Get Real About Eating Disorders

If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

By Kelly Brownell, PhD
WebMD Weight Loss Clinic - Live Events Transcript
Event Date: Tuesday, March 1, 2005

MODERATOR: Welcome to WebMD Live, Dr. Brownell. Anorexia, bulimia, binge eating -- all are serious health problems, yet there are those who still look at these behaviors as phases or lifestyle choices. Could you please comment?

BROWNELL: These are serious disorders indeed, and while it is true that some people get over them on their own, often it is the case that people need help from the outside. The eating disorders are not only important medically, but can seriously disrupt a person's day-to-day life and affect their happiness as well as their health.

MEMBER QUESTION: I have been struggling with bulimia for over 10 months now. I am an active member of the boards on WebMD and I read story after story of others like me. But I don't really know how my condition compares to others (I generally binge/purge between 2 and 6 times daily). I know any eating disorder behaviors should be cause for concern, I just don't know how deep I am in. So my question is: how do you classify eating disorders, specifically bulimia, as far as severity is concerned?

BROWNELL: By any diagnostic criteria, you have an eating disorder. Severity can be defined by a number of different factors, but when all is said and done, if you are engaging in behaviors that can be harmful medically and psychologically, and have been unable to stop them on your own, help from a therapist is in order. It is important to seek out someone expert on the treatment of eating disorders, so you do not just get general therapy help. The good news is that treatments for bulimia can be quite successful. I suggest you go to the web site of the National Eating Disorders Association (NEDA) for helpful information on how to find a therapist.

MEMBER QUESTION: My daughter has bulimia. She is in therapy but does not seem to be improving. She says she knows this is life threatening, but does she really? How can I help her? I am very afraid.

BROWNELL: If a person sees a therapist and does not improve it could be that the problems are very difficult, the person with the problems is resisting change, or the right therapy is not being applied. In the case of eating disorders, there are scientifically proven treatments, but a small number of therapists use them. It is important, therefore, to seek out someone who knows the proven therapies and will use them. I suggest contacting the NEDA web site as mentioned above. I cannot comment on the therapy your daughter is receiving, of course, but it is perfectly within your right to get different help if your daughter is not improving. Good luck!

MODERATOR: That web site is www.nationaleatingdisorders.org.

MEMBER QUESTION: What are some of the scientifically proven treatments for eating disorders?

BROWNELL: There are two proven treatments. One is called cognitive behavior therapy, and the other is called interpersonal therapy. In controlled studies, these two have about equivalent effects.

Medication can be helpful for some people, but is usually a second line of intervention unless there are other reasons (like serious depression) for using a drug.

It is perfectly reasonable when one seeks therapy to ask the therapist whether they are truly knowledgeable in using one of these therapies. If the therapist is not expert in these therapies, calling around to the local university psychology departments or the psychiatrist departments in the local hospital may turn up some names.

I'm very happy you asked this question. It is one of the most important questions that could be asked.

MODERATOR: Would you recommend any therapy for family members dealing with someone with eating disorders? Would it be of benefit to the one being treated for eating disorders?

BROWNELL: Especially for younger people with eating disorders, the family is nearly always involved, at least to some extent. Families can be extremely helpful in the process, but it depends in part on the family relationships and the approach the therapist is using.

If you have a family member in treatment, I would discuss with the person being treated and the therapist how you and other family members can be most helpful. Then make yourself available in any way possible. Just the fact that you're eager to help is a good sign and suggests a solid relationship that a person can draw upon for strength. The therapist can help channel that goodwill to specific behaviors and attitudes that might be struggling with the eating disorder.

MEMBER QUESTION: Would you please talk a little bit about the underlying causes for eating disorders?

BROWNELL: There are a number of causes. As scientists we cannot be entirely certain what the cause is for any person. There are certainly biological vulnerabilities. Studies have shown that an individual who has family members with an eating disorder is more likely to have one, but of course environment is involved as well. Scientists have investigated different family environments and psychological variables such as perfectionism in an attempt to see what makes certain individuals vulnerable to the eating disorders. The most likely scenario for any individual is that a variety of factors interact to create an eating disorder. It is also the case that treatments seem to be helpful to people no matter what the cause of the disorder. Hence, it is impossible to find a specific cause for most eating disorders but we do know that individuals benefit from proven treatments.

MEMBER QUESTION: Is too much exercise considered a problem? My friend said overexercising is a type of bulimia.

BROWNELL: Exercising to excess can be one form of purging. But exercise, of course, is also a healthy behavior. One needs to know when the line is crossed and normal healthy exercise becomes obsessive, preoccupying, and potentially harmful to one's health because of injuries.