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Psychotherapy for Eating Disorders

It can feel like there are any number of things that can come problematic about our relationship with food: not eating 'enough' of it, eating 'too much' of it, using it as an emotional crutch... Psychotherapy can offer a solution-focused way of tackling these issues.

Developing a happier relationship with food, eating and our bodies

Food, eating and body image are intertwined with emotional, cultural and mnemonic associations so that, when our relationship with food becomes problematic, it can seem hard to know where to start in trying to restore the balance.

At The House Partnership, we prefer not to label people according to the diagnostic criteria for “Eating Disorders”, precisely because this relationship is so complex and nuanced that concentrating on categorizing behaviours is far from helpful. Many people who struggle with eating don’t meet the official diagnostic criteria, but that doesn’t mean that they are any less distressed or deserving of help and care. Rather than thinking about therapies for ‘Anorexia’ or ‘Bulimia’, we believe instead in tailoring therapy to the precise needs of each individual – needs which often fail to conform to diagnostic boundaries.

Food issues can manifest themselves in a wide variety of ways, both between people, and within the same person. These experiences can include:

  • Consistently eating far less than is needed to maintain your usual body weight
  • Compensating for food eaten by exercising excessively, making yourself sick, or using other methods like laxatives
  • ‘Binge eating’ (eating vast amounts of food whilst feeling out of control and powerless to stop)
  • Hoarding and hiding food, or secretive eating
  • ‘Comfort eating’ or ’emotional eating’ (resorting to food at times of emotional stress)
  • Only eating a restricted set of foods, and feeling great anxiety about the prospect of eating other things
  • Failing to notice marked weight-loss in yourself, or perceiving yourself to be much larger than you actually are
  • Though eating very little yourself, showing a great preoccupation with food by e.g. cooking lots for others, buying lots of food and looking at it or smelling it but not eating it, collecting lots of recipes that you know you’ll never use…
  • Chewing food but spitting it out instead of swallowing it

As you can see from these examples, when our relationship with food becomes chaotic, this can have a massive effect on our lives and our relationships with others. Often though, the person involved can be the last to realise that there is a problem.

Though the specific form of therapy for each person with food and eating issues varies according to their particular problems, below is a look at some of the elements of psychotherapy that can be useful:

Exploring your representation of self-worth…

And how this relates to your eating behaviours: For many people, though they may not know it, their food issues are maintained by low self-esteem or self-worth. Although eating problems can never be said to be fully caused by social influences, living in a Western society which tells us that ‘thin=good’ and ‘fat=bad’ certainly doesn’t help.

Improving your personal relationships…

Helping you to identify and work through issues in your relationships, many of which may have become ruptured as your food issues have become increasingly problematic. This is informed by the understanding that emotional eating (or failure to eat) can be triggered by a variety of traumatic events surrounding relationships: their loss (through bereavement, divorce or estrangement), transition or dispute. The focus on this part of therapy is on improving internal and external communication, and redirecting attention from food and weight to the underlying issues that they may be about.

Changing problematic behaviours..

This can involve keeping a diary of food behaviours, thoughts and feelings and, with your therapist, beginning to make connections between them. This helps to develop insight into how we are maintaining our problems, which is an important prerequisite for positive change (how can I solve my problems if I do not concede that I have a part to play in my problems?). Later, you may work on finding more adaptive problem solving skills to use when faced with stressors or ‘triggers’, to minimise chances of relapse once therapy has ended.

 

These are just a few examples of some of the elements of psychotherapy for food issues. The common feature is that they are all focused on solving problems in the present, and working on skills needed to successfully navigate challenges in the future without resorting to food or food avoidance. Psychotherapy can be easy to confuse with psychoanalysis, which is a popular conception of all therapy i.e. lying on a couch whilst a Freudian figure dressed in tweed smoking a cigar (which, sometimes, is just a cigar!) tells you that your problems are your parents’ fault.

There is a vast and growing wealth of evidence to suggest that – especially for problems surrounding food, body image and weight – dwelling on negativity from the past whilst doing nothing to equip the person with positive skills to tackle their problems in the present is ineffective (and at worst detrimental) to treatment outcome.

The House Partnership, 9th March 2015

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