Eating Disorders: Therapies

There are many types of therapies that are employed in the fight against eating disorders. The two most commonly used methods of treatment are pharmacological and psychological.

Medical interventions, usually in the form of SSRI (selective serotonin reuptake inhibitors) antidepressants, are used to best effect in patients suffering from bulimia nervosa (BN) and binge eating disorder (BED). The use of antidepressants in anorexia nervosa (AN) patients is limited because compromised cardiovascular function can be exacerbated by the drugs and cause cardiac side effects.

On the other hand, psychological therapies are utilized to great effect in all eating disorders. Some of the most common therapies are highlighted below. Information on therapies comes from National Eating Disorder Association (NEDA)’s Parent Toolkit.

Individual Psychotherapy

Behavior Therapy (BT) is a type of psychotherapy that uses principles of learning to increase the frequency of desired behaviors and/or decrease the frequency of problem behaviors. Subtypes of BT include dialectical behavior therapy (DBT), exposure and response prevention (ERP), and hypnobehavioral therapy.

Cognitive Therapy (CT) is a type of psychotherapeutic treatment that attempts to change a patient’s feelings and behaviors by changing the way the patient thinks about or perceives his/her significant life experiences. Subtypes include cognitive analytic therapy and cognitive orientation therapy.

Cognitive Analytic Therapy (CAT) is a type of cognitive therapy that focuses its attention on discovering how a patient’s problems have evolved and how the procedures the patient has devised to cope with them may be ineffective or even harmful. CAT is designed to enable people to gain an understanding of how the difficulties they experience may be made worse by their habitual coping mechanisms. Problems are understood in the light of a person’s personal history and life experiences. The focus is on recognizing how these coping procedures originated and how they can be adapted.

Cognitive Behavior Therapy (CBT) is a goal-oriented, short-term treatment that addresses the psychological, familial, and societal factors associated with eating disorders. Therapy is centered on the principle that there are both behavioral and attitudinal disturbances regarding eating, weight, and shape. Specific versions of CBT are utilized in treating bulimia: CBT-BN and binge eating disorder: CBTBED.

Interpersonal Therapy (IPT) (also called interpersonal psychotherapy) is designed to help people with eating disorders identify and address their interpersonal problems, specifically those involving grief, interpersonal role conflicts, role transitions, and interpersonal deficits. In this therapy, no emphasis is placed directly on modifying eating habits. Instead, the expectation is that the therapy enables people to change as their interpersonal functioning improves. IPT usually involves 16 to 20 hour-long, one-on-one treatment sessions over a period of 4 to 5 months.

Family Psychotherapy

Maudsley Method is a family-centered treatment program with three distinct phases. During the first phase parents are placed in charge of the child’s eating patterns in hopes to break the cycle of not eating, or of binge eating and purging. The second phase begins once the child’s refeeding and eating is under control with a goal of returning independent eating to the child. The goal of the third and final phase is to address the broader concerns of the child’s development.

Group Psychotherapy

In addition to the therapies that overlap with individual psychotherapy--CBT and IPT-group psychotherapy can include:

Psychodynamic Therapy views the human personality as developing from interactions between conscious and unconscious mental processes. The purpose of all forms of psychodynamic treatment is to bring unconscious thoughts, emotions and memories into full consciousness so that the patient can gain more control over his/her life.

Psychoeducational Therapy is a treatment intended to teach people about their problem, how to treat it, and how to recognize signs of relapse so that they can get necessary treatment before their difficulty worsens or recurs. Family psychoeducation includes teaching coping strategies and problem-solving skills to families, friends, and/or caregivers to help them deal more effectively with the individual.

Self-help Groups

• ANAD (Anorexia Nervosa and Associated Disorders)
• 12-step approaches
• Eating Disorders Anonymous
• Web-based online programs

Alternative Therapies

Often used in conjunction with traditional forms of therapy, alternative therapies can be valuable. Alternative therapies include creative art, movement, psychodrama, and nutritional counseling. Additionally, anecdotal evidence has popularized biofeedback, coaching, eye movement desensitization, exercise, journaling, mandometer (a mandometer is a computer that measures food intake and is used to determine a course of therapy), massage, meditation, relaxation training, and yoga.