Eating disorders and obesity

The majority of patients with eating disorders are female. Most of those seeking treatment for weight loss are also women. Our culture views slenderness as beautiful, creating pressure to be thin. For some, however, the pursuit of thinness may be a way to avoid difficult developmental tasks, increase self-acceptance or get approval from others. Whatever its purpose, seeking slimness can lead to health problems as a result of starvation, binging and purging, or rapid cycles of weight loss and gain. Starvation and the binge-purge cycle themselves also create psychological problems. In this article, the etiology, maintenance and treatment of anorexia nervosa and bulimia are discussed from a cognitive-behavioral perspective. Attention is given to the interplay of physical, psychological and behavioral aspects of these disorders. Although obesity is a physical condition, not an emotional disorder, many women are distressed over their size due to the influence of cultural demands for thinness. The psychotherapist working with weight control may face the dilemma of whether to help a woman accept herself at her size or lose weight. Some guidelines for making a decision are discussed. Cognitions impeding weight loss are identified, and advances in cognitive-behavioral weight loss treatment are discussed.Jill Bresler is a psychologist in private practice and is on staff at the Institute for Rational-Emotive Therapy, New York City