Eating disorders are psychological conditions characterized by severe disturbances in eating habits and an individual's relationship with food and their body. These disorders can have serious consequences for health, both physical and mental.

The most common eating disorders include:

1. Anorexia Nervosa
   • Characteristics: Extremely restricted food intake, intense fear of weight gain, and distorted perception of body weight or shape.
   • Physical Symptoms: Severe weight loss, exhaustion, loss of menstruation in women, dry skin, weakness, and bone problems.
   • Behaviors: Excessive exercise, strict calorie control, avoidance of food.
2. Bulimia Nervosa
   • Characteristics: Repeated episodes of binge eating followed by "purging" behaviors, such as vomiting, using laxatives, excessive exercise, or fasting.
   • Physical Symptoms: Weight fluctuations, throat inflammation and pain, tooth erosion from frequent vomiting, swelling of the salivary glands.
   • Behaviors: Secrecy, excessive preoccupation with food and body weight, cycling between food restriction and binge eating.
3. Binge-Eating Disorder
   • Characteristics: Repeated episodes of binge eating without subsequent purging behaviors. The individual consumes large quantities of food in a short period and often feels unable to control their behavior during these episodes.
   • Physical Symptoms: Weight gain, health problems related to obesity, such as diabetes and cardiovascular diseases.
   • Behaviors: Shame or guilt after binge eating episodes, eating in secrecy, mood swings.

4. Orthorexia Nervosa

• Characteristics: Pathological obsession with healthy eating. Although orthorexia is not officially recognized as a disorder by the DSM-5, it is an emerging topic that involves excessive fixation on food quality and the "purity" of one’s diet.
• Behaviors: Avoiding specific foods or food groups deemed unhealthy, social isolation due to strict dietary rules.

5. Obesity with Psychological Symptoms

• Characteristics: While obesity is not considered a psychiatric disorder in itself, it may be associated with disordered eating habits and psychological disorders such as depression or anxiety. It often coexists with other eating disorders, like binge-eating disorder.

6. Avoidant/Restrictive Food Intake Disorder (ARFID)

• Characteristics: Avoidance of foods or limited food intake that is not related to body image or fear of weight gain. It often begins in childhood and may be due to sensory sensitivities, aversion to certain foods, or fear of choking or vomiting.
• Physical Symptoms: Malnutrition, weight loss, developmental problems in children.
• Behaviors: Avoiding foods that cause discomfort, selective eating.

7. Other Specified Feeding or Eating Disorder (OSFED)

• Characteristics: This category includes eating disorders that do not meet all the criteria for other disorders but are serious enough to require clinical attention. Examples include atypical anorexia (where weight remains normal despite significant restrictive eating) and subclinical bulimia.

8. Pica and Rumination Disorder

• Pica: Consumption of non-food substances, such as dirt, ice, or paper, for at least one month.
• Rumination Disorder: Repeated regurgitation of food that has already been consumed, which the individual may either re-swallow or expel.

Conclusion

Eating disorders require careful diagnosis and treatment, which often includes a combination of psychotherapy, nutritional education, and, in some cases, medication. These disorders can have serious impacts on health and quality of life, making timely intervention critical for recovery.

Key Elements of the CBT Treatment Protocol for Eating Disorders

• Assessment and Development of Therapeutic Alliance
  Initial Assessment: Therapy begins with a detailed evaluation of the nature and severity of the eating disorder. The therapist examines current eating habits, purging behaviors, thoughts related to food, weight, and body image, as well as any comorbidities, such as anxiety or depression.
  Therapeutic Alliance: Establishing a strong therapeutic alliance is critical, as it enhances patient collaboration and trust in the treatment.

• Education and Understanding of the Disorder
  Psychoeducation: The therapist provides psychoeducation regarding the eating disorder, explaining the cycle of the disorder (e.g., restrictive dieting → binge eating → purging or guilt). Understanding these mechanisms helps the patient realize the connection between their thoughts, feelings, and behaviors.
  Goal Setting: The therapist and patient set realistic and achievable goals to address symptoms.

• Establishing a Stable Eating Pattern
  Nutritional Stabilization: The therapist helps the patient develop a regular and balanced meal plan to stabilize eating habits and prevent binge eating or purging. Patients are encouraged to consume three main meals and two snacks daily.
  Food Diary: The patient may keep a food diary to track meals, thoughts, and emotions related to food. This helps identify dysfunctional patterns and target specific behaviors.

• Recognizing and Changing Dysfunctional Thoughts
  Cognitive Restructuring: The therapist works with the patient to recognize and challenge dysfunctional thoughts and beliefs related to food, weight, and body image. The goal is to replace these thoughts with more realistic and functional ones.
  Exploring Core Beliefs: The therapist and patient may explore deeper core beliefs, such as the need for perfectionism or low self-esteem, that contribute to the development and maintenance of the disorder.

• Addressing Dysfunctional Behaviors
  Avoiding and Eliminating Purging Behaviors: For disorders like bulimia, the protocol includes strategies for reducing and ultimately eliminating purging behaviors (e.g., vomiting, use of laxatives). This may involve delaying purging or developing alternative ways to manage anxiety.
  Exposure with Response Prevention: This technique may be used to address urges to binge eat or purge by exposing the patient to situations that trigger these behaviors while preventing the typical response.

• Developing Coping Skills and Stress Management
  Stress and Emotion Management: Patients learn techniques for managing stress, negative emotions, and urges without resorting to binge eating or other dysfunctional behaviors. These techniques may include relaxation, mindfulness, and deep breathing.
  Behavior Replacement: Patients are trained to replace dysfunctional behaviors (such as binge eating) with healthier behaviors, such as physical activity, social interactions, or creative hobbies.

• Maintenance of Change and Relapse Prevention
  Relapse Prevention Strategies: Therapy focuses on reinforcing positive changes and developing strategies to prevent relapse. Patients are encouraged to recognize signs that may indicate relapse and apply the skills learned in therapy to stay on track with recovery.
  Long-Term Support Planning: The therapist helps the patient develop a support plan, which may include integrating CBT into their daily life and continuing therapy or participating in support groups.