CBT for eating disorders, and how it can help build healthier relationships with food

Eating disorders are complex mental health conditions with multifaceted causes, including biological predispositions, psychological vulnerabilities, and environmental stressors1. Genetics, feelings of perfectionism, societal pressures, and emotional distress can all play a role in the development of disorders such as anorexia nervosa, bulimia nervosa, and binge eating disorder. 

In the UK alone, over 1.25 million people are affected by eating disorders2 – a stark figure that highlights the urgent need for effective treatment and support. Left untreated, these conditions can lead to severe physical health issues, emotional suffering, and fractured personal relationships.

Cognitive Behavioural Therapy (CBT) has long been used by clinicians as one of the most effective interventions for eating disorders. This evidence-based approach helps individuals identify and challenge distorted beliefs about food, body image, and self-worth, enabling them to develop healthier thought patterns and behaviours. 

By fostering self-awareness and providing practical tools for managing triggers, CBT addresses the root causes of disordered eating and promotes sustainable recovery. If you or someone you know is struggling, don’t wait to seek help – contact us today.

Exploring the most common eating disorders

Eating disorders exert profound implications for both physical health and psychological wellbeing3. 

They can arise from a multitude and combination of genetic predispositions, psychological stressors, and environmental influences, such as societal pressure to conform to unrealistic body standards4, fuelled in part by cultural tendencies around social media5. 

Yet; to understand these disorders fully, it’s beneficial to delve deeper into their physiological and neurological underpinnings, as well as their wide-ranging effects.

Anorexia nervosa

Anorexia nervosa is characterised by extreme calorie restriction, an intense fear of weight gain, and a distorted perception of body image6. 

It is often linked to dysfunction in the brain’s reward system, particularly involving the hypothalamus, which regulates hunger and satiety7. Neuroimaging studies have shown that individuals with anorexia experience altered dopamine signalling8, reducing their ability to derive pleasure from food.

Over time, the physical consequences of anorexia can be catastrophic. Severe weight loss leads to muscle wasting, including the heart muscle, increasing the risk of arrhythmias and heart failure. Bone density diminishes due to hormonal imbalances, predisposing individuals to osteoporosis at a young age9. In addition, cognitive effects include reduced concentration, memory impairment, and even structural brain changes, such as grey matter loss10, which can become permanent without timely intervention.

Bulimia nervosa

Bulimia nervosa is defined by cycles of binge eating and compensatory behaviours, such as purging, fasting, or excessive exercise. The neurobiology of bulimia often involves dysregulation of serotonin, a neurotransmitter that influences mood, appetite, and impulse control11 – this imbalance may explain the impulsive behaviours and emotional instability often observed in individuals with bulimia.

Physically, bulimia can negatively impact multiple systems. Purging behaviours can lead to chronic dehydration, electrolyte imbalances12, and damage to the oesophagus and stomach lining, increasing the risk of gastrointestinal perforations13. Frequent vomiting can erode dental enamel, causing irreversible dental decay14. Over time, these physical effects compound emotional distress, perpetuating a dangerous cycle of self-destructive behaviour.

Binge eating disorder

Binge eating disorder (BED) is characterised by recurrent episodes of consuming large amounts of food in a short period15, accompanied by feelings of loss of control and shame. 

BED has been linked to heightened activity in the brain’s amygdala, which processes emotional responses, and reduced activity in the prefrontal cortex, which governs impulse control and decision-making16.

The physical consequences of BED are both severe and long-lasting. 

Prolonged episodes of overeating can lead to obesity, increasing the risk of diabetes17, cardiovascular disease18, and liver dysfunction19. Additionally, like with other eating disorders, chronic binge eating typically places immense strain on mental health, contributing to anxiety, depression, and a diminished sense of self-worth.

Wider impacts and consequences

The effects of eating disorders extend beyond the individual, affecting families, caregivers, and communities. The social withdrawal and irritability commonly associated with these conditions strain relationships, isolating sufferers further. Moreover, untreated eating disorders often lead to co-occurring conditions, such as depression, substance abuse, or suicidal ideation.

At a societal level, eating disorders contribute to increased healthcare costs and lost productivity20. 

Early detection and treatment are important to help mitigate these far-reaching impacts. The most effective treatments address not only the physical symptoms of the individual, but also the underlying neurobiological, psychological, and wider social factors.

Through targeted, multidisciplinary interventions, it is possible to halt the progression of these devastating disorders and set individuals on a path to recovery.

How CBT for eating disorders helps – and what it looks like

Cognitive Behavioural Therapy (CBT) is a highly effective, evidence-based treatment for eating disorders21. By addressing the underlying thought patterns and behaviours that drive disordered eating, CBT helps patients build healthier relationships with food and their bodies.

The core principles of CBT for eating disorders

CBT focuses on identifying and challenging distorted thoughts, such as beliefs about body image, weight, or self-worth. For example, someone with anorexia nervosa may equate thinness with value, while an individual with bulimia might feel trapped in cycles of guilt and shame. 

CBT helps to:

• Recognise negative thought patterns: therapists work with patients to uncover harmful automatic thoughts around food and cognitive distortions that sustain disordered behaviours22.
• Develop coping strategies: patients learn healthier ways to manage emotions, such as anxiety or shame, without resorting to restrictive eating, bingeing, or purging.
• Promote behavioural change: techniques like exposure therapy help patients gradually reintroduce feared foods or establish regular eating patterns23.

A closer look at the process

CBT for eating disorders typically unfolds in structured, progressive stages:

1. Psychoeducation: patients are educated about the nature of their disorder, the biological effects of disordered eating, and the principles of CBT. Understanding the very real consequences of their behaviour fosters motivation for change.
2. Behavioural monitoring: patients maintain detailed records of their eating habits, thoughts, and emotions. This self-monitoring provides insights into triggers and patterns24, enabling targeted interventions and healthier nutrition. 
3. Cognitive restructuring: therapists guide patients in questioning and reframing irrational beliefs25. For instance, the thought, “eating dessert will make me lose control,” is challenged and replaced with healthier alternatives.
4. Relapse prevention: therapy includes strategies to anticipate and manage setbacks.

Scientific evidence and outcomes

Research has consistently shown that CBT reduces eating disorder symptoms26 and improves emotional wellbeing. It can be particularly effective in managing binge eating27 and bulimia28, with many patients experiencing sustained recovery. 

For anorexia, CBT is often integrated into a multidisciplinary approach that includes medical support and nutritional counselling 29,30.

However it is used, CBT not only addresses the immediate symptoms of eating disorders, but also actively empowers individuals to rebuild their lives. Despite some potential limitations31, by treating both the mind and the behaviour, CBT is very often a central tenet of long-term recovery.

Final thoughts

Recovering from an eating disorder is a deeply personal journey that requires compassion, clinical expertise, and a comprehensive, multidisciplinary approach. Cognitive Behavioural Therapy (CBT) has proven to be a cornerstone of effective treatment, helping individuals challenge destructive thought patterns, rebuild healthier habits, and reclaim their emotional wellbeing.

At Harbor London, we believe in treating the whole person – addressing the psychological, physical, and emotional aspects of recovery in a safe and nurturing environment. By combining evidence-based therapies like CBT with tailored care plans, we empower individuals to develop lasting resilience and a positive relationship with food and themselves.

If you or someone you know is struggling with an eating disorder, take the first step towards lasting recovery. Contact our team today to make a referral. 

References 

1. https://mentalhealth-uk.org/help-and-information/conditions/eating-disorders/causes/
2. https://www.beateatingdisorders.org.uk/get-information-and-support/about-eating-disorders/how-many-people-eating-disorder-uk/
3. https://www.nimh.nih.gov/health/publications/eating-disorders
4. https://www.mentalhealth.org.uk/our-work/research/body-image-how-we-think-and-feel-about-our-bodies/implications-and-recommendations-policy-and-action
5. https://www.nytimes.com/2022/03/31/learning/what-students-are-saying-about-how-social-media-affects-their-body-image.html
6. https://www.nhs.uk/mental-health/conditions/anorexia/overview/
7. https://www.sciencedirect.com/science/article/pii/B9780128206836000300
8. https://pmc.ncbi.nlm.nih.gov/articles/PMC7872149/ 
9. https://theros.org.uk/information-and-support/osteoporosis/causes/anorexia/
10. https://www.nature.com/articles/s41380-023-02378-4 
11. https://pmc.ncbi.nlm.nih.gov/articles/PMC305267/ 
12. https://www.eatingdisorderhope.com/information/bulimia/electrolytes-and-bulimia-why-is-this-a-big-deal
13. https://pmc.ncbi.nlm.nih.gov/articles/PMC8741521/
14. https://www.medicalnewstoday.com/articles/bulimia-teeth
15. https://www.beateatingdisorders.org.uk/get-information-and-support/about-eating-disorders/types/binge-eating-disorder/
16. https://www.psypost.org/brain-imaging-study-links-eating-disorders-to-elevated-amygdala-responses-when-anticipating-high-calorie-food/
17. https://www.diabetes.org.uk/living-with-diabetes/emotional-wellbeing/eating-disorders-and-diabetes
18. https://www.heart.org/en/news/2024/02/26/how-eating-disorders-can-damage-the-heart
19. https://onlinelibrary.wiley.com/doi/abs/10.1002/eat.23584
20. https://www.beateatingdisorders.org.uk/news/beat-news/three-half-year-delay-eating-disorder-treatment/
21. https://www.oxfordhealth.nhs.uk/camhs/wp-content/uploads/sites/13/2019/05/Eating-Disorders-CBTE-0718.pdf
22. https://jeatdisord.biomedcentral.com/articles/10.1186/s40337-015-0068-9
23. https://pubmed.ncbi.nlm.nih.gov/32224363/ 
24. https://psycnet.apa.org/record/1999-01917-008 
25. https://www.verywellmind.com/cognitive-behavioral-therapy-for-eating-disorders-4151114 
26. https://pubmed.ncbi.nlm.nih.gov/29083223/
27. https://div12.org/treatment/cognitive-behavioral-therapy-for-binge-eating-disorder/
28. https://div12.org/treatment/cognitive-behavioral-therapy-for-bulimia-nervosa/
29. https://jeatdisord.biomedcentral.com/articles/10.1186/s40337-022-00620-y
30. https://www.rcpsych.ac.uk/news-and-features/latest-news/detail/2022/02/23/new-integrated-treatment-could-transform-the-lives-of-adults-with-life-threatening-anorexia-nervosa 
31. https://www.psychologytoday.com/gb/blog/hunger-artist/201805/cbt-eating-disorders-not-yet-success-story