Eating Disorders

Eating disorders are the result of the interplay among biological, psychological, familial, 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, 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 bingeing, 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 Binge-Eating Disorder, all of which usually begin between early adolescence and early adulthood.

 Bulimia NervosaBinge Eating Disorder Anorexia Nervosa 
Do you have any of these symptoms?• Preoccupied with shape and weight
• Bingeing: 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 daily weighing, pinch body fat, try on “skinny” clothes • Disrupted social life because you avoid eating with others 
• Preoccupied with shape and weight
• Bingeing: 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 daily 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” 
• Significantly underweight:Body Mass Index* less than 17.5 orWeight 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
Who is affected?2-5% of American population2-5% of American population; 
30% of overweight adults 
Less than 1% of adolescent/young adult females

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

To see the Body Mass Index Table, click here

Binges typically occur in secret and may include rapid ingestion of food, agitation, feelings of disgust, or a feeling of “being outside oneself”. Binges most often consist of high-fat, carbohydrate-rich, food that the patient considers “forbidden” or “restricted” under other circumstances.

How do eating disorders develop?

The cognitive theory behind eating disorders postulates that an individual defines and evaluates oneself excessively in terms of shape and weight. The pursuit of thinness and/or weight loss becomes the main focus for the individual with an eating disorder. The tendency to judge self-worth in terms of weight and shape drives the individual to diet restrictively. Strict dieting, in turn, leads to psychological deprivation and physiological hunger. When combined with life stress, negative emotions, and poor self-image, hunger can trigger a binge. A binge elicits feelings of guilt, shame, self-loathing, and uncomfortable feelings of fullness. To compensate for the binge and a fear of gaining weight, bulimics may vomit, use laxatives, abuse diuretics or exercise excessively. Individuals with binge eating disorder do not use compensatory behaviors to offset the binge. Instead, they will attempt to restrict their food intake again (i.e. skip breakfast and lunch the day following an evening binge). The continuation of strict dieting propels the binge cycle. The belief that through weight control one can increase self-esteem leads to the exact opposite– psychological distress, guilt, shame and worthlessness.

How does Cognitive-Behavior Therapy for eating disorders work?

Eating disorders are chronic without treatment. Hospitalization is often required during the first phase of AN treatment to restore the patient to healthy weight and monitor medical health. Cardiac dysfunction and electrolyte imbalance are two serious medical consequences of AN. Once the patient achieves a medically-stable weight, cognitive-behavior therapy can be effective and beneficial for preventing relapse.

Cognitive-behavior therapy has been shown to be a superior form of treatment for individuals with bulimia nervosa (BN), binge eating disorder (BED), and other types of disordered eating by multiple research studies. It is more effective than a variety of other therapies and is regarded as the first line of treatment. Cognitive-behavior therapy addresses the psychological, familial, and societal factors associated with eating disorders and is centered around the principle that there are both behavioral and attitudinal disturbances regarding eating, weight, and shape.

Cognitive-behavior therapy directly targets the binge cycle. The therapist and patient will work together to change eating behaviors, to discontinue purging, and to challenge rules that prevent natural and healthy eating patterns. Adoption of more flexible eating patterns and learning coping skills are central to preventing binges. Education about meal-planning, nutrition, and the ineffectiveness of purging techniques is often a part of treatment.

Treatment also targets thoughts and feelings that can trigger binge-eating, including perfectionism and “all-or-nothing” thinking. For example, the therapist and a patient might work together to challenge this thought:

“Now that I ate a few Oreos at the party, I feel like I’ve blown my diet. I might as well eat the whole bag. I’ll start my diet over again tomorrow.”

Treatment sessions also focus on learning coping skills for stress or negative moods to decrease the likelihood that negative events will trigger a binge. Cognitive-behavior treatment also works to improve body image.

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 to bingeing, purging, and unhealthy eating habits.

What about weight loss?

The vast majority of individuals with BN are within a normal weight range whereas nearly one-half of all BED patients are overweight. Weight management then becomes an important issue for some of these people and it needs to be approached in a healthy manner. Research has shown that traditional weight control programs may be less effective in treating overweight individuals who binge eat compared with cognitive-behavior therapy. Weight loss can also be achieved with cognitive-behavior therapy by learning new strategies for healthy eating, meal planning, and portion control.

How long will I be in treatment?

Cognitive-behavior treatment for BN and BED typically lasts for 20 weeks, though you and your therapist will together discuss what is right for you. Treatment sessions are held weekly.

What do I need to do?

Cognitive-behavior treatment for BN and BED may initially be anxiety-provoking for patients, yet patients typically become more comfortable with the therapy once they observe how quickly it disrupts the binge cycle. 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-behavior 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.

For more information on bulimia, see
Also, information can be found at The Academy for Eating Disorders Some data on this page was derived and/or influenced by the writings of Robert L. Leahy B.A., M.S., Ph.D., Director of the American Institute for Cognitive Therapy