Recovery from Eating Disorders

Greta Noordenbos is a Senior Researcher in the Department of Clinical Psychology, Leiden University, the Netherlands. Founder of the Dutch Commission for the Prevention of Eating Disorders, she has contributed to health policy in the field and has co-edited Dutch language titles Handbook of Eating Disorders (2008) and The Prevention of Eating Disorders (1998).

About the Author x Foreword xi

Acknowledgements xii

Introduction 1

When have Eating Disorder Patients Recovered? 2

Can All Patients Recover from their Eating Disorder? 3

Recovered Patients as Guides and Role Models 3

Content of the Book 3

A Book for Both Clinicians and Clients 4

How Therapists and other Professionals may Use this Book 4

How Eating Disorder Patients may Use this Book 5

How Parents, Partners and Friends may Use this Book 6

1 Problems in the Period before the Eating Disorder 7

Introduction 7

Lack of Self-Esteem and Negative Self-Evaluation 8

Compliant and Pleasing Behaviour 8

Hiding Real Thoughts and Opinions from others 9

Sensitivity to the Needs of others 10

Perfectionism and Fear of Failure 11

Inner Criticism and Negative Self-Evaluation 11

Impaired Identity Development 12

Stages in the ego and identity development 13

Negative Body Attitude 13

Questionnaire about problems in the period before the eating disorder 14

Questions about problems and risk factors 15

Summary 15

2 First Stage: Extreme Dieting 17

Introduction 17

How does an Eating Disorder Start? 17

Differences Between Healthy and Extreme Dieters 19

Questions about your reasons for going on a diet 19

From Healthy to Extreme Dieting 20

Questions about your dieting patterns 21

Why Continue Dieting? 22

Eating Disorder or Identity Disorder? 23

Control over Food and Body 24

Denial of Problems 25

Summary 26

3 Negative Consequences of Eating Disorders 27

Introduction 27

Losing Control over Eating Habits 27

The Trap of Extreme Dieting 29

Eating Disorder: From Friend to Enemy 29

Rigid Rules and Obsessive-Compulsive Behaviour 30

Indoctrination and Brainwashing 31

Inner Criticism and Critical Voices 32

The Toxic Effects of Starvation 35

Depression and Suicidal Thoughts 36

Questionnaire about psychological consequences 37

Isolation 38

Questionnaire about social consequences 39

Physical consequences 39

Questionnaire about physical consequences 41

Summary 42

4 Turning Point and Motivation for Recovery 43

Introduction 43

The Deep Pit 44

Turning Point 45

Ambivalent Motivation for Change 47

Fear of Asking for Help 48

Questionnaires to Improve Motivation for Treatment 50

Questionnaire about improving eating habits 50

Motivation for Physical Recovery 51

Questionnaire about motivation for physical recovery 51

Motivation for More Self-Esteem 52

Questionnaire about motivation for more self-esteem 52

Motivation for a more Positive Body Attitude 52

Questionnaire about motivation to improve body attitude 53

Motivation for Better Emotion Regulation 53

Questionnaire about motivation for better emotion regulation 53

Motivation for Better Social Relationships 54

Questionnaire about motivation for improving social relationships 54

Motivation for Reducing Financial Problems 55

Questionnaire about motivation for reducing financial problems 55

Summary 56

5 Normalizing Eating Habits 57

Introduction 57

Overcoming the Fear of Increasing Food Intake 58

Changing Cognitions about Food 60

Three Regular Meals a Day 62

Regular Mealtimes 63

Reduction of Binges 64

Reduction of Purging 66

Healthy and Sufficient Food 68

Reduction of Laxatives, Diuretics and Slimming Pills 69

A: Stopping the laxatives immediately 69

B: Gradual reduction of laxatives 70

Drinking Water and other Liquids 70

No Extreme Exercising 71

Treatment of Comorbidity 72

Questionnaire about improving eating habits 72

Summary 73

6 A Positive Body Attitude 74

Introduction 74

Not Feeling Fat 74

No Longer Obsessed by Food and Weight 76

Being Able to Listen to Feelings of Hunger and Satiety 77

Developing a Positive Body Attitude 79

Assignment: Focus on positive aspects of your body 81

Assignment: Positive body evaluation 81

Learning Defence Strategies against Teasing 82

Assignment: Defence against teasing 83

Losing the Urge to Diet 84

Assignment: Strategies to feel better 85

Questionnaire about a better body attitude 86

Summary 86

7 Physical Recovery 88

Introduction 88

Normal and Stable Weight 88

Regular Periods 90

Normal Body Temperature 91

Normal Heartbeat and Pulse 91

No Anaemia 92

No Constipation 93

No Problems with Bowels and Stomach 94

No more Swollen Salivary Glands and Sore Throat 94

Healthy Skin 95

Healthy Teeth 95

Enough Sleep 96

Enough Energy 97

Reduction of Osteoporosis 98

Questionnaire about physical recovery 99

Summary 100

8 Developing More Self-Esteem 101

Introduction 101

More Self-Esteem 101

Assignment: Training positive thinking 103

Empowering Yourself 104

Become More Assertive 104

Assignment: Becoming more assertive 105

Less Emphasis on Pleasing others 106

Having Less Fear of Rejection 107

Assignment: Defending yourself against critical comments 108

Showing Less Compliant Behaviour 108

Assignment: Listening to one’s own feelings and desires 109

Having Less Perfectionism and Fear of Failure 110

Questionnaire about improving psychological well-being 111

Summary 112

9 Expressing Emotions 113

Introduction 113

No Longer Avoiding Negative Emotions 114

Assignment: Feeling and expressing emotions 115

Reduction of Critical Thoughts and Inner Voices 116

Assignment: Defence against inner critical thoughts 118

Assignment: Developing ideal compassion image and feelings 119

Recognizing and Expressing Emotions 120

Dare to Express Different Opinions 122

Assignment: Coping with different opinions and conflicts 123

No Longer Feeling Depressed 124

Questionnaire about improving emotion regulation 126

Summary 126

10 Improving Social Relations 127

Introduction 127

Learning to Trust other People 128

Participating in Social Activities 129

Education and Career 131

Intimate Relations 134

Pregnancy and Children 136

Questionnaire about developing better social contacts 137

Summary 137

11 The Most Important Questions and Answers about Recovery 139

Introduction 139

When have Eating Disorder Patients Recovered? 139

How many Patients Recover from their Eating Disorder? 140

Why do Not All Patients Recover? 141

How can the Recovery Rate Increase? 142

Do All Patients have a Relapse? 142

How long does it Take to Recover from an Eating Disorder? 143

What are the Important Goals for Treatment? 144

Which Treatments are Most Effective? 144

What Makes a Good Therapist? 145

Summary 146

12 Checklist for Full Recovery 148

Introduction 148

A. Questionnaire about healthy eating habits 148

B. Questionnaire about positive body attitude 149

C. Questionnaire about physical recovery 149

D. Questionnaire about psychological recovery 150

E. Questionnaire about coping better with emotions 150

F. Questionnaire about better social relationships 151

Conclusion 152

References 153

Index 159