predominantly affect women, young men can also develop eating disorders.  Below you will find the different types of eating disorders that are currently recognized in the medical field, as well as the reasons that cognitive behavioural therapy is the favoured treatment for eating disorders.

Symptoms and Features of Anorexia

Anorexia nervosa is defined in the Diagnostic and Statistical Manual of Mental Disorders – 5 (DSM-V) as having severe weight loss due to the distortion of one’s body image and excessive dieting, with an intense fear or anxiety about weight gain.

Associated features of anorexia include a marked disturbance in body image, different methods of weight loss, and medical consequences due to the excessive weight loss. This can be low/irregular heart rate and blood pressure, muscle loss and weakness, digestive problems, kidney failure, and infertility for women. Anorexia also has a higher mortality rate than any other psychological disorder. As many as 10% of those who experience anorexia in Canada die because of health problems or suicide.

Symptoms and Features of Bulimia

Bulimia nervosa is defined by its recurrent episodes of binge-eating (compulsion of excessive eating) and compensatory behaviour (purging) to prevent weight gain. The DSM-V states that the binge-eating and compensatory behaviours must occur on average at least once a week for three months.

Associated features of bulimia include being within 10% of the target body weight, different purging methods such as misuse of laxatives and self-induced vomiting, and health complications such as dental enamel erosion, digestive and intestinal problems, dehydration, and electrolyte imbalances that can lead to irregular heartbeat and seizures.

Symptoms and Features of Binge-Eating Disorder

Binge-eating disorder (BED) is characterized as recurring episodes of food binges at least once a week for three months without the compensatory behaviours, with these episodes including the feeling of lack of control over eating. There is also marked distress regarding binge-eating for those with BED. Binge-eating episodes are associated with at least three of the following:

1. Eating faster than usual

2. Eating until uncomfortably full

3. Eating large amounts when not hungry

4. Eating alone due to embarrassment over amount consuming

5. Feeling disgusted with self, depressed, or guilty after

Cognitive Behaviour Therapy as a Treatment for Eating Disorders

Cognitive Behavioural Therapy (CBT) seeks to develop ones awareness of negative or distorted thinking. The goal of CBT is to equip the person with coping skills to use when a challenging situation arises. These skills allow one to see the situation more clearly and one can therefore respond more effectively. Since eating disorders involve a distorted perception of oneself, CBT is a logical choice as part of a treatment plan.

CBT helps reduce binge-purging symptoms and can improve social adjustment. Studies suggest that CBT is superior to medication alone (and CBT combined with medication is the best course of treatment for bulimia nervosa). There are fewer studies that have been conducted for treatment approaches for anorexia nervosa and binge-eating disorder. The combination of CBT and medication, however, both have a role in effective treatment and may influence or improve remission rates.