Eating Disorders Myths Busted - Myth #9: Eating Disorders are for Life
In this ninth in a series of videos debunking nine myths about eating disorders, Cynthia Bulik, Ph.D., of the University of North Carolina, explains that eating disorders are treatable. The video was excerpted from a talk, "Eating Disorders Essentials: Replacing Myths with Realities," presented at the NIMH Alliance for Research Progress Winter Meeting, February 7, 2014 in Rockville, MD.
>>Bulik: So the ninth myth is that eating disorders are for life. And this gets a little complicated because some people do prefer, and this is a patient preference, to say that they are in recovery, sort of forever, to keep them vigilant about slipping or relapsing again. And I
think it's really important to validate and respect that patient preference. But the data show that eating disorders are not for life--so eating disorders are treatable. Recovery can and does
occur every age. For anorexia nervosa, nutritional rehabilitation and weight restoration are essential but only the first step in treatment. I know we have some family-based therapy advocates in the room. Whether your intervention is through family-based therapy or through in-patient re-feeding, the single most important thing to do is to get weight back on a patient first because their brains aren't working. You could do a lot of psychotherapy and get nowhere--you're just spinning your wheels in the mud because their brains simply aren't
working. I'm going take a little aside here because I didn't say it before and I want to make sure I do. I want to go back to the danger of that first diet. The reason it’s dangerous is that we all respond to negative energy balance or not eating enough food--being hungry--differently. Most of us when we’re hungry find that a really aversive experience. You might get more irritable, you might get a headache, you start foraging and looking around for
food, you might have difficulty making decisions because you're so hungry you don't know what to eat—it is not pleasant. People who have or who are vulnerable to developing anorexia nervosa: When they go on that first diet, they find it calming. So at baseline they're very
dysphoric and anxious and miserable. And it's the food deprivation that calms them. And so throughout their life, what they have to be really careful of is when they go through periods of stress again, falling back into that restriction trap because it gives them--it's like a drug, it's like a calming drug and that’s their high risk for relapse. Figuring out the neurobiology of what makes food restriction reinforcing for them is a gold mine when it comes to understanding anorexia nervosa. Third thing: Cognitive behavioral therapy works well for bulimia nervosa and for binge eating disorder. No medications have been shown to be effective in the treatment of anorexia nervosa—the only FDA-approved medication we have is fluoxetine or Prozac for bulimia nervosa. No other meds for any of the eating disorders. And, in part, that's because we don't understand the underlying biology of the illness. Hopefully by doing this genetic research we might be able to unlock some new pathways that will help us understand the neurobiology of anorexia, bulimia, and binge eating disorder and eventually lead to new drug targets. Medication can and does play a role in the treatment of bulimia and binge eating disorder but short term. It doesn't lead to long-term effects from what we know so far. Psychotherapy does seem to give people the tools to be able to keep their behavior under control in the long run. And finally individuals with eating disorders can thrive after recovery.