Disordered Eating Treatments

Disordered eating involves a number of different eating behaviors that may or may not be diagnosed as an eating disorder. Disordered eating is often accompanied by problematic (and often distressing) thoughts and beliefs about eating, shape, and weight, such as:

• “Eating will make me feel better.”
• “Eating a donut will make me fat.”
• “If I don’t carefully control my diet my weight will spiral out of control.”
• “I should only eat when I am truly hungry.”

Such behaviors and the thoughts that accompany them can contribute to the development of an eating disorder such anorexia nervosa, bulimia nervosa, binge eating disorder, or other specified feeding and eating disorder (OSFED).

This article discusses some of the disordered eating treatment strategies that can be helpful for changing thoughts and behaviors related to food, eating, shape, and weight.

How Thoughts Fuel Disordered Eating

On a daily basis, we all process thousands of thoughts. Many of our thoughts are automatic, and we don’t usually stop to examine whether they are facts or whether they are even useful.

Dysfunctional thoughts, also known as cognitive distortions, are thoughts that are inaccurate and destructive. These distortions can contribute to problematic eating behaviors such as restriction, bingeing, purging, and excessive exercise.

Types of Disordered Eating Treatments

Behavioral changes are most critical to recovery from disordered eating. There are also disordered eating treatments that employ strategies to help patients address dysfunctional thoughts.

Some of the treatments that may be helpful include cognitive behavioral therapy (CBT), a leading treatment for eating disorders, as well as psychotherapies such as acceptance and commitment therapy (ACT) and dialectical behavior therapy (DBT).

Cognitive Behavioral Therapy

CBT is considered the first-line approach to treating eating disorders, and it can also be an effective disordered eating treatment. This approach involves helping people understand how their automatic negative thoughts about food, eating, weight, and shape fuel their behaviors. Then, people work to change those thoughts and behaviors.

Acceptance and Commitment Therapy

ACT is a type of CBT that helps people practice acceptance of their thoughts and behaviors while working to commit to healthy and helpful actions. This approach suggests that trying to avoid or stop certain thoughts can worsen problems. Practicing acceptance while working toward goals can help build greater psychological flexibility.

Research suggests that ACT can help reduce feelings of discomfort about internal experiences while helping people commit to behaviors that are in line with their values.

Dialectical Behavior Therapy

DBT was originally developed to treat borderline personality disorder, but it has also been shown to be effective for other conditions, including disordered eating. It is a type of CBT that incorporates strategies such as mindfulness and acceptance to help people develop new skills, regulate their emotions, and tolerate psychological distress.

Disordered Eating Treatment Strategies

One thing that CBT, ACT, and DBT have in common is that they all help address the underlying thoughts that contribute to disordered eating. They may use similar methods to help address dysfunctional thoughts.

Externalize and Defuse Your Thoughts

Before accepting your thought as a command to follow, externalize it. For example, when you have the thought, “I can’t eat a bagel,” label it as “an disordered eating thought” and rephrase it as “My disordered eating is telling me not to have a bagel.”

Once you defuse the thought, it becomes easier to choose a more workable course of action that may involve disobeying the disordered eating, such as, “Thank you, disordered eating, but I’m not going to listen to you. I don’t want to let my mind bully me.” 

Challenge the Thought

Ask yourself any combination of the following questions:

What is the evidence for that thought? For example: “If I eat a bagel I will gain 5 pounds.” There is no evidence for this thought; a bagel could not possibly constitute enough calories to make me gain 5 pounds.

What are alternative beliefs? For example: “I shouldn’t eat unless I am truly hungry.” An alternative belief is “Since I enjoy eating with family members I need to sometimes work my mealtimes around the needs of others. This may mean eating when it is time for a meal even if I am not hungry.”

What are the consequences of having that thought? For example: “I’ve already blown it, so I’m going to go ahead and finish the box of cookies and start my diet tomorrow.” The consequence of this thought is that it causes me to binge which makes it worse because I end up eating even more than if I just work on accepting what I’ve already eaten.

Make a Coping Card

Take an index card and write the automatic or problematic thought on one side and the rational response on the other. This is a great strategy for those problematic thoughts that come up repeatedly. It is a good idea to review the cards daily and to keep them close at hand. You can also pull them out whenever you find that you are having the automatic thought.

For example, a common problematic thought could be, “I’m bored. Eating will make me feel better.” On the other side of this card, write “Eating when I am bored will only make me feel worse.”

Disobey Your Eating Disorder

On a paper make a list with two columns. In one column, write, “Ed says…” and in the other column, write, “Recovery requires…” On each line under “Ed says…” write what disordered eating tells you to do.

On the corresponding line under the “Recovery requires” column write down how you will specifically disobey that command. For example,

• “Ed says skip breakfast.” “Recovery requires me to eat breakfast.”
• “Ed says exercise today.” “Recovery requires me to take a day off.”
  

Run a Behavioral Experiment

Make a prediction: “If I allow myself dessert four nights this week, I will gain five pounds.” Run an experiment to test it out. Weigh yourself at the beginning and the end of the week. Have dessert four nights this week. Check to see if your prediction came true.

Over time, you will see that a number of beliefs are not accurate. This is another CBT approach.

A Word From Verywell

Disordered eating treatments can play an important role in improving eating behaviors and body image. Because disordered eating can contribute to the development of eating disorders, addressing these thoughts and behaviors early on may help prevent problems from becoming worse.

It is important to note that cognitive strategies alone will not usually resolve an eating disorder. However, they can be an important and helpful recovery tool for many people.

Many providers and patients also note that cognitive symptoms are often the last to improve and that recovery commonly requires behavioral change even in the face of persistent disordered eating thoughts.