MY SPECIALTIES:
EATING DISORDERS

Introduction

Anorexia Nervosa

Bulimia Nervosa

Binge Eating

Disordered Eating

Body Image

Obesity & Weight Management

Back to
Specialties Menu

Contact Dr. Nash

Introduction

What are the main types of eating disorders?

Anorexia nervosa and bulimia nervosa are the most well-known eating disorders. Recently binge eating disorder has been recognized as a separate eating disorder. Many people fall short of having a full-blown eating disorder but nevertheless suffer from disordered eating.

How do I know if I have an eating disorder or disordered eating?

In a society that continues to prize thinness, almost everyone worries about their weight at least occasionally. When concern about weight or shape is taken to the extreme, an eating disorder can develop that threatens well-being. Abnormal eating behavior, negative attitudes about the body, and emotional distress are the hallmarks of all eating disorders. Any kind of eating that causes you pain or distress points to a problem. The best way to know is to seek the consultation of a psychotherapist trained in assessing and treating eating disorders and eating problems.

How is an eating disorder treated?

The answer depends on the eating disorder in question. The first step in treating any eating disorder, and particularly anorexia, should be to have a physician rule out possible medical illness and determine that the person is not in immediate physical danger. Nutritional counseling is an important component of treatment. Usually treatment of any eating disorder is a team approach, involving the client's primary care physician, psychotherapist, psychiatrist, and nutritionist.

Psychological management is the foundation of treatment for those with eating disorders. The therapist needs to establish and maintain a good therapeutic alliance (relationship) with the client, coordinate care with other clinicians and care-givers, assess and monitor eating disorder symptoms and behaviors, assess and monitor the client's general medical and psychological condition, and if appropriate provide family assessment and treatment. Both the symptoms of an eating disorder and problems in the family or social relationships may be contributing to the maintenance of the disorder. In some cases, either family or couples therapy may be in order.

Cognitive-behavioral therapy (CBT) is the treatment for which the most evidence for efficacy currently exists. CBT involves identifying destructive thoughts, beliefs, and behaviors and replacing them with more positive ones. It involves learning new coping skills for managing stress and negative emotions. Psychotherapy may need to focus on improving the client's personal relationships. And it may involve helping the client get beyond an event or situation that established the eating disorder in the first place. In all cases, the client needs to adopt a healthy lifestyle involving an appropriate level of exercise and a healthy diet of moderate caloric intake.

Medications can sometimes be helpful in treating an eating disorder. Treatment of anorexia should not rely on psychotropic medications as the sole or primary treatment. The need for antidepressant medications for anorexia is usually best established following weight stabilization. Medication in the treatment of anorexia is generally used for the prevention of relapse among weight-restored clients or to treat associated problems such as depression or obsessive-compulsive symptoms.

For most bulimics and other eating disordered clients, antidepressant medications form an effective component of a treatment plan. Selective serotonin reuptake inhibitors (SSRIs) are safe and helpful in alleviating symptoms of depression, anxiety, obsessions, or certain impulse disorders. Other types of antidepressant medications can be used to reduce symptoms of binge eating and purging and may help prevent relapse. Appetite suppressant medications have been helpful in treating binge eating disorder. However, medication alone is insufficient and should be used in combination with psychotherapy, not as a replacement for it.

Some helpful websites on eating disorders that you might like to check out are:

• www.aedweb.org -- Academy for Eating Disorders
• www.anad.org -- National Association of Anorexia Nervosa & Associated Disorders*
• www.edap.org -- National Eating Disorders Association
• www.aabainc.org -- American Anorexia/Bulimia Association
• www.anred.com -- Anorexia Nervosa and Related Eating Disorders
• www.nimh.nih.gov -- National Institute of Mental Health
  

Dr. Joyce Nash, PhD    (650) 329-1000