Treating eating disorders through schema therapy

An eating disorder is a condition characterised by severe disturbed eating behaviour, as well as distressing thoughts and emotions.

Schema therapy can be a very effective treatment for eating disorders, allowing people to cope with their experiences in a healthy manner.

What are the signs and symptoms of an eating disorder?

There are a variety of different ways that eating disorders can present. However, some common signs and symptoms include:

  • Appearing uncomfortable around food consumption and restricting food intake.
  • Compensatory weight control behaviours. These might include trying to control and compensate through excessive exercise, fasting and/or purging.
  • Consuming large quantities of food in a short period of time, and then purging. This is commonly seen in those with binge eating disorders.
  • Discomfort with body, including compulsive mirror checking and calorie counting.

Using schema therapy to treat eating disorders

Schema therapy is one of the most effective treatment methods for eating disorders. It’s based upon Cognitive Behavioural Therapy (CBT) and seeks to identify childhood and adolescent origins of an eating disorder, especially early childhood experiences.

A schema is a framework through which we view the world; they allow us to process and organise information. Toxic or unstable home environment and/or childhood experiences lead to development of maladaptive schemas. Some of this may include:

  • Abandonment/instability
  • Mistrust
  • Shame
  • Social isolation or alienation
  • Emotional deprivation and approval seeking

Identifying causes in the early childhood environment

Early childhood experiences play a major role in shaping personality.

Research suggests that it is not necessarily what happened in childhood, but how people interpret that, that determines how they relate to others and how they function as adults.

A child’s logical brain doesn’t understand that a parent’s abuse, for example, is a result of that parent’s own insecurities and anxieties. Instead, the child infers that they are not loveable or worthy; it is safer and easier for them to believe in their own wrongness, as it’s something they think they can ultimately fix.

Fulfilling core emotional needs

Schema therapy identifies core emotional needs that are universal to every human. These include:

  • Secure attachment to others through safety, stability, nurturing and acceptance
  • Autonomy
  • A sense of identity
  • Freedom to express valid needs and emotions

When people develop an eating disorder, often their core emotional needs are largely unmet during childhood. Disordered patterns of eating are a way to cope with the pain and control their environment and experiences.

By restricting diet and controlling their weight, a person may fulfil their need for stability and certainty.

On the other hand, binge eating can provide self-calming and soothing, replacing a person’s need for nurturing that was absent during childhood.

At times, eating disorders may provide a person with a sense of identity, which they were unable to form while growing up in a toxic family environment.

Using an eating disorder as a coping mechanism

The pain of a schema will often cause a person to develop certain coping styles. Coping styles, however, do not necessarily heal the schema; they usually only minimise the pain associated with triggers.

The three styles of coping mechanisms include schema avoidance (flight), schema overcompensation (fight) and schema surrender (freeze).

Healthy coping modes

Schema coping modes are temporary emotional states that can surface as a result of a schema trigger.

The four main categories of coping modes are child modes (angry, impulsive, or happy child mode), coping survival modes (over-controlling eating and weight, detaching), internalised parent modes (self-punishing through restrictive diet, criticising self, induces guilt) and healthy adult modes (healthy, well-functioning adult, helps to regulate the other modes through self-observation.)

Talk to our psychologists for support

The goal of treatment through schema therapy is ultimately to help the client learn healthy ways of meeting their core emotional needs.

This may include identifying maladaptive schemas and empathetically confronting them, constructing a narrative that faces both good and bad childhood experiences and seeks to let their healthy adult mode deal with the pain triggered by schemas.

If you or somebody you know is struggling with an eating disorder, Clear Health Psychology has a range of psychologists with diverse expertise that can provide support, including schema therapy.

References

Simpson, S., & Smith, E. (Eds). (2019). Schema Therapy for Eating Disorders: Theory & Practice for Individual & Group Settings. Routledge.

Young, J.E., Klosko, J.S., & Weishaar, M.E. (2003). Schema Therapy: A Practitioner’s Guide. New York: Guilford

Dr Fazeela Moghal

Fazeela is a Clinical Psychologist at Clear Health Psychology. She has over 14 years of experience of helping people with diverse problems belonging to various countries, cultures, and age groups. She currently sees those 16 years and over. You can find out more about Dr Moghal here, or book an appointment through our website or by calling the number below.

Dr Fazeela Moghal