Mental health disorders are less stigmatized than ever before; widespread, effective help in the form of counseling and medicine are available for treatment. Conditions like anxiety and depression affect millions of people across all demographics, and though they are chronic, treatment is often achievable through applying the right mixture of medication and therapy.
These conditions also often co-occur with other, more dangerous disorders, and among these are eating disorders. While bulimia nervosa and anorexia nervosa are not the only eating disorders, they affect more people than is commonly thought, affecting at least .5% and 5% of the world’s population, with certain demographics having an even larger incidence. One of the most troublesome aspects of eating disorders is that they include mental health difficulties with comorbid physical health decline. Finally, they often manifest in conjunction with anxiety or depression, creating a complex presentation that requires a robust and detailed treatment plan.
One of the most successful treatment plans for many mental health disorders is cognitive-behavioral therapy, which reframes how we think in order to better address disordered thoughts and behaviors. In conjunction with this type of treatment, the practice of mindfulness has become increasingly useful to help keep triggers within context, thus leading to less maladaptive eating behaviors.
What Are Eating Disorders?
Eating disorders are mental health conditions that are typified by maladaptive eating habits and rituals. In many cases, eating disorders manifest as a result of trauma or a need to gain control over something when everything else in the life of the patient seems out of their ability to direct. In particular, patients who suffer from PTSD or anxiety as a result of neglect, abuse or a profound trauma are significantly more likely to suffer from a concurrent eating disorder.
There are two eating disorders most recognized by the general public — anorexia nervosa and bulimia nervosa — but there are others as well, including binge eating disorder and eating disorders otherwise not specified. The key component of all of them, however, is the use of ritualized eating behaviors to cope with underlying psychological distress. These can be exceedingly complex, or extremely simple, but they usually revolve around restricting food,purging it after eating, and/or binge eating episodes.
Common behaviors regarding food with anorexia nervosa are:
- Avoiding mealtimes with other people
- Sudden restriction on certain food groups, or an uncharacteristic adherence to a specific diet (veganism, low carb, etc.)
- Preoccupation with one’s body and weight, especially in a negative light
- Development or increase in body-critical self-talk
- Moodiness and isolation
- Avoiding eating in general
- Uncharacteristic increase in exercise, especially when done to excess (multiple sessions in a day, multi-hour stretches of exercise)
Behavioral changes characteristic of bulimia nervosa are:
- Hiding food wrappers or boxes
- Only eating when alone, or in extremely select company
- Periods of extreme caloric indulgence, especially when followed by long periods in the bathroom. These binge eating episodes may also be followed by periods of expressed guilt or depression, whereas the binge period will be more manic.
- Moodiness, isolation or a dramatic shift in peer groups
Physical Results of Eating Disorders
Anorexia nervosa sufferers often do not sleep well, fight off infections or heal easily. They will often be unable to maintain what is considered an appropriate weight for their age and height and will often complain of being cold. There are often marked periods of syncope and fainting, and other effects associated with malnutrition. Additionally, people with anorexia nervosa may have poor circulation, and their hair is prone to thinning or even falling out.
Bulimia nervosa patients, however, are less likely to exhibit malnutrition traits. Their body weight might remain constant, but the physical traits of bulimia are specific and not shared with anorexia, including:
- Calloused fingertips from inducing vomiting
- Worn, yellowed teeth and enamel from vomiting
- Syncopal episodes from electrolytic imbalance, due to laxative use or regurgitation
- Hoarseness or complaints of sore throat
- Enlarged salivary glands
Because of the interaction between dangerous physical symptoms and concurrent emotional and psychological concerns, treating eating disorders requires a well-designed plan. Often there is a collaboration between a dietitian, physician, and counselor, among other professionals. In particular, group and one-on-one therapy, especially with cognitive-behavioral methods, are considered the gold standard for treating eating disorders.
Mental Health Disorders that Often Occur with Eating Disorders
Anxiety and depression are the most common psychological disorders that manifest alongside eating disorders. It can be difficult to distinguish the effects of the eating disorder on mood and behavior from those that occur from anxiety and depression. This is why therapy should include the perspective of counselors trained in treating both eating disorders and other mental health disorders.
Eating disorders can also arise out of a maladaptive coping mechanism for already-present anxiety or depression. For instance, a child that is neglected in their youth might develop depression in their teen or young adult years. The rituals or volume by which food is consumed can be used as a way to cope with psychological distress.
Binge eating disorder is common among people suffering from PTSD and anxiety. The binge period reduces negative emotional states by engaging in the pleasant behavior of eating. As stated before, however, the incidence of eating disorder in patients suffering from PTSD — across all types of eating disorders — is remarkably higher than those in the general population.
Substance abuse disorders are also very common among people who engage in binge eating episodes, as with binge eating disorder and bulimia nervosa.
Treating these concurrent disorders is often a matter of determining the origin of both disorders. If the eating disorder manifested out of maladaptive coping mechanisms for a pre-existing anxiety disorder, then the root of the anxiety disorder should be solved first.Confronting the cause of their mental health conditions is often difficult, especially for people used to hiding their behaviors, which is common among people with eating disorders. This is why mindfulness is an effective approach to treating not just mental health disorders, but eating disorders specifically.
How Can Mindfulness Benefit Mental Health Treatment?
In broad terms, mindfulness has its roots in contemplative religious practice, like meditation in Buddhism, but in therapeutic practice, it’s typically not faith-based. The goal of mindfulness is to place cognitive distance between emotions and actions. For instance, through mindfulness, a person may have a small space of judgment between a triggering event and an urge to binge eat as a coping mechanism. At that moment, they can evaluate the urge – and it becomes a choice to engage with the maladaptive behavior or not. It’s also a matter of being able to step back and observe how our environment, social groups, and loved ones play a role in our coping and developing mental health problems.
Mindfulness incorporates breathing and meditation to teach practitioners how to evaluate — without judgment — feelings, emotions, and impulses that arise. By using observation, description and participation skills, the patient can ground themselves in the moment. Evaluating triggers without engaging them and without impulsively reacting to them makes a positive response more likely.
Using mindfulness techniques along with CBT makes treatment more effective and more likely to result in eating disorder recovery, as mindfulness can be practiced by the individual away from therapy. Mindfulness also allows them to view the interaction with their counselor in a less defensive manner, making the therapist an ally, even when they challenge the maladaptive behaviors.
Most germane to anxiety, mindfulness practice can contextualize events that occur and prevent catastrophic thinking or worse, panic attacks. The same benefit of observing impulses and emotions as they arise, however, can be used beneficially alongside cognitive behavioral therapy as treatment for many other disorders as well.
How Can Mindfulness Help with Eating Disorders?
Mindfulness training as we’ve discussed is particularly useful in identifying afflictive emotions and dealing with them without judgment. Some ways that mindfulness practice can help with eating disorder recovery are:
- Reduction in stress by learning better, more effective ways to cope with triggers. A person who turns to restrictive or binge-eating habits when confronted with stress can use mindfulness to reduce the impact that triggering events or situations have on them. Additionally, they can turn inward using meditative practice and breathing techniques to reduce the physical symptoms of stress that can cause disordered eating. Dealing with a panic attack before it arises can prevent a binge-eating episode or a week-long fast.
- Mindful eating is a way of evaluating not just what but why we’re eating. A person who practices mindfulness will have the space to stop themselves and ask if they’re eating (or avoiding eating) due to physiological hunger cues or because they’re frightened or anxious. Mindful eating also helps the patient understand that food is neutral; it’s neither bad nor good and their relationship with it doesn’t need to be rigidly controlled or worrisome.
- The ability of a mindful person to step back and evaluate their triggers and impulses allows them to better see the root of their conditions, which is exceptionally helpful during therapy. A person who can observe their actions and thoughts without guilt or judgment will find it easier to ignore maladaptive impulses, like disordered eating. They will also be more likely to engage fruitfully with their therapist.
Mindfulness has a lot to offer a person with mental health disorders, especially those who suffer from eating disorders. The next step is to incorporate it into a therapy plan.
Finding a Way Forward
As we discussed before, eating disorders have layers of complexity, and often involve other mental health conditions, like anxiety, PTSD and depression. Though mindfulness and cognitive behavioral therapy can help, a multi-faceted approach with a team of professionals working together is the best method for recovery.
Studies have shown that day treatment therapy at a treatment facility is a much better indicator for recovered patients to prevent relapse or difficulty integrating into “real life.” Treatment centers have medical staff, dietitians, personal trainers and therapists who are all specifically trained to handle eating disorders. Day treatment therapy has a higher success rate than hospitalization, especially when coupled with an aftercare program and mindfulness practice.
For many patients, simply starting mindfulness training is enough to increase their desire to seek help. Additionally, mindfulness can stem the progression of an eating disorder from mild to severe, especially when combined with therapy. Every advantage in the fight against eating disorders should be utilized, and mindfulness can be the key that unlocks a bright tomorrow for you and your loved one.