Edinburgh Therapy Service specialises in eating disorders, including binge eating disorder, bulimia, and ARFID (avoidant/restrictive food intake disorder). Please note that our practice does not offer treatment for anorexia nervosa, as this disorder often requires medical support, which we are unable to provide. You don’t need to meet the clinical criteria for an eating disorder to benefit from our therapeutic services. Therapy can be an invaluable source of support for those dealing with a variety of issues related to food and body image. Whether you struggle with food addiction, overeating, orthorexia, exercise, dieting addiction, etc., or are dealing with distorted or negative body image, we are here to help you.
An eating disorder is a psychological condition in which individuals utilise food control as a means to manage emotions and navigate various life situations. Common eating disorders include anorexia nervosa, bulimia nervosa, binge eating disorder, and avoidant/restrictive food intake disorder (ARFID). Each of these disorders has its own set of symptoms and diagnostic criteria, but they all involve an unhealthy relationship with food and body image. Eating disorders can have serious consequences if left untreated and often require professional intervention for recovery.
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At Edinburgh Therapy Service, we specialise in the full spectrum of eating disorders, except for anorexia nervosa or anorexic symptomatology. This exception is because anorexia often necessitates medical support that we are unable to provide. We work with bulimia nervosa, binge eating disorder, ARFID, and other food issues, such as orthorexia, food addiction, emotional eating, or body image concerns.
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Our therapists are qualified and registered with reputable professional associations for psychotherapy and counselling.
The DSM-5, a recognized diagnostic manual in the field of psychology, formally identifies several eating disorders. These include anorexia nervosa, bulimia nervosa, binge eating disorder (BED), and ARFID (avoidant/restrictive food intake disorder). However, the DSM-5 doesn’t cover every eating-related concern. Problems like orthorexia, characterised by an obsession with healthy eating, and emotional eating, where food is used as a coping mechanism for emotions, aren’t formally classified in the DSM-5 but are still important issues that people may experience and seek help for. Here you can read about some of the most common eating disorders and eating problems:
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This disorder involves severe food restriction, leading to dangerously low body weight. Individuals with anorexia often have an intense fear of gaining weight and a distorted body image.
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People with bulimia engage in recurrent episodes of binge eating, followed by purging behaviours like self-induced vomiting, laxative use, or excessive exercise.
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BED is defined by recurring episodes of consuming large amounts of food in a short time, accompanied by feelings of guilt or loss of control. Unlike bulimia, there is no regular use of purging methods.
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ARFID comprises limited food variety, avoidance of certain textures or smells, and a reluctance to eat specific foods, often leading to nutritional deficiencies.
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Orthorexia is an obsession with healthy eating to an extreme degree, often leading to rigid dietary restrictions that may negatively impact overall well-being.
The following questions can help you reflect on whether or not you might be experiencing signs of an eating disorder:
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» Do you find yourself preoccupied daily with thoughts about food, calories, dieting, or your body image?
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» Do you engage in behaviours like storing food, lying about what you eat, or constantly weighing and measuring yourself?
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» Have you experienced rapid and significant changes in your weight, either through loss or gain?
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» Are you meticulously tracking calories, exercise, or food intake?
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» Do you sometimes eat until you feel physically ill, or on the contrary, avoid eating even when you’re hungry?
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» Do you frequently make excuses to avoid eating in the presence of others?
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» Do you feel a need to compensate for eating, such as overexercising or engaging in other purging behaviours?
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» Have you taken to wearing loose or baggy clothing to conceal your body shape?
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» Do you have persistent worries about losing control over your eating habits and weight?
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» Are you experiencing changes in your social life or relationships due to your eating habits or concerns about your body?
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» Do you experience anxiety or panic about meals, eating in public, or trying new foods?
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» Have you received comments or concerns from friends or family members about your eating habits or appearance?
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» Have you lost interest in activities you once enjoyed because of your preoccupation with food and weight?
Initiating treatment can pose challenges, irrespective of where you are in your recovery journey. Whether it’s your initial attempt or your tenth, whether you’ve endured the condition for one, seven, or even more years, the crucial aspect is recognizing the right time to seek treatment for an eating disorder.
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An eating disorder often starts with what seems a harmless desire to adopt a healthier lifestyle. Individuals may embark on this path by initially reducing the quantity of food they consume and then transitioning to more strict restrictions. However, for some, this journey takes a more severe turn. It can begin with a specific diet regimen or meal plan that excludes entire food groups while promoting fasting practices. Rapid and dramatic weight loss may follow, accompanied by a misguided sense of accomplishment that propels them further down the path of extreme dieting. Eventually, a tipping point may be reached, leading to periods of binge eating and a profound sense of loss of control, following a period of strict discipline and restriction.
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As the obsession with food, weight, and eating deepens, those affected may find themselves caught in a cycle of irrational thoughts. Distinguishing between their thoughts and the intrusive, eating-disorder-driven mental chatter becomes increasingly challenging. When food, weight, and eating occupy an overwhelming portion of your mental landscape, it becomes clear that seeking professional treatment is not just an option but a pressing necessity. Eating disorders typically necessitate professional intervention, as they seldom resolve independently without adequate support and treatment.
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If you find yourself at this stage, we strongly encourage you to reach out for help. We are here to provide the support you need.
Cognitive-behavioural therapy for eating disorders (CBT-E) is recognized as a primary treatment approach for various eating disorders, including anorexia nervosa, bulimia nervosa, binge eating disorder, and avoidant/restrictive food intake disorder (ARFID). The National Institute for Health and Care Excellence (NICE) guidelines, which provide evidence-based recommendations for healthcare in the UK, recommend CBT-E for adults dealing with eating disorders. For children and young people, the preferred treatment often involves family therapy, and in some cases, CBT-E may be considered. At Edinburgh Therapy Service, we provide CBT-E for both young people over 16 years old and adults.
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CBT-E, or enhanced cognitive-behavioural therapy is the adapted version of CBT for eating disorders. CBT-E is a specialised and evidence-based therapeutic approach designed to treat eating disorders, including anorexia nervosa, bulimia nervosa, and binge eating disorder.Â
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CBT-E is a structured and goal-oriented approach, typically delivered over a defined number of sessions. The duration and intensity of treatment may vary depending on the severity and type of eating disorder.Â
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CBT-E for bulimia and binge eating disorder
In the context of CBT-E for bulimia and binge eating, the treatment typically begins by establishing a regular, balanced, and varied diet. The emphasis is on creating structured meal plans with multiple meals throughout the day, incorporating a variety of foods to reduce the occurrence of binges triggered by physical hunger. During this initial phase, individuals are encouraged to self-monitor their food intake and any binge episodes. Often, reducing the frequency of binges is achieved by addressing the underlying issue of hunger signals.
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Additionally, CBT-E addresses compensatory behaviours used after a binge, such as vomiting, diuretic or laxative use, which can perpetuate the cycle of bingeing and restricting. Therapists assist individuals in recognizing the negative consequences of these behaviours and support them in discontinuing their use.
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In the subsequent phase of therapy, the focus shifts towards developing healthier emotional regulation strategies as alternatives to binge eating. Cognitive restructuring techniques are employed to challenge and reframe unhelpful and unrealistic thoughts related to food and body image, replacing them with more constructive beliefs. Ultimately, CBT-E aims to empower individuals with eating disorders to establish a healthier relationship with food, manage their emotions effectively, and cultivate a more positive self-image.
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CBT-E for ARFID
Similar to CBT-E for bulimia and binge eating, CBT for ARFID helps clients identify and challenge unhelpful thoughts and beliefs about food, eating, and the consequences of trying new foods. Cognitive restructuring techniques aim to replace these negative cognitions with more balanced and realistic ones. Additionally, therapists work with individuals to develop balanced meal plans that include a wider variety of foods. Nutritional education helps them understand the importance of a diverse diet for their health.
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Different from bulimia and binge eating, exposure and response prevention (ERP) is often used as a component of CBT for ARFID. ERP consists of gradual exposure to avoided foods, conducted in a structured and supportive manner. People with ARFID work with their therapist to create a hierarchy of feared foods, starting with less challenging options and progressing towards more difficult ones. Exposure exercises are designed to help desensitise individuals to the sensory aspects of avoided foods. Furthermore, CBT teaches coping strategies to manage anxiety and discomfort during exposure exercises and while trying new foods. These strategies may include relaxation techniques, mindfulness, and problem-solving skills.
At Edinburgh Therapy Service, we specialise in treatment for a range of eating disorders and eating issues, including bulimia nervosa, binge eating disorder, and ARFID. This excludes anorexia nervosa, as this condition often requires medical support that we can’t provide. We use evidence-based treatments that are recommended by the NICE guidelines, ensuring that you receive the highest standard of care.
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We love working with individuals facing eating issues, and understanding that these challenges can be incredibly complex. We approach your concerns without judgement, providing a safe and empathetic space. We are trained in cognitive-behavioural therapy for eating disorders and are ready to adapt to your unique path to recovery. Take the first step and contact us!
Symptoms can vary depending on the eating disorder. Here we include some of the most typical ones:
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» Recurrent episodes of binge eating, characterised by consuming a large amount of food within a discrete period.
» Compensatory behaviours, such as self-induced vomiting, laxative or diuretic use, excessive exercise, or fasting, to prevent weight gain.
» A preoccupation with body weight and shape, often with a distorted self-image.
» Binge-purge cycles that occur at least once a week for three months or longer.
» Feelings of guilt, shame, or loss of control during binge-eating episodes.
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» Recurrent episodes of binge eating, similar to those in bulimia, without regular compensatory behaviours like vomiting or excessive exercise.
» Eating larger amounts of food than most people would under similar circumstances.
» Feeling a lack of control over eating during binge episodes.
» Eating rapidly during binge episodes and eating until uncomfortably full.
» Binge eating occurs at least once a week for three months or more.
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» Highly selective eating habits, often limiting food variety based on sensory characteristics like taste, texture, or smell.
» Avoidance or restriction of certain food groups, leading to imbalanced nutrition and potential nutritional deficiencies.
» Limited interest in trying new foods or an aversion to specific food items.
» Anxiety, fear, or disgust related to eating or trying new foods.
» Significant disruption to daily life, social functioning, or nutritional status due to eating habits.
As with many other psychological disorders, the exact cause of eating disorders is unknown. Several factors can contribute to their development and maintenance, including:
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Genetics: A family history of eating disorders may increase the risk of developing one.
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Psychological factors: Conditions such as anxiety, depression, low self-esteem, and perfectionism can play a role.
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Environmental factors: Societal pressures related to body image, media influence, and cultural attitudes towards beauty and weight.
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Trauma: Past traumatic events, like sexual abuse, can trigger disordered eating behaviours.
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Dieting: Repeated dieting or extreme calorie restriction can contribute to the development of eating disorders.
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Family dynamics: Dysfunctional family relationships or a focus on weight and appearance within the family.
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Personality traits: Perfectionism, impulsivity, and obsessive-compulsive tendencies may contribute.
The Edinburgh Therapy Service offers both in-person eating disorders therapy in Edinburgh (United Kingdom), and convenient online therapy accessible worldwide You can find our exact location here.Â
Hello and a warm welcome! I’m Cristina, and I specialise in helping individuals with eating disorders, including bulimia, binge eating, ARFID, body image issues, and various eating-related problems. I understand that these conditions present significant challenges. You may have tried numerous approaches, but the cycle of bingeing and feeling unable to stop can be demoralising, leaving you with a sense of hopelessness.
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Feelings of guilt and anxiety can become overwhelming, making it difficult to know how to move forward. You might find that thoughts about food occupy a substantial part of your day, preventing you from directing your energy toward things that truly matter to you.
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If you’re struggling with ARFID, you might be feeling confused about your experiences, and even the thought of eating can be overwhelming. I want you to know that I understand how difficult these issues can be, and I’m passionate about working with individuals facing eating disorders, body image concerns, and other eating-related issues.
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I’d be honoured to work with you on your journey to recovery and healing. Please reach out and take that first step towards a healthier relationship with food and yourself.
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de Jong, M., Spinhoven, P., Korrelboom, K., Deen, M., van der Meer, I., Danner, U. N., van der Schuur, S., Schoorl, M., & Hoek, H. W. (2020). Effectiveness of enhanced cognitive behavior therapy for eating disorders: A randomized controlled trial. The International journal of eating disorders, 53(5), 447–457.
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Le Grange, D., Eckhardt, S., Dalle Grave, R., Crosby, R., Peterson, C., Keery, H., . . . Martell, C. (2022). Enhanced cognitive-behavior therapy and family-based treatment for adolescents with an eating disorder: A non-randomized effectiveness trial. Psychological Medicine, 52(13), 2520-2530.Â
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Fairburn, C. G., Bailey-Straebler, S., Basden, S., Doll, H. A., Jones, R., Murphy, R., O’Connor, M. E., & Cooper, Z. (2015). A transdiagnostic comparison of enhanced cognitive behaviour therapy (CBT-E) and interpersonal psychotherapy in the treatment of eating disorders. Behaviour research and therapy, 70, 64–71.Â
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Wonderlich, S., Peterson, C., Crosby, R., Smith, T., Klein, M., Mitchell, J., & Crow, S. (2014). A randomized controlled comparison of integrative cognitive-affective therapy (ICAT) and enhanced cognitive-behavioral therapy (CBT-E) for bulimia nervosa. Psychological Medicine, 44(3), 543-553.Â
The Edinburgh Therapy Service is a psychotherapy and counseling practice based in Edinburgh, Scotland (United Kingdom). We offer therapy both in-person in Edinburgh and online, available in English and Spanish.
Contact us for more information or to book your first appointment: [email protected]