Eating Disorder Treatment: Where to Start and What to Expect
by Laura Fewell, B.A.
Choosing an eating disorder treatment program can be overwhelming, especially when you are not sure exactly which treatment (if any) you need. Outpatient? Intensive treatment? A therapist, dietitian, or other specialist? And how exactly do you know if you have an eating disorder or disordered eating? If the thought of receiving eating disorder treatment feels overwhelming or too foreign to consider, read on below for helpful information on where to start and what to expect from treatment.
First things first: Do I have an eating disorder (or disordered eating)?
How do you know if your eating behaviors are problematic or maybe just a bit eccentric? One question to ask yourself is if your thoughts about your weight, shape, or eating habits interfere with your life (such as making you feel bad about yourself or preventing you from going out with others). Another is to pay attention to how you feel before or after eating—do you feel anxious, guilty, or upset? Other signs or symptoms of disordered eating include:
If you can relate to any of these statements, you may consider talking to an ED professional. You can also access online screenings through trusted websites such as NEDA http://screening.mentalhealthscreening.org/NEDA or McCallum Place Eating Disorder Treatment Centers https://www.mccallumplace.com/do-i-have-an-eating-disorder.html.
I might have an eating disorder—now what?
If you think you might struggle with an ED or disordered eating, the best thing you can do for your health and well-being is reach out to a professional. You can start by talking to a therapist, dietitian, psychologist, or psychiatrist with experience in EDs about your concerns. Research shows that if you have an eating disorder you will have the best chance of recovery if you are treated by a professional who is an eating disorder specialist. It is a good idea to ask about their ED experience or to find someone with a CEDS designation (Certified Eating Disorder Specialist). Although many professionals are willing to work with EDs, they are not all ED experts. Most ED professionals will recommend treatment options, such as going to regular outpatient appointments or looking into a higher level of care, like day programs or residential treatment. Some ED treatment centers offer free assessments and provide recommendations for levels of care to fit your needs. You can find ED referrals through the National Eating Disorders Association (http://www.nationaleatingdisorders.org/find-help-support), Eating Disorder Hope (https://www.eatingdisorderhope.com/treatment-for-eating-disorders/therapists-specialists), or by contacting Dr. Cheri Levinson at email@example.com.
Eating disorder treatment: What to expect
If you find that you need more than outpatient ED treatment (or a professional suggests you need a higher level of care), you may be referred to a day program or a residential program. Though spending most of your day (or overnight) at a treatment center may seem overwhelming, most programs are designed to take place in a therapeutic environment and have the goal of integrating you back into your normal life as quickly as possible. Below are general components of treatment programs that you can expect.
Prior to treatment: Once you find a program that looks like a good fit, call the admissions or intake office to inquire about an assessment. They will schedule a time to ask you about your personal information and history and will likely ask you to see your doctor for a medical workup. They will also call your insurance provider and discuss what types and portions of treatment they are willing to pay. Once they get this information, they will make treatment recommendations and set up an admission date if necessary.
Day 1: Arrive at the treatment center and expect to fill out lots of paperwork. You will be introduced to treatment professionals, other clients, and staff. Staff will go over program guidelines with you and layout what the program will be like. This day will probably feel like a whirlwind! I advise our clients that the first couple of days are the most difficult—between new faces, a new environment, and the fear of the unknown, there are lots of factors that can make the first few days feel scary. Typically by the 3rd or 4th day, though, clients are used to the routine and begin getting to know their peers and the staff. Soon after, they begin developing bonds with others and learn to trust the treatment center as a safe environment comprised of people who care about them.
Weights: Most programs will collect weights regularly, such as daily or weekly. This can feel a bit awkward at first, but most people get used to it quickly. In fact, it is part of your treatment & recovery!
Treatment team appointments: Throughout treatment, you will meet with your treatment team regularly. Your treatment team will likely be made up of a therapist, dietitian, and doctor, all of whom will set up a treatment plan for you and work with you towards your goals.
Meals: This is often the most anxiety provoking component of treatment. People often wonder, “Will I be forced to eat or not be allowed to eat enough? What happens if I feel too anxious during meal times?” Rest assured that, while not always easy, you will be given a personalized meal plan that will be exactly what you need. Your dietitian will work with you to educate you on what types of meals and portions are best for you.
Groups: An important part of treatment is developing skills and insight that will assist you in recovery. There are a variety of therapeutic groups each day that take place outside of meal times. These often include skills and processing groups, nutrition, art, and other specialized treatment modules (like cognitive behavior therapy) that aid in the healing process.
Other components of treatment: Depending on the treatment center, there will be nurses and/or doctors on staff who are available if a medical issue comes up. Patient care staff are available if clients need something, such as using the restroom or just talking after a hard day. There may also be exercise specialists to help clients who struggle with unhealthy or limited exercise, and some programs even have specialists who help athletes seeking recovery from their eating disorder while training for their sport.
A sample day program schedule may include:*
9:30am: weights and vital signs obtained
10am: snack (if applicable)
3pm: snack (if applicable)
7:30pm: program ends
*During the day, treatment team members may meet with patients in place of attending groups.
Treatment discharge: As you progress through treatment and get your eating habits and health back on track, you will begin preparing for discharge. A good treatment team will help you make a plan for what you’ll do after treatment, and they should help you find outpatient professionals so you can continue care in a meaningful way. Though many people want to know how long they’ll be in treatment, it is hard to give an exact length of time because of the highly individualized components of care. Some people need a few weeks to get on track, while others require a longer treatment stay to reach their health goals.
Taking the next step
Deciding to seek help for an eating disorder or disordered eating is not easy, but it is worth it. There is hope out there! Below are a list of resources if you would like to begin your journey to recovery. You can also contact Dr. Cheri Levinson if you have questions or would like to discuss treatment options.
Dr. Cheri Levinson: firstname.lastname@example.org
National Eating Disorders Association: www.nationaleatingdisorders.org
Eating Disorder Hope: www.eatingdisorderhope.com
McCallum Place Eating Disorder Centers: www.mccallumplace.com
Why Being Perfect Isn’t Always What It Seems: The Link Between Eating Disorders
By: Leigh C. Brosof
We all know someone who is (or perhaps recognize within ourselves) a perfectionist: the person who gets good grades or excels at their job, is involved in a myriad of activities outside of school/work, and seems to never settle for anything but the best. This can’t possibly be a bad thing, right? While having high standards is not necessarily harmful, high levels of perfectionism can create vulnerability for certain problems to develop, especially in terms of disordered eating. In fact, perfectionism is recognized as a vulnerability factor for eating disorders.
In order to understand why perfectionism can be harmful at times, it is first important to define exactly what perfectionism is. Colloquially, perfectionism is defined as anything less than perfect being unacceptable, where being “perfect” means living up to standards of extreme excellence or not making any mistakes (Merriam-Webster, 2016). This is actually a pretty complex definition when you look at it, and that’s why perfectionism is defined in a slightly different way by researchers. Researchers view perfectionism as a multi-dimensional construct, meaning that it’s made up of multiple parts (Frost et al., 1990).
More specifically, perfectionism can be broken down into two parts: adaptive and maladaptive perfectionism (Hewitt, Flett, Turnbull-Donovan, & Mikail, 1991). Adaptive perfectionism is when an individual has high standards for themselves. Maladaptive perfectionism can also be called evaluative perfectionism. In this type of perfectionism, individuals become preoccupied over making mistakes, which then leads to self-critical evaluation. Whereas adaptive perfectionism is healthy because it pushes an individual to do his or her best and set high expectations (DiBartolo, Frost, Chang, LaSota, & Grills, 2004), maladaptive perfectionism is harmful because it means that nothing we do will ever be good enough and that we set unattainable standards for ourselves. This can obviously lead to disappointment and feelings of inadequacy.
So, how does this relate to eating? If an individual sets unattainable standards for themselves in all areas of their life because of perfectionistic tendencies, then this can lead to negative outcomes for mental health, such as anxiety and depression, as well as disordered eating attitudes and behaviors (DiBartolo, Li, & Frost, 2008). In fact, some research has linked a specific type of perfectionism to eating disorders (Bardone-Cone et al., 2007). This type of perfectionism is the excessive worry over making mistakes.
Researchers have proposed different theories as to why perfectionism may lead to eating disorders. For instance, some researchers have proposed that disordered eating behaviors manifest after an individual high in perfectionism internalizes the thin-ideal (or the societal belief that being thin is the ideal body type). This thin-ideal set by society, however, is unattainable. The pursuit of this impossible thin-ideal along with the self-criticism that accompanies maladaptive perfectionism might lead to disordered eating. Other theories suggest that perfectionism may lead to other negative outcomes, such as low self-esteem or fears of being judged by others based on appearance and that these outcomes then lead to disordered eating behaviors (Brosof & Levinson, 2017; Mackinnon et al., 2011).
Importantly, by better understanding how perfectionism relates to eating disorders, we now also know that we can create interventions to target perfectionism to help treat eating disorders. For instance, one type of treatment might be having a patient practice making mistakes to help them learn that making a mistake does not lead to terrible outcomes. We can also help prevent eating disorders by helping people already high in perfectionism through similar interventions.
It is important to remember that everyone makes mistakes and that making mistakes is normal! In fact, making mistakes is how you learn. It is also important to know that there is no such thing as a “perfect” body or a “perfect” diet. All of our bodies are different in order to do different things and need to be fueled according to our own needs. You are worthwhile person and you are good enough, no matter what. If you are or someone you know is struggling with disordered eating or other mental health problems due to perfectionism, there is help. We are currently offering a perfectionism group treatment, please reach out if you are interested in joining. You can also call the National Eating Disorder Association helpline at 1-800-931-2237.
Dr. Levinson is featured in a story on positive self-image, read the story here:
Listen as we discuss the research ongoing in the EAT lab:
https://soundcloud.com/uofl/12-05-16-uofl-today-ruther-levinson-brosof (starts at 17:20)
Reflections on the Eating Disorder Research Society and Association for Behavioral and Cognitive Therapies Meetings
Reflections on the Eating Disorder Research Society and Association for Behavioral and Cognitive Therapies Meetings
by: Cheri A Levinson, Ph.D.
The last weekend of October was a busy one, as I was attending two meetings at once! I had the chance to attend the Eating Disorder Research Society for the first time, as well as the Association for Behavioral and Cognitive Therapies. I left both conferences full of new ideas. Here are some of the highlights of what I learned:
Heather Thompson-Brenner presented work on disseminating the Unified Protocol for Emotional Disorders in a Residential Care Facility (for eating disorders). This work is really exciting because it suggested that targeting underlying emotional disorders may be an effective treatment in a residential level of care. I am not aware of much work identifying treatments that work in such a high level of care, let alone one that is targeting symptoms of multiple disorders. I am hopeful we will see more of this in the coming years.
Eric van Furth presented his work on the top research priorities for eating disorders identified by patients, carers, and families. Some of the top priorities were identifying if clinicians should target the eating disorder or the underlying problems first, comorbidity, and the development of personalized treatment (and see below on how we might develop these treatments). Dr. Furth also discussed his hope that funding agencies would pay more attention to what patients and carers asked for. I whole-heartedly agree. This type of research seems like a great starting point for identifying clinical research that is applicable and helpful to the people who are actually suffering from these problems.
Some other highlights from EDRS. Laura Berner presented her work showing that there are brain regions that are associated with feelings of loss of control eating, research was presented showing patients did better when randomly assigned to day treatment than to inpatient treatment, and Patrick Kennedy gave the keynote address urging eating disorder researchers to think more globally about connecting with other non-eating disorder groups.
Now on to ABCT. I didn’t get to spend as much time at ABCT, but there were two highlights that stood out to me. First, Robert Krueger presented his work showing how the level of analysis impacts how psychopathology is defined. At the broadest level all psychopathology clumps together, it then separates into two clusters (externalizing and internalizing) and then an OCD cluster emerges. And guess what falls into the OCD cluster? Eating disorders!
Last, Aaron Fisher presented work using ecological momentary assessment to develop personalized interventions. I had several discussions with other colleagues about this idea and I am really excited about the possibilities that might come from these methods. Let me explain using network analysis. If you assess symptoms say 100 times across several weeks, you can use this data to build an individual network of symptoms. You can then identify what symptoms may be of specific importance within the individual and develop treatments targeted at that symptom. Why am I so excited about this idea? Anorexia nervosa is a particularly heterogeneous disorder and I think this method might pave the way for personalized treatments specially designed for each individual.
All in all a great (two!) conferences. I’m already looking forward to next year.
Check out the Courier Journal article that Dr. Levinson helped with:
Network Models of Psychopathology Part II
by Benjamin Calebs, B.A.
Clinical Implications of Network Analysis
Network analysis can also help identify which symptoms might be most important to maintaining a mental disorder. If we can identify the most important symptoms of a disorder, then perhaps clinical interventions targeted at these symptoms could cause reductions in the severity of other symptoms in the network (Borsboom & Cramer, 2013; McNally, 2016). For example, if a client has symptoms of generalized anxiety disorder such as irritability, insomnia, and worry, network models suggest that it would be beneficial to target the core symptoms that are causally related to many others within the mental disorder. If clinicians were to target the symptom of excessive worry then this could reduce both the insomnia and the irritability arising from the insomnia. By targeting core symptoms in this manner, therapeutic interventions such as cognitive behavioral therapy could indirectly impact many other symptoms of a mental disorder.
Network analysis also affords researchers a deeper understanding of comorbidity (two or more disorders occurring at the same time) between different mental disorders (Cramer, Waldorp, van der Maas, & Borsboom, 2010). Many mental disorders are highly comorbid with other mental disorders. When mental disorders are conceptualized as networks of symptoms, researchers can look at the interaction between specific symptoms across disorders that may be contributing to the comorbidity. For example, researchers could look at a comorbidity network containing symptoms of both post-traumatic stress disorder and eating disorders to see how the disorders interact (see figure below from some exciting new work in our lab!).
Researchers could then look for core symptoms in a comorbidity network in the same way that one looks for such symptoms in a single disorder. Researchers can also look for symptoms that bridge the mental disorders to see how symptoms of one disorder might relate to the development of symptoms in other disorders (Borsboom & Cramer, 2013). If targeted clinical interventions are directed at the core symptoms or bridge symptoms in a comorbidity network then this could reduce symptoms across the different mental disorders.
Network models of psychopathology also have the benefit of allowing researchers to look at causal relationships between the different symptoms (Borsboom & Cramer, 2013; McNally, 2016). However, to actually determine causality one would need to gather longitudinal or experimental data. This is one of the exciting directions in which research on network models of psychopathology is headed. Researchers are beginning to develop ways of comparing networks across time to see how changes in the network structure of a mental disorder relate to changes in symptom severity (Beard et al., 2016; van Borkulo et al., 2015). As can be seen, network models of psychopathology have many benefits and open up exciting possibilities for both research and clinical practice.
Network Models of Psychopathology Part I
Benjamin Calebs, B.A.
The precise nature of mental disorders has often been debated within the field of psychology. In particular, psychologists have debated about whether mental disorders are socially-constructed or whether they are biologically-based like other medical diseases. One exciting new way to address this issue is the network approach to psychopathology (Borsboom & Cramer, 2013; McNally, 2016). This approach involves a reconceptualization of psychopathology that builds on insights from various perspectives on the nature of mental disorders.
However, before exploring where the field of psychology may be headed, it would be useful to start with a look at where psychology has been. This will be helpful for understanding and appreciating network models of psychopathology.
Categories versus Dimensions?
As was mentioned, psychologists have different theories about the nature of mental disorders. There has also been much debate about whether psychopathology should be measured using a categorical framework or a dimensional framework. A categorical conceptualization of psychopathology uses a cut-off score to define who has a mental disorder and who does not. In this framework, an individual either has or does not have a mental disorder. The problem with cut-off scores is that a cut-off can seem arbitrary and may not necessarily relate to the impairment that an individual experiences as a consequence of their symptoms of psychological distress. A dimensional conceptualization looks at mental disorders as sets of symptoms that many individuals experience to some degree but that some individuals experience more than others. For example, many people might get sad from time to time, but someone with depression would have this experience more days than not over an extended period of time. The dimensional approach highlights this inherent variability across individuals in symptoms that are associated with mental disorders.
Latent Variable Theory?
Interestingly both of these frameworks (i.e., the categorical framework and the dimensional framework) operate from a shared underlying theory that is often taken for granted. This theory is known as latent variable theory (Borsboom et al., 2016; Eaton, 2015; McNally, 2016). Latent variable theory is based on the idea that many mental disorders are latent constructs that are unobservable. This implies that mental disorders cannot be directly measured. However, researchers and clinicians can gather information about the symptoms associated with mental disorders, such as thoughts, feelings, and behaviors. For example, latent variable theory suggests that generalized anxiety disorder is not directly observable, but the symptoms of generalized anxiety disorder can be observed and measured. Clinicians and researchers use measures of observable anxiety symptoms like worry, insomnia, fatigue, and irritability to evaluate an individual’s level of anxiety. The number and severity of anxiety symptoms are used to identify clinically relevant generalized anxiety (Borsboom et al., 2016; Eaton, 2015).
Latent variable theories of mental disorders borrow the model of disease from the field of medicine (Borsboom & Cramer, 2013; Borsboom et al., 2016; Eaton, 2015). Following latent variable theory, a mental disorder is considered a disease that causes symptoms (e.g., generalized anxiety disorder causes insomnia and fatigue) in the same way that a physical disease causes physical symptoms (e.g., asthma causes coughing). However, there are some shortcomings associated with this understanding of psychopathology. It is unclear if there is a single underlying cause behind many mental disorders in the same way as exists for physical diseases. For example, it is known that coronary heart disease is caused by a build-up of plaque deposits in the coronary arteries and that this can, in turn, cause symptoms such shortness of breath and chest pain. Yet it is unclear if mental disorders behave in this same way. Also, the symptoms of mental disorders are considered independent of one another in latent variable theory. This means that it is assumed that the symptoms are unrelated to each other. Instead, symptoms are theorized to be associated because of their relationship to the underlying, unobservable mental disorder.
Networks of Symptoms?
Researchers in the field of psychometrics, which is the study of how psychological constructs are measured, have begun to apply a novel theoretical framework known as network theory to help understand psychopathology (Borsboom & Cramer, 2013; McNally, 2016). Network theory is an interdisciplinary field that studies anything that can be conceptualized as a collection of parts that are connected in some way. Network theory has been applied to a variety of domains. Network researchers have looked at everything from neural networks to food webs to economies. Network theory and analysis have often been applied to social networks with individuals acting as nodes in a network and the relationships between them serving as links. Network analysis can be used to study the structure of networks, as well as the dynamic interaction between the different nodes (Newman, 2003).
In the study of psychopathology, the symptoms are considered nodes and the correlations between them are considered the links. Mental disorders can then be conceptualized as a network of symptom nodes. For example, an eating disorder could be conceptualized as a network consisting of symptoms such as the fear of gaining weight, a strong desire to be thin, and dissatisfaction with one’s body shape (Forbush, Siew, & Vitevitch, 2016). Clinicians and researchers also acknowledge that mental disorder symptoms have the potential to interact, with symptoms of a disorder acting as the cause of other symptoms within that same disorder. For example, someone with generalized anxiety disorder could experience severe worrying. These worries could cause the person to lose sleep. This insomnia could, in turn, lead to irritability and fatigue as the individual is unable to get adequate rest (Borsboom & Cramer, 2013; Borsboom et al., 2016; Eaton, 2015). The different symptoms of a mental disorder are related, but some might be more related than others. Network analysis can help researchers better understand how the symptoms of which a mental disorder is composed are related.
Why do we care about these different models of psychopathology? Stay tuned for Part II where we discuss clinical implications of network analysis and show some of the work we’ve been doing in the EAT lab.
Eating Disorder Outcomes: Does Intensive Eating Disorder Treatment Help?
By Laura Fewell, B.A.
Eating disorders (EDs) are serious illnesses that can come in lots of different forms. Restricting food, binge eating, purging, and over-exercising can lead to severe health consequences, such as imbalanced electrolytes and metabolic disturbances, slow or irregular heartbeats, and severe low or high weight. In fact, anorexia nervosa has the highest mortality rate of any mental illness. Often times, EDs are also accompanied by severe anxiety and depression. Yet many people with EDs do not understand how serious the effects of EDs are, and they are not sure where to go or what to do for help. So what are their options? Where do people go for help? And does it work?
Many people with eating disorders can benefit from seeing a team of outpatient specialists, such as therapists, dietitians, and psychiatrists. Yet others need more intensive treatment with structured care and medical management, such as inpatient (24 hour treatment in a hospital), residential (24 hour treatment in a home-like facility), and partial hospitalization (day treatment programs, typically 6 to 10 hours a day). But the literature shows mixed outcomes from intensive treatment centers, and much of the available research has been conducted on small samples. As the research coordinator at an eating disorder clinic, I wanted to look at the outcomes in our population and share those with others.
Since 2012, I have been collecting data from our patients (in either residential or partial hospitalization programming) to get a better idea of what people with EDs experience, how clients progress throughout intensive treatment, and if clients are doing better after treatment. I also wanted to investigate factors that may contribute to relapse or success after treatment, such as anxiety or how long someone has had an ED. The measures I’ve used look at ED thoughts and behaviors, social impairment, worry, depression, quality of life, and change in weight. More recently, I’ve added in measures looking at obsessive compulsive traits and compulsive exercise (stay tuned for those results!).
We currently have data on over 500 patients, and together with Dr. Cheri Levinson, we analyzed the data to test my two primary questions. First, do patients with eating disorders improve? And then, what thoughts and behaviors are related to improvement? We found that patients have improved ED thoughts and behaviors, social impairment, worry, depression, quality of life, and change in weight after receiving intensive ED treatment. What’s more, patients continue to have improved symptoms as long as a year following treatment discharge. This is huge! This tells us that people who have serious EDs and go through intensive treatment can not only get their health back on track, but also see improvements in their mood and quality of life.
Next, we looked at what thoughts and behaviors are related to this improvement. We found that worry and depression were contributing to more eating disorder issues later on. We also found that when clients weren’t functioning at a high social level (for example, getting along with others or engaging in life activities), they were experiencing more eating disorder issues later on. So when worry, depression, and social functioning are focused on as part of ED treatment, clients are more likely to do better after treatment. To learn more about our results, stop by the ABCT Obesity and Eating Disorders Special Interest Group Poster Session on Friday, October 27th at 6:30pm! https://www.eventscribe.com/2016/ABCT/aaSearchByDay.asp?h=Full%20Schedule&BCFO=P|MCS|WK|AM|CIT|SS|CGR|CR|IP|LA|MP|MWK|PD|SYM|INS|SIG|RPD|PA
While there is still much to be learned in the world of EDs, we are encouraged to find our ED treatment is effective and can lead to improved lives for those who suffer from EDs. We will continue to collect information that informs ED treatment centers practices, but in the meantime, those who struggle with EDs can be comforted to know there is help out there.
If you or someone you know might struggle with an eating disorder, please reach out and talk to someone. Help can be found through the National Eating Disorders Association’s confidential hotline 1-800-931-2237. You can also reach out to Dr. Cheri Levinson at email@example.com or to McCallum Place Eating Disorder Treatment Centers at 800-828-8158.
Does dieting contribute to eating disorders?
by Leigh Brosof, B.A.
When was the last time you were on a diet? Most women (and men) have been on a diet at some point in their lives. When we think about dieting in mainstream culture, we often think about celebrities, about fad diets (such as Atkins or paleo), and about counting calories to lose weight leading up to a big event, like a wedding or prom. But is dieting unhealthy? How long do we have to stay on a diet for it to be “bad” for us? And what do we really know about how dieting impacts eating disorders? The truth is that the link between dieting and eating disorders is a lot more complex than we might think. Fortunately, recent research has gone a long way in trying to clear up exactly what dieting is and how it contributes to eating disorders.
Dieting has commonly been regarded as an important factor that may lead to eating disorders (Stice, 2002). Theoretically, dieting can lead to disordered eating behaviors in two ways: physiologically and psychologically (Polivy & Herman, 1985).
In order to really break down why dieting may be harmful, it is necessary to define dieting. Although the definition of dieting seems straightforward, there are actually a lot of different things that are often all called “dieting.” Here, we will define:
Research shows that this difference in definition is important. When people report that they are trying to lower the amount of calories they eat (i.e., engaging in dietary restraint), there is a relationship between dieting and disordered eating (Stice, 2002). However, when caloric intake is actually measured, dieting does not predict disordered eating. This indicates that dietary restraint, but not dieting, is what may be important in contributing to disordered eating.
Further studies have supported the idea that dieting might not necessarily be harmful. Some studies even show that dieting can actually lead to less eating disorder symptoms in some instances (Presnell & Stice, 2003; Stice, Martinez, Presnell, &Groesz, 2006; Stice, Presnell, Groesz, & Shaw, 2005). Additionally, other research has suggested that the relationship between dietary restraint and eating disorders may not be completely straightforward either. Many studies have found conflicting results, some indicating that dietary restraint may lead to disordered eating and others showing no relationship between dietary restraint and disordered eating (Stice, 2002). One study investigated these differences by reviewing many of the studies on dietary restraint and eating disorders and concluded that dietary restraint may not actually be harmful either (Schaumberg, Anderson, Anderson, Reilly, & Gorrell, 2016). Obviously, all of these mixed findings can be pretty confusing.
So, if this is the case, can we say anything about dieting and eating disorders? Why do some studies find that dieting (or dietary restraint) is harmful, whereas others do not? Some of the most recent research may have the answer: one study found that it is the type of dieting that may help to untangle the relationship between dieting and disordered eating (Elran-Barak et al., 2015). Extreme dieting, such as fasting, may tend to lead to disordered eating behavior, whereas less intense dieting, such as eating low calories meals, may not tend to lead to disordered eating.
Therefore, when thinking about dieting, it seems important to think about what kind of restriction is occurring. If a person is eating a smaller amount of calories but not overly restricting his or her food intake, it appears that it may not necessarily lead to harmful outcomes. On the other hand, if a person is not eating for many hours at a time and engaging in extreme behavior, then it may be a better indicator that it will lead to bigger problems with eating.
Of course, as discussed, there are a lot of different findings regarding dieting and eating disorders, and researchers will continue to try to investigate the link between the two. At the end of the day, what is most important is that we all eat to fuel ourselves for what our bodies need and to follow a balanced lifestyle. If you are ever worried about your own or a friend’s eating habits, please reach out and talk to someone. Help can be found through the National Eating Disorders Association’s confidential hotline 1-800-931-2237.