CBT for Anorexia (And Eating Disorders)

Written by: Ankita Kathad – MA
(Clinical Psychology)

Last updated date : April 25, 2022

Anna noticed that her friend sally was getting thinner day by day. Sally had stopped eating her lunch. She stopped getting her lunch box. Moreover, she drank very little water during the day. Her weight was far below the recommended body weight. Anna realised that sally was showing symptoms of an eating disorder-Anorexia Disorder. That is to say, it is a disorder is when a person doesn’t eat enough to maintain a healthy body weight. This article deals with CBT for anorexia and CBT for eating disorders.

Chapter 1:
What Are the Symptoms of Anorexia?

Before understanding the treatment, let us look at the disorder closely.

  • People have a fear of becoming fat and going out of shape. They are underweight and cannot maintain a healthy Body mass index for their age and height.
  • Moreover, people refuse to eat and drink water even though they are very underweight.
  • They suffer from very low self-esteem. They often suffer from emotional problems.
  • People with this disorder are in denial. They cannot accept that their body is medically underweight.

This disorder involves a lack of proper nutrition. In this condition people often face malnutrition. People have a very thin and pale bodies. They also suffer from dehydration, low immunity, stomach aches, low blood pressure and serious medical issues. Let us understand the causes of anorexia. Knowledge of the causes helps us understand CBT for anorexia better.

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Chapter 2:
What Causes Anorexia?

This disorder occurs when a person has unrealistic goals of having a ‘thin body’. They feel that an ideal body is a size zero body. Our media represents a thin body as lovely. In some professions such as acting or sports, a thin body is preferred. Even in modelling, people like to look at a thin body. In CBT for anorexia, people are taught to have realistic hopes.

Some people have trauma from childhood. This includes fat-shaming in childhood. Some parents force girls to stay thin and lean. This is so she can find a suitable match for herself. Moreover, in youth Children going through changes can become insecure with their bodies. They will start unhealthy diet routines to reduce their body weight. In CBT for eating disorders, these thoughts are challenged.

Even stressful life events can be a cause of under-eating. When you are under a lot of stress, eating helps you cope with the pressure. Similarly, if you are going through a major life event such as college or marriage, it can be stressful. You may forget to eat or under-eat.

Some people may have a need for perfectionism. They might want their body to look a certain way. They may start under-eating to control their body weight.

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Chapter 3:
CBT for Anorexia

The treatment for Anorexia has three major aspects:

Firstly it involves helping the person restore lost weight. This is an important step because the person can face serious medical problems due to low weight. In this step, essential nutrients and vitamins are given. This helps the person gain the lost strength.

Secondly, therapy is given to the person. Therapy focuses on changing irrational beliefs. Thoughts that are negative are the target of the therapy.

Finally, the goal is to help the person achieve a full recovery. The therapist helps them maintain a healthy weight. Follow up is crucial.

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Chapter 4:
What Is CBT?

CBT is an evidence-based therapy for various behaviour problems. It involves many techniques. It focuses on changing the negative thoughts behind a behaviour. CBT targets the core belief of a person. Moreover, it helps the person to understand their patterns of thoughts. CBT is considered very helpful in treating eating disorders. Since an eating disorder is a combination of behavioural and cognitive issues, CBT is useful.

Here is a list of some CBT techniques:

  1. Identifying negative automatic thoughts
  2. Setting goals
  3. Problem-solving
  4. Self-monitoring
  5. Learning helpful ways of coping
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Chapter 5:
CBT for Anorexia and Eating Disorder

CBT for eating disorders includes a range of methods. The common belief an eating disorder involves a negative feeling about one’s body. CBT helps you to monitor your negative thinking patterns that lead to unhealthy behaviours. CBT for anorexia or CBT for eating disorders thus focuses more on unhealthy eating to cope with stress. Eating disorders are a cluster of disorder which includes overeating, under-eating and purging. The major reason for all of them is the need for a ‘perfect’ body. Negative self-image and low self-esteem are common in all of them. Following are the CBT steps. for other eating disorders.
Identifying Negative Automatic Thoughts
In CBT for anorexia, the therapist tries to know the core beliefs. The person may want to be perfect. They feel that they are too fat. Moreover, the therapist focuses on unhealthy coping that the person uses. In doing so, the therapist questions unhealthy eating patterns. All these thoughts will be recorded.
Challenging
In this stage, the therapist will question the negative thoughts. Unhealthy coping methods are changed. Here the therapist will try to explain how the unhealthy ways are in a way harming the person. For example, a person may think that their body is not perfect. The therapist will ask the person’s definition of ‘perfect’. The therapist will explain about body image. The person can have all or nothing thoughts. For example, they can think- If I eat this cake, I will become very fat and people will make fun of me. Additionally, they will think that missing one day of workouts will make them very fat. These thoughts are changed. They begin to think in moderation. For example, the person can think that I can eat a small piece of cake and then make sure to not eat junk later on.
Food Records
An important step in CBT for anorexia and eating disorders involves food records. It involves a food timetable, calorie count and feelings about food. The client records every time they eat food. This includes water intake. The person has to note down feelings about food before and after eating. For example, the person can note down if a particular food item was making them upset. They can write down that eating fruits made them feel good.
Facing Problems
Exposure is a well-known step in CBT. The person comes face to face with food that scares them. For example, if a person is afraid of butter as it has fatty content, they are made to face the butter. They have to look at it, then touch it. The idea is to get rid of avoidance and denial.
Meal Planning
A therapist works with other experts to make a proper meal plan for the client. For example, a meal plan will have proteins, vitamins and healthy fat. This is done to make sure that the body has all the nutrients needed for a healthy life. The therapist gives proper rewards for following the plan. Additionally, routine weight checks are a part of this. More so, blood tests and blood pressure checks are important
Awareness
Education helps to understand the medical problems of undereating. The family members also help in this process of recovery. For example, they can remind the client to eat on time. They can also motivate the client to be healthy. Positive messages are given so the client finds strength. They can also tell the client that they look beautiful no matter what. The client can also read books on body image. They can watch videos of people who spread body positivity. There are articles and courses on Epsychonline which can help people with eating disorders. These are curated by experts. These courses can be useful for you or your friends if you are going through eating disorders. Do check them out.