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Wednesday, 30 March 2011

Top Tips For Eating Disorders: The Client Must Be Anxious for Therapy To Work

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


  1. "People with anorexia will believe “If I eat a piece of toast I will gain 5 lbs”."
    I understand that this was purely an example, but I have anorexia (I've got the binge/purge bit too) and I know that if I eat a piece of toast I will not gain 5lbs. To me that is a ludicrous statement, example or otherwise. I'm sure it may apply to SOME folk with anorexia, but it is not so simple as to be used as a sweeping statement.
    I know that may seem a trivial thing to bring up, but all these trivialities add up to massive misunderstandings regarding eating disorders in the media, the general public and even within professional ED practitioning circles. I've friends with eating disorders who have "adopted" such beliefs, over time, in order to fit the diagnosis and access treatment or purely because they felt that they had not "perfected" their ED without such a belief! I myself know that it is extremely difficult to accept treatment from a team who already have a definite set idea of what behaviours and thought patterns they will encounter during treatment. So, if you like, I kind of see generalised statements as more harmful than useful.

    I feel I need to apologise if the above comes across as combative - I just am passionate about individually tailored treatment!
    I agree wholeheartedly that facing and riding anxiety is an integral part of dealing with an eating disorder. I have ridden many waves of anxiety. Some have taken me to small (but important) successes, others have dumped me further into despair. To me it seems there is wave upon wave upon wave of anxiety and to keep up the momentum/motivation to hop on and ride them all is exhausting. This is where I am right now.
    I'm not so much "too scared to try it" as I am too exhausted to face another onslaught of anxiety which may or may not lead to a positive outcome...So, maybe I AM too scared to try it..Too scared of a possible failure and not meeting expectations of those who hold faith in me that I will, someday, put it all together and be "recovered". I'm anxious about NOT recovering! This anxiety keeps me from recovering - the one thing I'm scared of NOT doing! At some point I fear I will over-analyse myself into my grave.
    As ever Deanne, you've got me thinking..
    Perhaps that is the point you were making: do more, think less? Or maybe that's what I take away because that is what I wish I would ruddy do! I'm beginning to think I am a perfect example of the way being malnourished is detrimental to cognition!
    I am talking in circles so I will stop!

  2. You are right that it is wrong to generalise. When someone is sitting in front of a piece of toast and can't eat it, we rely on people like you to teach us what is going through your head.To find out what this awful paralyzing fear is about. It isnt about getting fat although you strongly beleive this is what it is all about perhaps.
    This may surprise you since I have been there, and the surprise might be that when we get well we develop amnesia for the terror and we say "what was all that about?"
    I dont care if you are combative, I am also. I am hearing that you are exhausted. I expect that you wish you had your real energy back perhaps you dont even remember what it was like to wake up free, and that is the issue Rufty.

    My heart goes out to you.

    Even "well" life isnt perfect and I spend a great deal of time learning so that my life feels richer and I feel stronger.