Overcoming
Disordered Eating

Overcoming Disordered Eating
Information Pack A
Take Charge … Initiate Change
Module 2
How Ready Am I to Change?
Introduction
How Ready am I to Change?
Worksheet: Change Process Balance Sheet
What Kind of Treatment is Right for Me?
Treatment of Eating Disorders
Module Summary
About This Module

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This is the second module of Information Pack A, which provides information about disordered eating andoffers strategies to help you start changing the behaviours associated with your disordered eating and weightcontrol habits. We suggest you read through all the modules of this Information Pack, in order, before
embarking on change.
If you do think you might suffer from an eating disorder, it is important that you talk to your General Practitioner, as
there are many physical complications that can arise from being at an unhealthily low weight or from losing weightvery quickly, or from purging. We advise you to seek professional help with working on an eating disorder.
If you use any extreme weight control behaviours – even rarely – you should also see your General Practitioner for a
full medical check-up, as your health might be compromised. Such extreme measures include:• extreme food restriction/fasting (and/or rapid weight loss)• purging (self-induced vomiting, misuse of laxatives or diuretics)• extreme exercise

The information provided in this document is for information purposes only. Please refer to the full
disclaimer and copyright statement available at http://www.cci.health.wa.gov.au regarding the informationon this website before making use of such information.
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Introduction
In Module 1 we provided information about the unhealthy impact of eating disorders. We introduced BMI(Body Mass Index) and showed you how to calculate your current BMI and your healthy weight range. We
helped you identify whether or not you had an eating disorder or disordered eating of any kind. In thismodule we will help you identify the pros and cons of changing, and work out whether or not you areready to change. We will help you decide whether this type of self-help is appropriate for you or whether
you need treatment from a professional. We will then describe the approach taken throughout thisinformation pack.

How Ready Am I to Change?
Research has identified a number of stages in the process of readiness for change. First, there is precontemplation, where someone is not ready or willing to consider change. (An example of this is a young
woman who has lost a lot of weight, but won’t admit she has a problem.) Secondly, there iscontemplation, where the person has begun to consider changing, but hasn’t yet taken any action. (Thismight be when the young woman realises she has a problem but is reluctant to go for help, as she isterrified of putting on weight.) Thirdly, there is the preparation stage, where someone is preparing to
make a move towards change. (Here, the young woman has got the phone number of a local clinic, but
hasn’t had the courage to call them for an appointment.) Lastly, there is action, when the person is actively
involved in change. (The young woman is engaged in treatment.)
How ready are you to change? Which stage are you in? It’s not always that simple, as you canswitch from one stage to another in minutes! And just because someone has started to havetherapy for an eating disorder, it doesn’t necessarily mean s/he is in the action mode. S/he may
have gone back into the preparation or even contemplation stage. Write down some of yourthoughts about where you are in this process.

Ambivalence
There is probably a part of you that is eager to get healthy, and another part that is terrified ofgiving up your disordered eating. This can be seen as an internal battle between the healthy you
and the eating disordered you. We do understand this, and we refer to this as ambivalence. We
know that people who have eating disorders find it hard to change and hard to give up theirdisordered eating. Some people see their eating disorder as a friend, or a lifeline.
We hope to show you that disordered eating is dominating your life in an unhealthy way. While you are in
the middle of your disordered eating, you are listening to messages from the eating disorder mindset. For
example, if you are giving yourself messages such as: “I’m a pig, if I eat that I’ll get fat”, it is not going to
make you feel good about yourself. What we are offering is a new set of messages, to build up a morepositive sense of self and to replace the old eating disordered messages with a new constructive mindset.
(We will say more about “Mindsets” in Information Pack B.)
Is this the right time?
It’s easy to say that there is never a ‘right time’ to embark on a challenge, and it’s easy to put off change
indefinitely. However, this is often an excuse. We urge you to take up the challenge of improving yourhealth by improving your eating and weight control behaviours.
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However, there can be a ‘wrong time’ to start your change programme. Examples of a wrong time are: aserious illness diagnosed in yourself, a family member or friend; the death of a loved one; an accident or
injury; losing a job; having to move home. These can be traumatic, and it is reasonable that such an
experience might mean you aren’t ready to focus on your disordered eating. If you are in the midst of
turmoil and you don’t think you can commit fully to this endeavour now, then wait until you are ready andtake up the challenge then, with renewed vigour. Set a date when you will re-read this module and write it
down as a commitment to yourself. Make a plan (e.g., come back to it in 3 months; write a reminder inyour diary).

A word about weight and weight loss
The goal of weight loss is incompatible with recovering from an eating disorder. If you are serious about working
on your disordered eating, you mustn’t be trying to lose weight at the same time. This is because if you aretrying to lose weight, you will be tempted, however subtly (and maybe not so subtly!) to restrict your foodintake. In the next module we will show how this would lead to overeating and/or binge eating, and thecycle of your disordered eating would be maintained.
Most people of average weight (with a BMI of 20-25) who follow eating guidelines such as those provided inthis information package find that their weight stays within about 1 kg of where they started. Some people
actually lose weight once they stop binge eating. Even if you REALLY want to lose weight now, we
recommend that you suspend that goal, at least temporarily. If you work through this information package
and still want to lose weight at some point in the future, then you can go ahead (with advice from a dietitianor your doctor). But you must decide: “What do I want NOW? Do I want to work on my disorderedeating, or do I want to lose weight, even if it means continuing with my disordered eating?” You can’t doboth at the same time. Remember, even if you are in the ‘healthy weight range’, if you are engaging in vomiting or
laxative misuse, you should see your General Practitioner for a medical check-up.
If you are objectively overweight (with a BMI of above 30) it might make sense for you to be contemplating
losing weight in order to improve your health. If you have been binge eating and now stop this behaviour, it
is likely that you will lose weight anyway. But again, we suggest that you put any plans for weight loss on theback burner until you have been able to develop regular eating habits (Module 5) and have stopped binge
eating (Module 6). We suggest that you work through all the modules in this information pack before
addressing the issue of weight loss. Once you are eating in a healthier manner and have developed healthy
habits and helpful coping patterns, you may wish to revisit the notion of weight loss. If you have not lost
weight, you may want to get advice from a dietitian for help with a healthy weight-reduction plan.
Remember, if you have a BMI over 30, you should see your General Practitioner for a medical check-up.
If you are objectively underweight (with a BMI of below 19) it is not healthy to lose more weight. In fact, tobecome healthy again, you will need to regain some weight. We realise this might be daunting and we hopeto help you with this challenge. Once you learn to eat regularly and let go of your dietary rules, it is likelythat you will regain your health and attain a weight within the healthy range. Remember, if you have a BMI
under 18, you should see your General Practitioner for a medical check-up.
Overleaf is a worksheet designed to help you examine the pros and cons of keeping with or changing yourdisturbed eating habits and weight control behaviours. Please take a few minutes to look it over, and fill in
the four sections.

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Change Process Balance Sheet

Take a moment to think about your disordered eating…
List the negative consequences of
List the positive aspects of experiencing yourexperiencing your current problem. Thinkcurrent problem. There are positives andabout the difficulties that you are currently
negatives about almost every situation. (Forexperiencing. (For example, perhaps you are feeling example, perhaps you have been using eating to
dizzy, or can’t concentrate because of yourmanage painful feelings.)
preoccupation with food.)

List the personal benefits that you expect if
you change yourself. Think about a general goal
and how you will have to change in order to achieveit. (For example, perhaps you will be able to enjoy
eating out with friends if you overcome yourdisordered eating.)

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List the personal costs that you expect if youchange yourself. What do you think you’ll need togive up in order to change? There are costs andbenefits to almost all types of change. (For example,
perhaps you’ll be expected to do things differently
and get out of your comfort zone.)

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What did you learn from doing this exercise? How ready for change do you think you are? How
willing are you to suspend the goal of weight loss? Take a few moments to jot down your thoughts.

What Kind of Treatment is Right for Me?
If you are reading this far into the module, it is likely that you are at least willing to consider changing yourbehaviours. You deserve a pat on the back and encouragement. It takes courage to change. Please
remember to read through all of the modules before embarking on any serious commitment to change.
Change is difficult for anyone, and changing disordered eating is particularly challenging! So we ask you tothink very seriously before making a commitment to change. We feel it’s important that you are fully awareof what’s entailed and how hard it might be at times. We will offer guidance to help you at all stages of thisInformation Pack, but you need to be prepared to continue, even when the going gets tough. It’s likerunning a marathon: we can be the “coach” behind the scenes, offering advice and direction, and yourfriends/partner/family can be the “cheerleaders”…but at the end of the day, it’s YOU doing the hard work.
This set of Information Packs is designed to help anyone with disordered eating and/or weight control
habits. Although the stereotypical person with an eating disorder is a teenager or young woman, what wesay here is applicable equally to men of all ages and older women who have eating problems.
Before we go further into describing the kind of help that we offer in this Information Pack, you should ask
yourself: Is self-help the best way for me to tackle my problems? Are my problems too serious and do I
need professional help?
There are many directions you could take. You could work on these modules on your own. You could
work on these modules with a friend. You could get professional help. You could seek professional help at
the same time as working through these Information Packs. The main point here is that you recognise thatyou want to change - even if it’s only a tiny part of you that does! At the very least, if working through thisInformation Pack is a first step that moves you forward, then it will have been useful.
Please note: self-help might be just right for you, but it may not be sufficient and you may need professional help. In
any case, we do urge you to get a medical check-up from your General Practitioner. It is important to realise that
there are many physical complications from some of the most common weight control methods, especially strict
dieting (rapid weight loss, extremely low weight) and purging (self-induced vomiting and laxative misuse). See Pages
6-8 of Module 1 for more details.

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Treatment for Eating Disorders
One of the most common forms of treatment for eating disorders is Cognitive Behavioural
Therapy (CBT). CBT is designed to change the behaviours and thoughts (cognitions) that keep
an eating disorder going. CBT is the leading evidence-based approach to treating eating
disorders. It has also been shown to be useful in self-help. In this information package, we
follow the principles of CBT. We draw on work by experts in the field of eating disorders,
who publish in scientific journals and present their findings at specialist conferences.
The focus of CBT is changing behaviours and challenging the thoughts that keep the disorder going. Being
conscious or aware of a behaviour or a thought is vital in order for change to occur. If you aren’t aware ofsomething, how could you possibly change it? Obviously, just being aware isn’t sufficient, but developing
awareness is a necessary first step in changing behaviours. Once you become aware of the behaviours you
thought were automatic and out of your control, you realise that they are amenable to change and you
CAN gain control over your eating. We will be helping you develop awareness about what you are doing –which may not always be welcome or easy. You may prefer to hide your head in the sand than confront
reality…but if you do this, you won’t change.
We will now outline some of the key components of CBT for eating disorders. These components will be
expanded in subsequent modules. You can use them to help you work on your disordered eating, but if you
have an eating disorder you may also need professional help in overcoming your problems.
Understanding the Vicious Cycle
We will be explaining in Module 3 how disturbed eating habits develop and what keeps them going. We callthis the ‘vicious cycle’ of disordered eating.
Self-Monitoring
To combat your disordered eating habits you will need to keep a record of your food intake. We callthis “self-monitoring”, which will be introduced in Module 4. Self-monitoring allows you to identify
the type of situations and events that influence your eating or trigger disordered eating. You will findthat when you are conscious of your eating habits, you can start to make changes.
Regular Eating
Regular eating is central to overcoming disordered eating. This behaviour will be introduced in Module 5.
Regular eating involves eating something roughly every three hours, and usually takes the form of threemeals and 2-3 snacks each day. Regular eating will help you to establish a positive eating routine. Regulareating will help to combat infrequent eating, because it will give structure to your eating. Regular eating will
also help to combat binge eating, because it will prevent the extreme hunger that can lead to over-eating.
Regular Weighing
Weighing yourself just once a week will help you to gain an accurate understanding about the relationshipbetween changes in your eating habits and changes in your body weight. It is important that you do notweigh yourself more than once a week, because this may lead you to assume, mistakenly, that thefluctuations of normal body weight are associated with particular meals or foods. We will talk more about
this in Module 5. We also want you to take charge of your life by focusing on changing your behaviours andnot being dependent on the information provided by weighing scales.

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Psycho-Education
As you progress through this information package, you will be given information about disturbed eating
habits and weight control behaviours. You will come to understand what maintains your disordered eatingand how you can use this information to overcome it. You will also learn about the ineffectiveness of
dietary restraint and purging as weight control methods, and find out about their negative consequences.
This education about disordered eating is central to CBT. When you understand your disturbed eating, you
can learn to “outsmart” it. We will give you specific information about disturbed weight control measuresin Module 6.
Behavioural Change
Once these preliminary objectives are in place, you will find you can start to address specific disorderedbehaviours, such as restricted food intake, binge eating, purging and driven exercise. We will begin tocombat these behaviours in Modules 6 – 8.
Cognitive Change‘Cognitions’ are thoughts. In Information Pack B we will help you identify and change the unhelpful thinking
that accompanies disordered eating. We will help you understand how your preoccupation with controlling
eating, shape and weight actually keeps it going. We recommend that you complete Information Pack A (tackling
behavioural change) before progressing to Information Pack B.
Awareness of your thinking patterns (“Meta-Cognitive Awareness”)
The term ‘meta-cognitive’ refers to the process of thinking about your thinking. It’s like taking a “helicopterview”, so that you can look down at yourself and your thought processes from a distance, and be moreobjective about yourself and your thinking. Being aware of your thoughts will help you to challenge
unhelpful and dysfunctional thinking. An important part of this process will involve learning about your‘mindsets’. Everyone has mindsets that influence the way they see the world. However, people with eating
disorders have mindsets that lead them to interpret events in a way that reinforces or strengthens theirdisordered eating. You may recognise such mindsets in your own thinking. For example, if you were told
“You look well”, would your mindset lead you to interpret this comment as “You look fat”? When you canrecognise your own mindsets, you can begin to challenge the assumptions that support your disorderedeating. (We will say more about “Mindsets” and meta-cognitive awareness in Information Pack B.)
Commitment
We encourage you to take this process of change one step at a time. It may take a while, but this is not a
race. It is likely you have been experiencing disordered eating and weight control measures for some time,
so be patient! Make a commitment to yourself to work on change – and to COMPLETE working throughthese modules. You will find that it is worth it! Write down your commitment to yourself.

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Module Summary
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It is important to recognise any disordered eating you might have, and to identify whether you have an
eating disorder.
It is useful to think about how ready you are to change your disordered eating and to develop healthiereating habits.
It is common for people with eating disorders to be ambivalent about change. In other words, while
there is a healthy part of them wanting to get healthier, there is also another part of them which isafraid to let go of their disordered eating.
You may wish to seek professional help if you have an eating disorder. This may be instead of, or as an
adjunct to, this self-help information pack.
Cognitive Behavioural Therapy (CBT) is the leading evidence-based approach to Eating Disorders. CBTaims to educate people about eating disorders and alter the behaviours and thought patterns thatmaintain their disordered eating.
This information package follows the principles of CBT.

What I Have Learned in this Module
Think about what you have learned in this module and any useful bits of information, tips or strategies thatyou want to remember. Write them down below so you can refer to them later.

Think about how you might use the information you have just learned. Write down some ways in which
you could make use of this information.

Coming Up…
In Module 3 (How Eating Disorders are Maintained)
we’ll explore the factors that keep an eating disorder
going. We’ll also discuss how these factors can result ina vicious cycle of disordered eating.

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About This Module
CONTRIBUTORS
Dr. Anthea Fursland (Ph.D.1)
Principal Clinical Psychologist
Centre for Clinical Interventions

Paula Nathan (M.Psych.3)
Director, Centre for Clinical Interventions
Adjunct Senior Lecturer, School of Psychiatry andClinical Neuroscience, University of Western Australia

Dr. Sue Byrne (Ph.D.1, D.Phil.2)
Senior Clinical Psychologist
University of Western Australia andCentre for Clinical Interventions

Amy Lampard (B.A. Hons.4)
MPsych (Clinical)/ PhD Candidate
University of Western Australia

1 Doctor of Philosophy (Clinical Psychology)

2 Doctor of Philosophy (Clinical Psychology)

3 Master of Psychology (Clinical Psychology)

4 Bachelor of Arts (Psychology) with Honours

We would also like to thank Karina Allen for her contributions to the presentation of these Information Packs.
BACKGROUND
The concepts and strategies in this module have been developed from evidence-based psychologicaltreatment of eating disorders, primarily Cognitive Behaviour Therapy (CBT). This can be found in thefollowing:•••

Fairburn, C. G. (1995) Overcoming Binge Eating. New York: The Guilford Press
Fairburn, C. G., Cooper, Z., & Shafran, R. (2003) Cognitive behaviour therapy for eating disorders:a “transdiagnostic” theory and treatment. Behaviour Research and Therapy 41, pp 509-528
Fairburn, C. G. (2008) Cognitive Behavior Therapy and Eating Disorders. New York: The Guilford
Press“OVERCOMING DISORDERED EATING”
This module forms part of:
Fursland, A., Byrne, S. & Nathan, P. (2007) Overcoming Disordered Eating. Perth, Western Australia: Centre
for Clinical Interventions
ISBN: 0-975799525

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Created: March 2007. Revised November 2010.

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