G. Terence Wilson, Ph.D.

Terry Wilson on Body Image,

Binge Eating, & Overeating

By Lynn Mollick & Milton Spett

            “Weight concerns and body image problems are the engines that drive eating disorders,” asserted G. Terence Wilson at NJ-ACT’s January 28 workshop. The meeting was attended by a record 77 members.

          CBT has a clear advantage over drug treatment for eating disorders. Terry recommends that therapists base their treatment on Christopher Fairburn’s Overcoming Binge Eating (Guilford). Patients should also read this book.

          Assessment. Begin treatment by assessing the interaction among shape and weight concerns, negative affect, dysfunctional dieting, bingeing, and purging. Terry recommends self-monitoring, behavioral analysis, and two brief questionnaires – the Beck Depression Inventory and Fairburn and Cooper’s Eating Disorders Examination Self-Report Questionnaire.

            Weighing. Some patients avoid facing their eating problem by avoiding the scale or wearing baggy clothing. Others weigh themselves compulsively. Terry recommends weekly weighings, either by patients or by the therapist. If patients believe that they will overeat and gain weight unless they weigh themselves frequently, ask them to try weekly weighings for a week. 

            Body Image. Ask patients to choose a time and place to look in the mirror. Ask them to non-judgmentally look at their entire body instead of focusing on parts they dislike. Tell them to focus on their actual reflection rather than their distorted, internal image of how they look. 

            Eating. Early in treatment, help patients establish a regular eating pattern of three meals and two planned snacks a day. Teach patients that skipping meals, eating too little, and avoiding forbidden foods triggers bingeing, purging, and negative affect. Patients are surprised by how quickly they stop bingeing once they establish a regular eating pattern.

            Encourage patients to include forbidden foods in their diet. Forbidden foods should be carefully introduced in low affect situations, not made part of their daily diet. Patients need to learn that eating a moderate portion of a forbidden food does not necessarily result in a loss of control.

            Cognitions. Disputation often fails to change strongly-held, dysfunctional cognitions about shape and weight. Try Acceptance and Commitment interventions such as:

            1) Change the eliciting stimuli. Instead of challenging dysfunctional cognitions, analyze their antecedents. When did the thoughts occur?  What was the patient feeling when the thoughts occurred? Change the situation that provoked the dysfunctional thoughts and feelings. If a patient observes that tight clothing triggers her dysfunctional thoughts and feelings, suggest that she wear looser clothing.

            2) Instead of disputing a dysfunctional cognition, point out its dysfunctional consequences. Then articulate an alternate cognition that has more functional consequences. For example, “Since being comfortable is more important than wearing a size 4, I will wear comfortable pants of any size.”

            3) Find strategies other than dysfunctional eating for coping with dysfunctional thoughts and feelings.

            4) Accept what cannot be changed. One can lose weight (10% is the average in weight loss programs), but one cannot change ones body shape. Mindfulness can help achieve this self-acceptance.

            5)  Metacognitive Awareness – Accept that negative thoughts about weight and shape are just thoughts, not facts. For example, “I believe that I am fat, but this does not mean that I really am fat.”  See Acceptance and Commitment Therapy, Hayes, et al. (Guilford) for additional interventions.   

            Terry suggests supplementing these interventions with Interpersonal Therapy and anti-rumination techniques when appropriate. He also reports that CBT is effective for eating disorders, even when other emotional disorders, such as borderline personality disorder, co-exist. However, patients who have not begun to respond after 6 sessions, or those with BDI scores above 18 are more difficult to treat.  

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