Eating Disorders (Holistic)

Eating disorders are complex conditions involving psychological factors and nutritional deficiencies. The term eating disorders includes anorexia nervosa, bulimia, and binge-eating.

The psychological factors may include an inability to cope with stress, problems with family and other relationships, feelings of deprivation, and experiences of physical, sexual, or emotional abuse. Psychotherapy is an essential part of the treatment for eating disorders, along with nutrition counseling and medical care as needed.¹

A person with anorexia does not eat enough to maintain a healthy weight; she views herself as overweight and is anxious about gaining weight. Anorexia typically begins in early adolescence, mainly among girls, though the numbers of boys developing this condition is increasing. People with anorexia weigh less than 85% of the normal weight for their age and height. Excessive exercise, vomiting, and abuse of laxatives and/or diuretics may also occur. Severe anorexia can be life threatening.

Bulimia, also known as bingeing and purging, is more common than anorexia, and usually affects teenage girls and women in their twenties. It involves a recurring, emotionally driven cycle of compulsive consumption of large quantities of high-calorie food in a short period of time, followed by induced vomiting. Some individuals also use laxatives, drugs that induce vomiting, diuretics, or excessive exercise in an attempt to purge. About 50% of anorexics also purge, and both bulimia and anorexia can coexist in the same person.² Unlike those with anorexia, some people affected by bulimia maintain normal or even excessive body weight.

Binge-eating disorder is similar to bulimia but no purging is done. It is more common than either bulimia or anorexia nervosa, and people with binge-eating disorder are usually overweight.³

People with eating disorders may have a preoccupation with weight and food, anxiety about their body image, and/or a feeling that they lose control over how much they eat. They may also exercise compulsively and, in women, experience missed menstrual periods. They may also frequently use laxatives, diet pills, and medicines designed to induce vomiting or reduce fluid retention.

Although regular, moderate exercise offers important health benefits, for many people excessive exercise is a common component of eating disorders, especially anorexia nervosa.⁴ In one controlled trial, a majority of the people with eating disorders reported that participation in competitive sports and exercise performed as part of a weight loss plan contributed to their condition.⁵ For people with eating disorders, it is important to establish and maintain healthy exercise habits; these individuals should consult with a healthcare professional skilled in eating disorders.

Psychological counseling, for both the individual and her family, and behavior modification training are also commonly used for people with eating disorders, often as part of a team approach that also includes nutrition counseling and medical care. Numerous preliminary and controlled studies have shown that the psychotherapy technique known as cognitive-behavioral therapy is effective in reducing the symptoms of bulimia.^{6, 7} For example, one study found 69% of a group receiving cognitive-behavioral therapy were abstaining from binge-eating and purging six months later compared to only 15% of a group keeping a diary of their behavior.⁸ Preliminary studies⁹ and one controlled trial¹⁰ suggest another technique, interpersonal psychotherapy, is equally effective for people with bulimia. Cognitive behavioral therapy and interpersonal psychotherapy have also been effective for people with binge-eating disorder in controlled trials,^{11, 12} resulting in cessation of binge-eating in almost half of the subjects in one report.¹³

The effectiveness of psychotherapy for anorexia nervosa is less clear.^{14, 15} One controlled trial found that psychotherapy (type unspecified) significantly improved weight gain compared to no treatment, and complete or nearly complete recovery occurred in 60% of the patients.¹⁶ Two other studies comparing different types of psychotherapy for anorexia nervosa found comparable improvement from all types;^{17, 18} one of these studies reported moderate improvement in 63% of cases.¹⁹ Long-term effectiveness of psychotherapy for eating disorders has not been studied.