Overcoming
Disordered Eating

Overcoming Disordered Eating
Information Pack A
Take Charge … Initiate Change
Module 9

Progress Review & Barriers to Change
Introduction
Reviewing Your Progress
Worksheet: Progress checklist
Barriers to ChangeWorksheet: Change process balance sheet
The Way Forward
Summary of Information Pack A
Module Summary
About This module

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This is the final 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 tothe full disclaimer and copyright statement available at http://www.cci.health.wa.gov.au
regarding the information on this website before making use of such information.
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Introduction
At this stage in the process of working through our Information Packs, you may find it useful to review the
progress you have made. We began by outlining the different types of eating disorders and you identified
your own disturbed eating habits and weight control behaviours. We looked at your readiness to change,
and introduced the central principles of Cognitive Behaviour Therapy. We examined the mechanisms thatmaintain your disordered eating. This gave you an understanding of how your eating problem developed,
what kept it going, and what you needed to change in order to break its cycle. We initiated self-monitoring,
regular eating and regular weighing. Implementing these behaviours was the first step in positive behaviourchange. We addressed binge eating and associated compensatory behaviours. You were encouraged toaddress these behaviours in your own life by tackling anything you identified as a cause of your binge eating/compensatory behaviour, especially dietary rules, which we then covered in more detail.
In this module you will be encouraged to rate your progress on changing your behaviours, before we moveon to changing your thoughts, or cognitions (thought patterns). Remember, it is the unhelpful thinking, suchas the excessive emphasis on controlling eating, shape and weight, that is central to maintaining disorderedeating and weight control measures. We will be dealing with changing cognitions in Information Pack B.
As you moved through the previous modules, you may have found it hard to change some behaviours. Thisis your chance to identify the causes of these difficulties. Firstly, we will examine each of the goals
addressed in previous modules and identify areas that need improvement. Secondly, we will identify
possible barriers to change. We will then be ready to move on to challenging cognitions (thoughts).

Reviewing Your Progress
We will now evaluate each of the tasks addressed in previous modules. This is your chance to consider
how well you have been performing, and identify areas you find especially challenging. Remember that noone expects you to be perfect. You are breaking ingrained habits and this process takes time. Congratulate
yourself on tasks that you are performing well, and do not berate yourself over tasks that still need work.
Self-Monitoring
In Module 4 we encouraged you to make daily food intake records. Now is the time to review yourprogress on this task. You may find it helpful to consider how well you have addressed the following points:• Do you always make your food records in “real-time”? If not, what are your reasons? For example, do
you find it hard to complete food records when eating with friends? Or do you find it hard to carry
your food records with you at all times?
• Are you honest in your food records? If not, have you been ashamed of recording some of youractions?
• Are you making food intake records every day? If not, why? Are you finding it hard to motivateyourself? Or does it interfere with other tasks? Are you having trouble finding time?
• Are you writing in that right-hand column, about your thoughts and feelings and the situation? Are you
critically reviewing your food records to identify important issues? If not, why?
Carefully consider your performance on each of these self-monitoring goals. If you aren’t fulfilling some ofthese goals, identify the reasons why. Evaluate your progress and write your thoughts in the space below.

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Regular Eating
In Module 5 you were asked to begin a program of regular eating. At this stage, you should be eating
something every 3-4 hours each day. To evaluate your progress on this goal consider the following points:• Do you ever skip meals or snacks? If yes, why? Do you miss meals or snacks when you are busy? Are
you scared of weight gain with regular eating? Are you not planning your meals and snacks in advance?
• Do you eat between meals or snacks? If so, are you eating enough in your meals and snacks?
Take some time to evaluate your own regular eating, and identify any obstacles to achieving this goal.

Weekly Weighing
In Module 5 we asked you to weigh yourself just once a week. Have you been able to do that?
What has it been like? Have you noticed how you react when you see that number on thescale? Take a few moments to evaluate how you’re doing in terms of weekly weighing, andidentify any obstacles to achieving this goal.

Progress Check
If you have been able to make the changes above (self-monitoring, regular eating and weekly weighing), thenyou should feel proud of yourself. But we realise that this is a huge challenge you have taken on, and thatyou may still have areas of disturbed eating habits or weight control behaviours. Now is the time to takestock and see how you are doing in these areas.
Overleaf you will find a checklist. Go ahead and fill it out, thinking about yourself during the past week.
Doing so will help you identify areas of progress and areas which you continue to find challenging.
Firstly, how is your health? Is being underweight still an issue for you? Are you having regular periods? Are
you experiencing other physical complications, such as dizziness, headaches, heart palpitations?
To what extent are you binge-eating, vomiting or abusing laxatives or overexercising? (We will addressthese again later in this module.) Are you still restricting the times you allow yourself to eat? Restricting
yourself to a narrow range of foods? Restricting how much you eat?
How much are you preoccupied with food/eating or shape/weight? Are you spending much time “feelingfat”? Are you still afraid of gaining weight? Are you still weighing yourself frequently or avoiding the scales?
Are you engaged in a lot of body checking (such as looking at body parts in the mirror, pinching yourself tocheck for fat) or avoiding looking at our body? We will address these other concerns in Information Pack B.

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Progress Checklist
Please rate yourself on how much these issues are present for you (over the past week):
No problem

A little

Moderate

A lot

ExtremePhysical healthBeing underweight (BMI under 19)
Menstruation (irregular/absent)
Other physical complications
Disturbed eating habits and weight control behaviours
Binge eating
Vomiting
Misuse of laxatives/diuretics
Over-exercising
Irregular eating (“when”)
Low variety of foods (“what”)
Undereating (“how much”)
Preoccupation with food/eating
Preoccupation with shape/ weight & its control
Feeling fat
Fear of gaining weight or getting fat
Frequent weighing or avoidance
Body shape checking or avoidance

So, how do you think you are doing? Give yourself a pat on the back for any progress you have made, but
don’t put yourself down for not having completely overcome your disordered eating! It is good to look at
areas of success and issues that are still challenging in order to get useful information. What can we learn?
We learn where our strengths lie and where we face the hardest challenges. We learn where we need toprioritise our energies.
Let’s look at the first few issues from the checklist. Others will be dealt with in Information Pack B.

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Addressing Binge Eating
If you binge, you will be aiming to cease this behaviour. In Modules 3 and 6 we examined the way people
binge eat in response to the physiological effects of hunger. We established the way dietary restriction
leads to hunger and preoccupation with food, which then encourages binge eating. To stop this form of
binge eating, you needed to stop restricting your food intake.
Now is the time to examine how well you have addressed binge eating so far. To do this, you need to ask
yourself some questions. How often do you binge eat now? Has the frequency of this behaviour decreased?
Are your binges smaller? Do you still restrict your food intake? If you are still binge eating, do not despair.
No one expects you to be able to stop this habit completely overnight.
Take some time to consider what situations and thoughts are associated with your residual binge eating.
You may find it useful to consult your food records. Have you started addressing these situations or
thoughts that encourage binge eating? How can you address them better in the future? Conversely, if you
are having success in addressing your binge eating, identify the positive behaviours that help you in this goal.

Addressing Purging: Self-induced Vomiting and Laxative Misuse
In Modules 3 and 6 we examined how purging behaviours are used to try to compensate for binge eating.
At this stage, you should be aiming to cease all purging behaviour.
Now is the time to evaluate your progress on this task so far. Are you still purging, either through selfinduced vomiting or laxative misuse? Take note of any improvements you may have made, such as adecrease in purging since you started working through this information package. Congratulate yourself onsuch progress; you don’t need to make a complete recovery yet to feel proud of your achievements.
However, if you are still struggling with purging, you do need to identify the reasons why. Are you still
binge eating? Do you feel uncomfortable with food in your stomach? Do you fear weight gain when you eat?
Do you purge to control your mood? Take some time to identify the reasons why you find it hard to stop
purging and write your thoughts below. Conversely, if you are having success in controlling your purging,
identify the behaviours that are encouraging this positive change.

Addressing Driven Exercise
This is the final goal that you need to evaluate at this stage. If you have had a problem withexcessive exercise, how well have you addressed this issue so far? Do you still exercise
intensely for the purpose of extreme weight control or to compensate for binge episodes?
Do you prioritise your exercise over seeing friends or having fun? How often do you engage
in such driven exercise? If you are still exercising excessively, consider the thoughts orsituations that encourage you to exercise. Write your thoughts below.

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Barriers to Change
As you evaluated each goal above, you will have identified relevant “barriers to change”. Barriers to change
can be situational factors, emotional influences, or personal vulnerabilities that prevent you from achieving
your goal. We will now briefly examine some of the barriers that you may have identified, and some you
may not have considered. If you see barriers that you didn’t think of earlier, feel free to go back andexamine these in your own progress evaluations.
In Information Pack B we will be addressing the unhelpful cognitions, or thought patterns, that help
maintain disordered eating habits and weight control behaviours. These include: preoccupation with food,eating, weight and shape; feeling fat; and fear of weight gain which often results in body checking and/or
avoidance (including weighing).
Possible Explanations for Limited Progress
In order to move forward and make further progress in overcoming your eating disorder, it is helpful toidentify what might be holding back your progress. Again, we urge you not to beat yourself up where youfind that progress has been thwarted, but to enter this phase in the spirit of enquiry. We want you to act
like a detective, looking for clues, drawing conclusions and developing strategies.
First, let’s look again at two major components of eating disorders that often continue to maintain thevicious cycle. These first two are major barriers to progress, and we encourage you to tackle them rightaway if you are still finding them to be a problem for you.
BingesResidual binge eating is a major barrier to progress. Until you stop binge eating you will likely find it very
difficult to stop purging or engaging in driven exercise. To remove this barrier, you need to address dietary
restraint. You must work really hard at stopping all forms of dieting behaviour and strict dietary rules.
Fear of Weight Gain
Fear of gaining weight will influence your ability to eat regularly, and subsequently increase the likelihood of
dietary restraint and binge eating. It will also encourage purging and driven exercise. You may want to takeanother look at Module 8.
Other Obstacles
There may be other factors that are getting in the way of overcoming your disordered eating.
We have listed a few here, and we encourage you to read through these to see if any apply toyou. Please be honest with yourself, as it’s the only way you are going to learn about whatmight be hindering your progress.
Insufficient Priority and Planning
To make changes in your behaviour, you need to make dealing with your eating problems a priority. Selfmonitoring and regular eating require such priority. Other activities may need to be put on hold to spend
time on these tasks. Furthermore, behaviours such as self-monitoring and regular eating require planning.
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If you will be somewhere that makes it difficult to cope with these tasks, you need to plan ahead in orderto face the situation with confidence. Are you giving enough priority to overcoming your disorderedeating? Are you planning sufficiently? Jot down your thoughts about this.

Reluctance to Face the Problem
It is understandable that facing your problematic eating habits may be hard. We realise that many people
with disordered eating are ambivalent about change. (See Module 2 for more discussion about ambivalence
and readiness for change.) Part of changing is recognising and facing up to the seriousness of your problem.
Do you think that you are still shying away from facing the reality of your disordered eating?
What could you do to encourage that healthy part of you to admit that you have a serious problem? Jot
down your thoughts about this.

Fear of Change
Change can indeed be scary. We tend to cling to the familiar, and perhaps you feel about your disorderedeating: “better the devil you know”, or “the lesser of two evils”. But remember, disturbed eating habits andweight control behaviours are harmful to your health, your relationships and your social and work/school
life, and the alternative might not be as frightening as you think. Often people find that, when they
eventually face what they’re afraid of, the reality isn’t as bad as they’d feared.
What would you need to do to be less afraid of change or to overcome that fear so that you could moveon with recovering from your disordered eating? Write down some thoughts.

Not Convinced by CBT Approach
Another roadblock in your recovery might be that you have doubts about this approach to tackling yourdisordered eating. Cognitive Behavioural Therapy (CBT) may not be ideal for everyone, but it is helpful tomany people and is the most successful treatment for eating disorders. Do you find the approach overly
simplistic? Not attending to your individual needs sufficiently? Clearly, self-help materials have to be aimed
at a general audience, but we have tried to design these Information Packs so that they are bothcomprehensive and yet you can tailor them to your particular needs.
However, if you remain unconvinced of the CBT approach and are thinking of abandoning any recovery
plan, we would like you to reflect a moment. Might there be anything else going on, such as a reluctance todeal with your problems and looking for a convenient reason to end your efforts at overcoming yourdisordered eating?

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If you don’t like the approach taken in this information package, are you willing to seek help elsewhere?
You may decide to go for professional help instead, which may be the right solution for you. Jot down any
thoughts that come to mind.

Extreme Self-Criticism
People who are extremely self-critical will find reasons to blame themselves for not doing better, and willoften abandon their efforts altogether. We know that overcoming disordered eating is hard work, so if you
are struggling, that is normal. You don’t need to feel like a failure and give up. Self-critical people often findit hard to acknowledge any success, seeing only what they describe as “failure”. Do you fit this profile? If so,
think of the changes and gains you have made, however small, and pat yourself on the back. Jot down any
thought you have about this. (Low self-esteem will be examined further in Module 5 of Information Pack B.)

Insufficient Motivation
Insufficient motivation can impact on all areas of your progress. Any change can be uncomfortable, evenwhen making change for the better. Sometimes it can be hard to find the motivation to make these difficultchanges. Are you having trouble with becoming motivated about sticking to your plan?
Take a moment to analyse your disordered eating. This is a good time to take another look at the pros andcons of change. What are the negative consequences of your disordered eating? Does it prevent you
spending time with friends, or does it make you anxious? What about the positive consequences of yourdisordered eating? Maybe it helps you to deal with unpleasant emotions? Now imagine you have recoveredfrom your disordered eating. What are the benefits and what are the costs of this recovery? Do you feel
more in control of your life? Or do you feel out of your comfort zone?
Remember the Change Process exercise that we introduced in Module 2? Do you think the negative
consequences of your disordered eating outweigh the positive consequences? Change is undoubtedly hard,but do the benefits outweigh the costs? If so, draw motivation from this exercise. Overleaf you will find thechange process sheet to complete. If you find this exercise useful, repeat it when needed.

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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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External Factors
Sometimes, even with the best will in the world, there are factors outside us that prevent us from moving
forward. Let us consider if you are facing any such problems that are getting in the way of your recovery
from disturbed eating habits and weight control behaviours.
Negative Impact of Family/Friends
Occasionally we find people who are struggling with their problem but are having their efforts thwarted bysomeone close to them who is sabotaging their progress. Is there anyone in your life who is so negative
towards your problems and your recovery that it has knocked you off track? If so, how could you get backon track? How could you deal with that person or those people? Take a moment to think about and write
down your thoughts.

Adverse Circumstances/Crises
What we mean by this is when some event in your life has occurred unexpectedly and is so distressing or
stressful that you cannot focus on your recovery. Some examples are: a serious illness diagnosed inyourself, a family member or friend; the death of a loved one; an accident or injury; losing a job; having tomove home. These can be traumatic, and it is reasonable that such an experience might have derailed you.
Has something like this occurred in your life? Has it meant that you haven’t been able to focus on
overcoming your disordered eating? If this is so, we suggest that you do indeed give yourself permission to
put aside your recovery – for now. You’ve got this far, and it would be a shame not to come back to it at alater date. Write down some thoughts about when you might want to come back to this information
package and start work again on your recovery. Make a plan (e.g., come back to it in 3 months, write areminder in my diary).

The Way Forward
Now you have had the opportunity to look at the progress you have made, and identify any difficulties you
may have experienced in this process of change. It is time to take stock, take a step back, and take abroader view, a ‘helicopter view’ of yourself and your efforts to overcome your disordered eating. The
next step is to work through the modules of Information Pack B, which focus on changing your unhelpful
thoughts related to controlling eating, weight and shape. How ready are you to tackle this next stage? Write
down some thoughts, and create a plan to help you keep moving forward.

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Summary of Information Pack A
We hope that this Information Pack has been useful in helping you change the behaviours that maintain yourdisordered eating and weight control measures. We encourage you to continue this challenging work, andto work through the next 7 modules of Information Pack B, in which we will help you change the unhelpful
thoughts that keep eating disorders going. Research has found that in order to overcome disordered eating,it is necessary to change not only unhealthy behaviours but unhealthy thoughts.
But before you embark on the next stage of your recovery, it might be useful to recap on what you havelearned so far in this Information Pack.
In Modules 1 and 2 we defined eating disorders as disturbed eating habits or weight control behaviours.
We described the various kinds of eating disorders and the impact that they have on people’s physicalhealth, as well as the emotional and social consequences. We described the theory that guides theinformation and suggestions in this information pack: Cognitive Behaviour Therapy (CBT). We explained
how engaging in disordered eating or weight control behaviours, even rarely, can lead to problems. We
helped you identify your own disordered eating and weight control behaviours. We discussed how thisinformation pack might be helpful in moving you back in the direction of health, but we highlighted thelimitations of using self-help materials. We urged you to go to your General Practitioner for a check-up if
you engage in any extreme eating or weight control behaviours and encouraged you to seek professional
help if you think you might have an eating disorder.
In Module 3 we looked at what keeps eating disorders going. We showed how people with eating disorders
tend to judge their self-worth based on their ability to control their eating, weight and shape. They use
various strategies in an effort to control these, including strict dietary rules and purging (vomiting or
misusing laxatives or diuretics). Breaking their rules is distressing and may result in “all-or-nothing” thinking
and binge eating, plus compensatory behaviours (fasting, purging and/or excessive exercise) often seen in
Bulimia Nervosa. Extreme weight loss can result in the “starvation syndrome” seen in Anorexia Nervosa.
All this makes up a vicious cycle (of disordered eating and weight control strategies) that keeps itself going.
In Modules 4 and 5 we introduced the strategy of self-monitoring (food records), and stressed the need tocomplete these in “real time”. We highlighted the importance of regular eating, i.e., eating every 3-4 hours.
This helps to break certain dietary rules, especially when to eat, and breaks the cycle of restricted eating,hunger and preoccupation with food that leads to binge eating. We also encouraged you to weigh yourself
only once a week to reduce your preoccupation with weight and shape and to reduce the impact of
misleading information.
In Module 6 we discussed binge eating, purging (vomiting and the misuse of laxatives or diuretics) anddriven exercise. We reminded you that dietary restraint results in hunger, which makes it more likely thatyou will binge. After a binge, many people resort to compensatory behaviours in an effort to rid themselvesof the food they have consumed in the binge. We explained how these extreme weight control behaviours
are not only ineffective but harmful.
In Module 7 we looked at the problem of managing intense negative moods. We introduced some skills to
help you cope better with negative emotions without resorting to binge eating (or purging or restricting
food or exercising excessively).
In Modules 8 we revisited dietary rules, looking at dietary restriction and dietary restraint. These lead topreoccupation with food and physiological hunger, which result in either binge eating or starvation, both ofwhich can be harmful. We examined residual binges and the fear of weight gain.

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Module Summary
•
•
•
•
•

At this stage it is useful to review your progress in changing your behaviours, in preparation for moving
on to changing your cognitions (thinking patterns) which we will cover in Information Pack B.
It is helpful to review your progress on each of the following behavioural changes: self-monitoring,
regular eating, and addressing binge eating, purging and driven exercise. Evaluate any problems that arepreventing you from making these changes.
Identify any barriers to progress. These include residual binge eating and fear of weight gain, as well asother obstacles and external factors.
Identify difficulties in motivation (using our change process balance worksheet).
Prepare yourself for working on the thought patterns (Information Pack B).

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 Information Pack B, we’ll begin to look at the thoughts thatkeep disordered eating going.

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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. Hons4)
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 AND REFERENCES
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 references:•••

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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