Art Therapy For Eating Disorders

  • Valentina Torres MonserratMaster's degree awarded by Argentine Society of Reproductive Medicine, Developmental biology and human embryology
  • Regina LopesSenior Nursing Assistant, Health and Social Care, The Open University

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Overview

Eating disorders (ED) are complex health conditions which affect a person’s eating behaviours. They can occur in anyone regardless of gender and age. The causative factors include mental health illness such as excessive stress, and biological, medical or sociocultural factors.1 Since the underlying mechanisms of EDs are highly correlated to psychological factors, holistic approaches to the treatment become increasingly essential.

Therefore, art therapies have the potential to be an innovative way to combat EDs through the exploration of the patient’s emotions and thoughts. They typically involve using artistic expression as a means to express and address the underlying emotional, psychological, and relational issues that affect the disorders of eating behaviours.2

Understanding eating disorders

The most common EDs are anorexia nervosa (AN), bulimia nervosa (BN) and binge eating disorders (BED). Studies show that there is a worrying increase in ED occurrence from 3.5% from 2000-2006 to 7.8% in the 2013-2018 period.3 National Eating Disorder Association (NEDA) reported that in the United States alone, 30 million people are suffering from EDs.

Although there are many speculations on the sudden increase of EDs worldwide, experts suggest that it may be due to the recent advancement of technology, particularly social media. The popularity of social media has the potential to make its users more self-conscious about their body image and pressure to conform to gender stereotypes. 

Types of eating disorders

ED symptoms include being overly self-conscious of body weight and as a result, eating very little or uncontrollably. According to the National Health Service (NHS), ED is a psychological condition where a person uses the control of food as a coping mechanism for dealing with their own emotions or various life situations. These features characterise ED as a mental illness because the cause of the disorder does not rely on the ability of the body to get enough nutrition but rather due to psychological distress, obsessing with weight gain or loss and excessive exercise.

Therefore, the National Institute of Mental Health (NIMH) categorises ED as a biologically-influenced medical illness. Although EDs can occur in anyone, young adults and teenagers are more susceptible. It is crucial to remember that a person with an ED may appear physically healthy while suffering from the illness concurrently.

Anorexia nervosa

Anorexia nervosa (AN) is a condition where people avoid eating, only eating a small amount of food or obsessively calculating the caloric intake of food. They may also be obsessed with their weight, continuously weighing themselves throughout the day because they see themselves as overweight. There are two types of AN: binge-purge and restrictive types. Although a person restricts the food intake in both types, in the binge-purge type, there may be episodes of consuming food excessively in a short period and induce vomiting or taking a laxative to remove the food. 

Consequences of AN include:

  • Low blood pressure
  • Muscle weakness
  • Brittle nails and hair
  • Yellow discolouration of the skin
  • Feeling tiredness all the time
  • Multiple organ failure

Bulimia nervosa

Bulimia nervosa (BN) is a disorder characterised by repeated episodes of uncontrollably eating an excessive amount of food. After eating, the individual may feel regret and try to force out of the food by inducing vomiting, taking a laxative, exercising intensively or doing all of the actions together. Different from AN, patients with BN may appear normal weight or overweight.

Consequences of BN include:

  • Sore throat 
  • Gastrointestinal problems
  • Sensitive teeth (due to exposure to stomach acid while vomiting)
  • Dehydration
  • Irregular levels of electrolytes such as calcium and minerals imbalance
  • Stroke 
  • Heart attack

Binge eating disorder

Binge eating disorder (BED) is a disease where a person eats a large amount of food during a short period and loses the control to stop eating. Unlike BN, BED patients may not try to induce vomiting or excessive exercise.4 According to the NHS, patients may feel ashamed and disgusted with themselves after eating. So, they try to eat alone or very discreetly quickly to hide the quantity of food they are consuming.

Causes and risk factors

There are a variety of causes of ED. They can be categorised into three groups: biological factors, psychological factors and sociocultural factors.

Biological factors include:

  • Hormone imbalance influencing appetite and body weight
  • Family history of ED and genetic traits
  • Defects in neurochemical signalling affecting appetite

Psychological factors include:

  • Mental illnesses such as depression and anxiety
  • Low confidence and dissatisfaction with body image
  • Coping mechanism for stress, negative emotions and trauma

Sociocultural factors include:

  • Peer and Society influence on appearance
  • Social media influence on achieving unrealistic beauty standard
  • Pressure from cultural standards of attractiveness1 

Art therapy

According to the American Art Therapy Association, art therapy can be defined as the mental health profession to improve the physical, mental and emotional well-being of individuals by using the creative process of art-making. This treatment method is developed by the combined effort of psychotherapists, educators and artists after identifying the importance of imaginative creation, metaphor and non-verbal communication.3 The most prominent advantage of art therapy is that it can be used to treat patients regardless of age, gender and disability. 

Types of arts therapy:

  • Art therapy
  • Music therapy
  • Drama therapy
  • Movement or Dance therapy
  • Expressive therapy1

The role of art therapy in eating disorder treatment

Art therapy can play a crucial role in treating eating disorders by providing a non-verbal and creative outlet for individuals to express their emotions and experiences. Through art-making, individuals can explore their relationship with food, body image, and self-esteem in a non-threatening and supportive environment. Additionally, art therapy can help individuals develop healthy coping strategies and improve self-awareness, which are essential for long-term recovery from eating disorders.1 

During the treatment, patients can express their inner complex emotions related to eating disorders through their art. Another key aspect of the treatment lies in the ability to address body image issues which is a difficult challenge for ED patients. By actively encouraging them to express their perception of their body, it will become a powerful tool to help reshape distorted body image.

Art therapy is delivered by art therapists who are trained clinicians with master's or higher degrees. The treatment is provided in independent clinics, medical institutions, schools and wellness centres. The relationship built between the art therapist and the patients plays a crucial role in the results of the treatment. This forms a zero judgement space where a patient can share their experiences and emotions openly.

Art therapy techniques for eating disorders

There are a few techniques which can be incorporated into the ED treatment plan. 

  • Visual journaling
  • Collage making
  • Sculpture and clay work
  • Guided drawing and painting
  • Group art therapy sessions5

Benefits of art therapy in eating disorder recovery

  • Improving self-esteem and self-awareness
  • Better control of emotions
  • Coping with stress and traumas
  • Developing the perception of body image

Challenges and considerations

While art therapy can be greatly beneficial, there are also challenges and considerations to be mindful of. These may include the need for trained and experienced art therapists, navigating resistance to artistic expression and ensuring the safety and emotional well-being of patients during art-creation processes. By addressing these aspects, art therapy can be integrated effectively into the treatment of eating disorders, offering individuals a valuable pathway towards healing and recovery.1 

FAQ's

What are the steps in art therapy?

Firstly, an art therapist will make an initial assessment of the patient to determine medical history, problems, concerns, and aims that the patient wants to achieve and their willingness to continue with the therapy. Once therapy starts, the patient will participate in creating an art form such as a painting or a clay work, while being observed and asked questions from time to time by the therapist.

After the creation process, the therapist will discuss with the patient their work and the emotions they feel during the session. Lastly, the therapist will provide feedback from their observations to the patient. 

What does art therapy help with?

Art therapy can improve physical, mental and emotional well-being. It allows an individual to better express their inner feelings and improve interpersonal relationships. It can also enhance self-perception of the body image and therefore, is highly beneficial for eating disorder treatments.

Can you do art therapy on your own?

Since the process of art creation can help you relax and decrease your stress level, it is helpful to do drawing or journaling if you are having a bad day. Crucially, art therapy must only be delivered by trained art therapists.

Summary

Eating disorders are complicated diseases and can manifest in many forms. Although an individual may appear healthy, they can still be suffering from an ED. Without proper initiation of treatment, some of the EDs such as Anorexia Nervosa can be fatal. Art therapy is an emerging treatment for EDs, aims to focus on underlying psychology and offers a person the chance to freely express their emotions in a safe environment. Therefore making it a powerful tool for positive influence on the path to recovering from eating disorders.

References

  1. Bucharová M, Malá A, Kantor J, Svobodová Z. Arts Therapies Interventions and Their Outcomes in the Treatment of Eating Disorders: Scoping Review Protocol. Behavioral Sciences [Internet]. 2020 [cited 2024 Feb 14]; 10(12):188. Available from: https://www.mdpi.com/2076-328X/10/12/188
  2. Galmiche M, Déchelotte P, Lambert G, Tavolacci MP. Prevalence of eating disorders over the 2000–2018 period: a systematic literature review. The American Journal of Clinical Nutrition [Internet]. 2019 [cited 2024 Feb 14]; 109(5):1402–13. Available from: https://linkinghub.elsevier.com/retrieve/pii/S000291652203177X
  3. Karkou V, Sanderson P. Arts therapies: a research-based map of the field. Edinburgh ; New York: Elsevier Churchill Livingstone; 2006.
  4. Hilbert A. Binge-Eating Disorder. Psychiatric Clinics of North America [Internet]. 2019 [cited 2024 Feb 14]; 42(1):33–43. Available from: https://www.sciencedirect.com/science/article/pii/S0193953X18311699
  5. Brooke SL. The creative therapies and eating disorders. Springfield, Ill.: Charles C. Thomas; 2008.

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This content is purely informational and isn’t medical guidance. It shouldn’t replace professional medical counsel. Always consult your physician regarding treatment risks and benefits. See our editorial standards for more details.

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Thandar Khaing

BSc. Biological Sciences, University of Leeds

I am a final year student at the University of Leeds, studying Biological Sciences. I am particularly interested in medical communication and have a passion for creating health and beauty-related content.

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