People with eating disorders present with dietary chaos. There is starving, dieting, stuffing, purging, feasting and fasting, lots of coffee and diet drinks. This changes the body, assaults the brain, including appetite systems, fosters weight instability and leads to many of the emotional symptoms like depression which people bring to treatment.
Part of our work is nutritional rehab. This will help the body to burn energy rather than store it as fat. It will help with feelings and appetite control. For binge eating-purging clients we have to bring structure into the diet. We have to deal with strange beliefs about food such as “I am addicted to chocolate” and beliefs about good and bad foods. People with anorexia will believe “If I eat a piece of toast I will gain 5 lbs”. They believe “If I start eating again I will never stop”. People who binge think “If I eat a normal diet my weight will shoot up”.
Changing eating and other habits, like constantly weighing yourself, or constantly checking yourself in the mirror is a very scary thing to do. But how can you learn that your worst beliefs will not happen unless you are prepared to test them out? You may well be right about your convictions. However, If you can let a good therapist be your guide and agree to experiment with change slowly and purposefully, you may find that your fears were just imaginings.
They key for a therapist is to explain to their people that recovery depends on doing some things that will make them anxious. We must always remember how hard it is to change any habit, even the smallest ones in our own lives. We can negotiate with people what level of anxiety is manageable so that they can test our some new behaviours one week at a time. For example, next week you will eat regularly even if you binge. Or, next week delay for 5 minutes before you agree to purge. Or, next week how about having a glass of milk first if you feel the need to binge.
The changes have to be enough to make the person anxious about the outcome but not so great that they are too scared to try it.
Acknowledgement, Prof. Glenn Waller CBT Today Dec 2010