Recovery from Eating Disorders: A Guide for Clinicians and Their Clients

Recovering from eating disorders such as anorexia and bulimia nervosa is a long and difficult process, which Recovery from Eating Disorders charts through the testimony of former patients who have battled these conditions – and won. Full of insight and personal revelation, these case histories exemplify above all else that full recovery is possible. Aimed at readers on both sides of the clinical process, whether patients or health professionals, the guide provides a detailed survey of successful approaches to tackling eating disorders, showing how these contribute to finely calibrated strategies for physical, psychological and social recovery. It includes material covering every stage of the eating disorder cycle, from warning signs to the conditions that sustain the improvements in health and quality of life that are in each case so hard–won.

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

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).

"Overall, this is a very readable book that will be useful to both early–career and experienced clinical psychologists who want to develop strategies for their clinical work and understand the service–user position whilst benefitting from up–to–date research and developments in the eating disorder field."   ( The British Psychological Society , 1 August 2013)