Eating Disorders Treatment Disordered Eating Treatments By Lauren Muhlheim, PsyD, CEDS Lauren Muhlheim, PsyD, CEDS Facebook LinkedIn Twitter Lauren Muhlheim, PsyD, is a certified eating disorders expert and clinical psychologist who provides cognitive behavioral psychotherapy. Learn about our editorial process Updated on March 22, 2022 Medically reviewed Verywell Mind articles are reviewed by board-certified physicians and mental healthcare professionals. Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Rachel Goldman, PhD, FTOS Medically reviewed by Rachel Goldman, PhD, FTOS Facebook LinkedIn Twitter Rachel Goldman, PhD FTOS, is a licensed psychologist, clinical assistant professor, speaker, wellness expert specializing in eating behaviors, stress management, and health behavior change. Learn about our Medical Review Board Print JGI / Jamie Grill / Getty Images Table of Contents View All Table of Contents How Thoughts Fuel Disordered Eating Types of Disordered Eating Treatments Strategies That Can Help 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. Recap Distorted thoughts play a role in disordered eating behaviors, which can eventually lead to the development of an eating disorder. Disordered eating treatments often focus on changing these underlying thought patterns to help improve mental well-being and eating behaviors. Excessive Exercise and Eating Disorders 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. Recap Several types of therapy can be helpful as disordered eating treatments. Cognitive behavioral therapy, acceptance and commitment therapy, and dialectical behavior therapy are three treatments that work to address the thoughts that often fuel disordered eating behaviors. How Cognitive Behavioral Therapy Can Help 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.” Externalizing and defusing thoughts are strategies from acceptance and commitment therapy (ACT). The Best Online Therapy Programs We've tried, tested and written unbiased reviews of the best online therapy programs including Talkspace, Betterhelp, and Regain. 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. One helpful cognitive behavioral therapy (CBT) strategy is to identify dysfunctional thoughts and replace them with facts. This can reduce distress and help with inserting more functional behaviors that support recovery. 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.” Coping cards are a helpful strategy from Judith Beck’s book Cognitive Behavior Therapy: Basics and Beyond. Causes of Eating Disorders 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.” This approach comes from Life Without Ed by Jenni Schaefer and Thom Rutledge and from the field of narrative therapy. 9 Essential Facts About Eating Disorders 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. Recap In addition to formal disordered eating treatment, there are also a number of strategies that you can use on your own to help overcome distorted thinking. Such strategies are drawn from CBT, ACT, and DBT treatments and can help you become more aware of these thoughts and manage them more effectively. What Is Rumination Disorder? 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. Self-Help Can Help for Eating Disorders 11 Sources Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Belloch A, Roncero M, Perpiñá C. Obsessional and eating disorder-related Intrusive thoughts: differences and similarities within and between individuals vulnerable to OCD or to EDs. Eur Eat Disord Rev. 2016;24(6):446-454. doi:10.1002/erv.2458 Del Pozo MA, Harbeck S, Zahn S, Kliem S, Kröger C. Cognitive distortions in anorexia nervosa and borderline personality disorder. Psychiatry Res. 2018;260:164-172. doi:10.1016/j.psychres.2017.11.043 Davis LE, Attia E. Recent advances in therapies for eating disorders. F1000Res. 2019;8:1693. doi:10.12688/f1000research.19847.1 Agras WS, Fitzsimmons-craft EE, Wilfley DE. Evolution of cognitive-behavioral therapy for eating disorders. Behav Res Ther. 2017;88:26-36. doi:10.1016/j.brat.2016.09.004 Fogelkvist M, Gustafsson SA, Kjellin L, Parling T. Acceptance and commitment therapy to reduce eating disorder symptoms and body image problems in patients with residual eating disorder symptoms: A randomized controlled trial. Body Image. 2020;32:155-166. doi:10.1016/j.bodyim.2020.01.002 Wisniewski L, Ben-Porath DD. Dialectical behavior therapy and eating disorders: The use of contingency management procedures to manage dialectical dilemmas. Am J Psychother. 2015;69(2):129-40. doi:10.1176/appi.psychotherapy.2015.69.2.129 Larsson A, Hooper N, Osborne LA, Bennett P, Mchugh L. Using brief cognitive restructuring and cognitive defusion techniques to cope with negative thoughts. Behav Modif. 2016;40(3):452-482. doi:10.1177/0145445515621488 Reuman L, Buchholz JL, Blakey SM, Abramowitz JS. Cognitive change via rational discussion. In: Abromowitz JA, Blakey SM, eds. Clinical Handbook of Fear and Anxiety: Maintenance Processes and Treatment Mechanisms. American Psychological Association. 2020:287-303. doi:10.1037/0000150-016 Beck JS. Cognitive Behavior Therapy: Basics and Beyond. 2nd ed. Guilford Press. Schaefer J, Rutledge T. Life Without Ed: How One Woman Declared Independence From Her Eating Disorder and How You Can Too. McGraw Hill Education. Franco KN, Sieke EH, Dickstein L, Falcone T. Eating disorders. Cleveland Clinic, Center for Continuing Education. By Lauren Muhlheim, PsyD, CEDS Lauren Muhlheim, PsyD, is a certified eating disorders expert and clinical psychologist who provides cognitive behavioral psychotherapy. See Our Editorial Process Meet Our Review Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? Other Helpful Report an Error Submit Speak to a Therapist for Eating Disorders Advertiser Disclosure × The offers that appear in this table are from partnerships from which Verywell Mind receives compensation.