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I seriously think each person with an eating disorder should keep a diary…. Everyone has a
story to tell when entangled in an eating disorder, and most people really want to read it. You
never know what your story can bring to others!! Get to writing you story and with this you can
do some cognitive therapy for yourself at the same time. I think being self-aware is the first start
of control over pretty much everything in life.

Cognitive-Behavioral Therapy...
is a form of psychotherapy that emphasizes the important role of thinking in how we feel and what we

Cognitive-behavioral therapy does not exist as a distinct therapeutic technique. The term
"cognitive-behavioral therapy (CBT)" is a very general term for a classification of therapies with
similarities.  There are several approaches to cognitive-behavioral therapy, including Rational
Emotive Behavior Therapy, Rational Behavior Therapy, Rational Living Therapy, Cognitive
Therapy, and Dialectic Behavior Therapy.

However, most cognitive-behavioral therapies have the following characteristics:

1. CBT is based on the Cognitive Model of Emotional Response.
Cognitive-behavioral therapy is based on the idea that our thoughts
cause our feelings and behaviors, not external things, like people, situations,
and events.  The benefit of this fact is that we can change the way we think to
feel / act better even if the situation does not change.
2. CBT is Briefer and Time-Limited.
Cognitive-behavioral therapy is considered among the most rapid in terms of
results obtained.  The average number of sessions clients receive (across all
types of problems and approaches to CBT) is only 16.  Other forms of
therapy,  like psychoanalysis, can take years.  What enables CBT to be briefer
is its highly instructive nature and the fact that it makes use of homework
assignments.  CBT is time-limited in that we help clients understand at the
very beginning of the therapy process that there will be a point when the formal
therapy will end.  The ending of the formal therapy is a decision made by the
therapist and client.  Therefore, CBT is not an open-ended, never-ending process.
3. A sound therapeutic relationship is necessary for effective therapy, but not the focus.
Some forms of therapy assume that the main reason people get better in
therapy is because of the positive relationship between the therapist and
client.  Cognitive-behavioral therapists believe it is important to have a good,
trusting relationship, but that is not enough.  CBT therapists believe that the
clients change because they learn how to think differently and they act on that
learning.  Therefore, CBT therapists focus on teaching rational self-counseling skills.
4. CBT is a collaborative effort between the therapist and the client.
Cognitive-behavioral therapists seek to learn what their clients want out of life
(their goals) and then help their clients achieve those goals.  The therapist's
role is to listen, teach, and encourage, while the client's roles is to express
concerns, learn, and implement that learning.
5. CBT is based on aspects of stoic philosophy.
Not all approaches to CBT emphasize stoicism.  Rational Emotive
Behavior Therapy, Rational Behavior Therapy, and Rational Living
Therapy emphasize aspects of stoicism.  Beck's Cognitive Therapy is not based on stoicism.    
Cognitive-behavioral therapy does not tell people how they should feel.
However, most people seeking therapy do not want to feel they way they have
been feeling. The approaches that emphasize stoicism teach the benefits of
feeling, at worst, calm when confronted with undesirable situations.  They also
emphasize the fact that we have our undesirable situations whether we are
upset about them or not.  If we are upset about our problems, we have two
problems -- the problem, and our upset about it.  Most people want to have the
fewest number of problems possible.  So when we learn how to more calmly
accept a personal problem, not only do we feel better, but we usually put
ourselves in a better position to make use of our intelligence, knowledge,
energy, and resources to resolve the problem.
6. CBT uses the Socratic Method.
Cognitive-behavioral therapists want to gain a very good understanding of
their clients' concerns.  That's why they often ask questions.  They also
encourage their clients to ask questions of themselves, like, "How do I
really know that those people are laughing at me?"  
"Could they be laughing about something else?"
7. CBT is structured and directive.
Cognitive-behavioral therapists have a specific agenda for each session.
Specific techniques / concepts are taught during each session.  CBT
focuses on the client's goals.  We do not tell our clients what their goals
"should" be, or what they "should" tolerate.  We are directive in the sense that
we show our clients how to think and behave in ways to obtain what they
want. Therefore, CBT therapists do not tell their clients what to do -- rather,
they teach their clients how to do.
8. CBT is based on an educational model.
CBT is based on the scientifically supported assumption that most emotional
and behavioral reactions are learned.  Therefore, the goal of therapy is to
help clients unlearn their unwanted reactions and to learn a new way of reacting.  

Therefore, CBT has nothing to do with "just talking".  People can "just talk" with anyone.

The educational emphasis of CBT has an additional benefit -- it leads to
long term results.  When people understand how and why they are doing
well, they know what to do to continue doing well.
9. CBT theory and techniques rely on the Inductive Method.
A central aspect of Rational thinking is that it is based on fact. Often, we
upset ourselves about things when, in fact, the situation isn't like we think it
is.  If we knew that, we would not waste our time upsetting ourselves.

Therefore, the inductive method encourages us to look at our thoughts as
being hypotheses or guesses that can be questioned and tested.  If we find
that our hypotheses are incorrect (because we have new information), then we
can change our thinking to be in line with how the situation really is.

10. Homework is a central feature of CBT.
If when you attempted to learn your multiplication tables you spent only one
hour per week studying them, you might still be wondering what 5 X 5
equals.  You very likely spent a great deal of time at home studying your
multiplication tables, maybe with flashcards.

The same is the case with psychotherapy.  Goal achievement (if obtained)
could take a very long time if all a person were only to think about the
techniques and topics taught was for one hour per week.  That's why CBT
therapists assign reading assignments and encourage their clients to
practice the techniques learned.
Cognitive-behavioral therapy is an active type of counseling. Sessions usually are held once a
week for as long as you need to master new skills. Individual sessions last 1 hour, and group
sessions may be longer.
During cognitive-behavioral therapy for anorexia, you learn:
•        About your illness, its symptoms, and how to predict when symptoms will most likely recur.
•        To keep a diary of eating episodes, binge eating, purging, and the events that may have
triggered these episodes.
•        To eat more regularly, with meals or snacks spaced no more than 3 or 4 hours apart.
•        How to change the way you think about your symptoms. This reduces the power the
symptoms have over you.
•        How to change self-defeating thought patterns into patterns that are more helpful. This
improves mood and your sense of mastery over your life. This helps you avoid future episodes.
•        Ways to handle daily problems differently.
What To Expect After Treatment
You can use your cognitive-behavioral skills throughout your life. You may find that additional
"tune-up" sessions help you stay on track with your new skills.
Why It Is Done
Cognitive-behavioral therapy is used to treat the mental and emotional elements of an eating
disorder. This type of therapy is done to change how you think and feel about food, eating, and
body image. It is also done to help correct poor eating habits and prevent relapse.
How Well It Works
Cognitive-behavioral therapy is considered effective for the treatment of eating disorders.1 But
because eating disorder behaviors can endure for a long period of time, ongoing psychological
treatment is usually required for at least a year and may be needed for several years.2
Cognitive-behavioral therapy may be more effective in treating bulimia nervosa rather than
anorexia nervosa.
There are no known risks associated with cognitive-behavioral therapy.

Why Does Cognitive Behavioural Therapy Work with Eating Disorders?
For individuals suffering from eating disorders, understanding the relationships between
thoughts, emotions and actions is highly important. Once these relationships are understood,
the individual suffering from an eating disorder can replace the negative thoughts and
emotions which have led to abnormal food and eating behaviours and with more positive
thoughts and emotions that will lead back towards a healthy lifestyle. However, in order for
these relationships to be clear, it may take several weeks of tracking thoughts, feelings and
food and eating behaviours before the individual will accept this proof. Often therapists will ask
individuals to keep a journal or food diary in order to more accurately record their thoughts,
feelings and actions towards food and eating during a given period of time.
Does Cognitive Behavioural Therapy Cure Eating Disorders?
No, cognitive behavioural therapy (CBT) does not cure eating disorders. The recovery from an
eating disorder is a long journey, and there may be relapses along the way. When relapses do
occur, attending “top up” therapy sessions may make a difference.
What Exactly Does Cognitive Behavioural Therapy Teach?
In addition to teaching individuals how to identify the links between their thoughts, emotions
and actions, cognitive behavioural therapy (CBT) also teaches individuals how to avoid and
tolerate stressful situations, and how to best deal with stress to avoid a relapse into disordered
eating. In addition, CBT also teaches individuals that they themselves hold the power to their
recovery, which can be comforting to individuals who feel that their lives are otherwise out of
their control.
How Is Cognitive Behavioural Therapy Accessed?
Cognitive behavioural therapy (CBT) is only offered by qualified, trained therapists so a referral
from a GP, hospital or clinic is one way of accessing this type of therapy. Engaging a private
professional is another means of accessing cognitive behavioural therapy. For further
information on eating disorders, CBT and treatment, visit Beating Eating Disorders or discuss
the matter with a local medical or mental health professional.
Marya Hornbacher  some quotes from Wasted: A Memoir of Anorexia and Bulimia
"You never come back, not all the way. Always there is an odd distance between you
and the people you love and the people you meet, a barrier thin as the glass of a
mirror, you never come all the way out of the mirror; you stand, for the rest of your
life, with one foot in this world and no one in another, where everything is upside
down and backward and sad."
— Marya Hornbacher (Wasted: A Memoir of Anorexia and Bulimia)

"There is never a sudden revelation, a complete and tidy explanation for why it
happened, or why it ends, or why or who you are. You want one and I want one, but
there isn't one. It comes in bits and pieces, and you stitch them together wherever
they fit, and when you are done you hold yourself up, and still there are holes and
you are a rag doll, invented, imperfect. And yet you are all that you have, so you
must be enough. There is no other way."
— Marya Hornbacher (Wasted: A Memoir of Anorexia and Bulimia)

"We turn skeletons into goddesses and look to them as if they might teach us how
not to need."
— Marya Hornbacher

"Hatred is so much closer to love than indifference."
— Marya Hornbacher (Wasted: A Memoir of Anorexia and Bulimia)
"This is the very boring part of eating disorders, the aftermath. When you eat and
hate that you eat. And yet of course you must eat. You don’t really entertain the
notion of going back. You, with some startling new level of clarity, realize that going
back would be far worse than simply being as you are. This is obvious to anyone
without an eating disorder. This is not always obvious to you."
— Marya Hornbacher (Wasted: A Memoir of Anorexia and Bulimia)

"The anoretic operates under the astounding illusion that she can escape the flesh,
and, by association, the realm of emotions."
— Marya Hornbacher (Wasted: A Memoir of Anorexia and Bulimia
"The bragging was the worst. I hear this in schools all over the country, in cafés and
restaurants, in bars, on the Internet, for Pete's sake, on buses, on sidewalks:
Women yammering about how little they eat. Oh, I'm Starving, I haven't eaten all day,
I think I'll have a great big piece of lettuce, I'm not hungry, I don't like to eat in the
morning (in the afternoon, in the evening, on Tuesdays, when my nails aren't
painted, when my shin hurts, when it's raining, when it's sunny, on national holidays,
after or before 2 A.M.). I heard it in the hospital, that terrible ironic whine from the
chapped lips of women starving to death, But I'm not hun-greeee. To hear women
tell it, we're never hungry. We live on little Ms. Pac-Man power pellets. Food makes
us queasy, food makes us itchy, food is too messy, all I really like to eat is celery. To
hear women tell it we're ethereal beings who eat with the greatest distaste,
scraping scraps of food between our teeth with our upper lips curled.

For your edification, it's bullshit."
— Marya Hornbacher (Wasted: A Memoir of Anorexia and Bulimia)
Read more about Wasted: A memoir of  Anorexia and Bulimia.


It is estimated that 8 million Americans have an eating disorder – seven million
women and one million men
One in 200 American women suffers from anorexia
Two to three in 100 American women suffers from bulimia
Nearly half of all Americans personally know someone with an eating disorder (Note:
One in five Americans suffers from mental illnesses.)
An estimated 10 – 15% of people with anorexia or bulimia are males

Eating disorders have the highest mortality rate of any mental illness
A study by the National Association of Anorexia Nervosa and Associated Disorders
reported that 5 – 10% of anorexics die within 10 years after contracting the disease;
18-20% of anorexics will be dead after 20 years and only 30 – 40% ever fully recover
The mortality rate associated with anorexia nervosa is 12 times higher than the
death rate of ALL causes of death for females 15 – 24 years old.
20% of people suffering from anorexia will prematurely die from complications
related to their eating disorder, including suicide and heart problems

Only 1 in 10 people with eating disorders receive treatment
About 80% of the girls/women who have accessed care for their eating disorders do
not get the intensity of treatment they need to stay in recovery – they are often sent
home weeks earlier than the recommended stay
Treatment of an eating disorder in the US ranges from $500 per day to $2,000 per
day. The average cost for a month of inpatient treatment is $30,000. It is estimated
that individuals with eating disorders need anywhere from 3 – 6 months of inpatient
care. Health insurance companies for several reasons do not typically cover the
cost of treating eating disorders
The cost of outpatient treatment, including therapy and medical monitoring, can
extend to $100,000 or more

Anorexia is the 3rd most common chronic illness among adolescents
95% of those who have eating disorders are between the ages of 12 and 25
50% of girls between the ages of 11 and 13 see themselves as overweight
80% of 13-year-olds have attempted to lose weight
Rates of minorities with eating disorders are similar to those of white women
74% of American Indian girls reported dieting and purging with diet pills
Essence magazine, in 1994, reported that 53.5% of their respondents, African-
American females were at risk of an eating disorder
Eating disorders are one of the most common psychological problems facing young
women in Japan.

Paula Abdul
Justine Batemen
Karen Carpenter
Nadia Comaneci
Susan Dey
Jane Fonda
Tracey Gold
Elton John Jamie Lynn-Sigler
Cherry Boone O’Neill
Barbara Niven
Alexandra Paul
Princess Di
Lynn Redgrave
Kathy Rigby
Joan Rivers
Jeannine Turner

Myth: Eating Disorders Only Affect Teenagers
In fact, eating disorders can, and do, affect members of every population. While 86% of diagnosed
individuals experienced the onset of the
illness prior to age 20 (according to a 10-year study by ANAD), there is a growing population of
middle-aged and post-menopausal women
with eating disorders. Like the buying of a sports-car for a middle-aged man, an eating disorder can
be the manifestation of a sort of
mid-life crisis for women.

Myth: Eating Disorders Only Affect Women
Current statistics show that 1 out of every 10 people suffering from an eating disorder is male, but
researchers are discovering that
gender bias in diagnosis could be resulting in artificially low numbers. Eating disorders manifest
differently in males and females, and until
more studies are conducted on eating disorders in men, we can't know just how many there are out

Recent research also shows that the population with the highest percentage of eating disordered
members is that of the homosexual
male. This does not, by any means, indicate that straight men do not practice disordered eating.
Simply that the accepted methods for
diagnosis translate more readily from females (both hetero- and homo-sexual) to gay men.

Myth: Eating Disorders Are A Phase
As many as one out of every four anorexics dies of her disease. Eating disorders have the highest
mortality rate of any mental illness,
ranking far above the the numbers of suicides, which are regularly quoted in middle- and high school
health classes. However, with
treatment, the casualties fall to only about 4%, proving that the therapeutic model does, in fact, work,
though health insurance often
refuses to cover it, insisting that once medically stable, an eating disordered person is "cured."
Increasingly, doctors and lawmakers alike
are calling for insurance to offer full coverage of these serious illnesses.

Myth: Anorexics Don't Eat, Bulimics Puke
Diagnosis is not so cut-and-dry. Anorexia is not characterized by fasting, but by severe restriction.
Bulimia consists of cycles of
binge-and-purge behavior, but purging does not always mean self-induced vomiting. In addition,
anorexics do sometimes binge, and
sometimes purge, and some bulimics have periods of restriction or fasting. There is a third
diagnosis called "Eating Disorder Not
Otherwise Specified," or EDNOS, which serves as a catch-all for those meet some of the
characteristics of each, but who do not fit entirely
into one category or another.