Eating Disorders

The Role of Clinical Hypnosis in the Treatment of Eating Disorders

Hypnotizability in eating disordered populations can be viewed as a personality trait as well as ability. In addition to hypnotic performance, in the literature hypnotizability correlates with eating disorders. In eating disordered populations, bulimics are significantly more hypnotizable than anorexics; anorexics of the purging subtype generally are more hypnotizable than restricting anorexics.

In one study, researchers found that 73% of 30 bulimic patients were moderately to highly hypnotizable. They also studied hypnotizability in bulimic populations and confirmed previous findings of hypnotizability in this population. In another study of bulimic patients, researchers found that bulimics were highly hypnotizable when compared with other psychiatric patients and show high dissociative ability. High hypnotizables are hypersensitive to psychological and physiological changes. They generally have superior sensory memory and have a superior ability to transfer information from sensory memory to short term memory. This ability could be used to rapidly learn and retain operant anxiety. This is the possible reason that bulimics find strong emotion or feelings intolerable for them.

In 1986 H. M. Pettinati reported that having the ability to experience dissociation may be a relevant factor in regards to the high hypnotizability found in bulimic patients. Clinicians have compared the acts of binge eating and purging to dissociative experiences.

In another group of 30 bulimics, 75% had experienced dissociation. Dissociation has not been found to be a feature of anorexia nervosa of the restricting type. Researchers found higher scores in bulimics and purging anorexics on the Dissociation Questionnaire (DIS-Q. They reported that hypnotizability and dissociation can be related to body image distortion which is common in both anorexia and bulimia nervosa. An individual who is highly hypnotizable can easily absorb or internalize the messages from society that promote a slim body shape as the ideal. This is the factor that is known as suggestibility. Internalization of the thin body ideal leads to body dissatisfaction.

Both anorexics and bulimics have been found to have equivalent body image disturbances; both populations overestimate their body size. This population utilizes restrained eating as a strategy to meet society’s ideal and also to reduce negative affect.

Many anorexics are of low hypnotic ability and as a result they frequently demonstrate a hyposensitivity to psychological and physiological changes, a tendency to deny psychological causation of behavior, and a propensity to remain in denial of the severity of their illness. The anorexic that is low in hypnotic ability is subject to stress disorders because he or she is relatively insensitive to or deficient in attention to relationships between psychological states and physiological states. They have a psychological insensitivity to changes in mood and feelings. They have a lack of proprioceptive or interoceptive awareness which means they lack the ability to discriminate between different feeling states in the body, such as being hungry and being full. Many anorexics are alexithymic, meaning they have no words for moods.

Clinical hypnosis can be one of the most effective interventions in the treatment of eating disordered clients. Rapport must first be established as clients can view hypnosis as something that is going to take away their perceived control. Relaxation is the best place to start. Teaching relaxation techniques while the client is in an altered state is not only effective but also helps the client intensify the transference with the clinician. Hypnosis can be used to build ego strength and used in ego integration, to modify eating disordered behaviors, to alter body distortion, to teach sensitivity to being hungry and full, and age progression. Age regression should be used rarely and then only by an experienced hypnotherapist as many underlying issues may surface before the client is ready to deal with them.

The addition of clinical hypnosis by a skilled professional greatly enhances the treatment of an eating disordered client. Clients find that hypnosis actually helps them regain control and maintain a healthy weight.

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Hypnotherapy for Bulimia

As we can see below, Hypnotherapy, or hypnosis, is a well researched, safe, side effect free way of treating Bulimia Nervosa.

Griffiths treated bulimic patients with 4 weeks of behavioral therapy highlighting self-monitoring to establish healthy eating patterns, followed by 4 weeks of hypnotherapy to enhance self-control of bingeing and vomiting episodes. There was a significant reduction in both bingeing and vomiting measured in 6 weeks and in two years. Eight of the 14 participants (57%) were abstinent from bingeing and 10 (71%) were abstinent from vomiting for 3 months prior to the 2-year follow-up. These results suggest that adding a self-hypnosis component subsequent to a behavioral treatment may aid participants in maintaining their progress.

bulimiaThe addition of hypnosis to Cognitive Behavioral Therapy (CBT) revealed significantly less binge frequency and compensatory behavior frequency at posttreatment among the CBT+Hypnosis group than the CBT group (Barga & Barabasz (in press). The hypnotic suggestions were built based on Barabasz’s work (1990) on posthypnotic suggestions for creating awareness in individuals with bulimia which included (a) triggers precipitating urges to binge and to engage in compensatory behaviors, (b) negative consequences of bingeing/engaging in compensatory behaviors and benefits of not bingeing/not engaging in compensatory behaviors, (c) the participant’s control and choice over bingeing and engaging in compensatory behaviors, and (d) rational thinking about the participant’s body weight and shape. The participants were instructed to practice these hypnotic suggestions at least once daily.

Maryelln Crowley and Anna Campion reviewing the treatment of bulimia and obesity in the book Essentials of Clinical Hypnosis: An Evidence-Based Approach, edited by Lynn and Kirsh (2006) described how hypnosis can be used as an adjunct to cognitive-behavior therapy for bulimia. Their treatment protocol includes three stages. In stage one of ten sessions, in addition to education, development of alternative methods of weight control and teaching self-monitoring, hypnosis can be used with posthypnotic suggestions for self-monitoring of dysfunctional behavior and focusing on the benefits of change. Hypnosis can also help clients become more interpersonally oriented and less focused on food and eating behavior. Stage two consists of eight sessions focusing on cognitive restructuring aimed to reinforce that the root of the problem, is very often, extreme dietary rules. The hypnotic component is used to help clients reintroduce forbidden foods gradually and with control. Stage three is oriented to helping clients to set realistic expectations and develop plans to deal with urges to binge or purge. Thus, hypnosis can be a valuable adjunct to behavior and cognitive therapy of bulimia.

Treatment of bulimia with hypnosis involving awareness and control in clients with high dissociative capacity. International Journal of Psychosomatics, 37, 53-56.

Barga, J & Barabasz, M (in press). Effects of Hypnosis as an adjunct to Cognitive-Behavior therapy in the treatment of Bulimia. International Journal of Clinical and Experimental Hypnosis. In Barabasz, M (2007) Efficacy of hypnotherapy in the treatment of Eating Disorders. International Journal of Clinical and Experimental Hypnosis, 55(3):318-335.

Griffifths, RA. (1995) Two-year follow-up findings of hypnobehavioral treatment for bulimia nervosa. Australian Journal of Clinical and Experimental Hypnosis, 23 (2), 135-144.

Lynn SJ & Kirsch I (2006) Essentials of clinical Hypnosis: An evidence-based approach. Washington, D.C.: American Psychological Association.

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Hypnotherapy and Bulimia

In an age when young people, especially girls and young women, are subjected to pressure from many directions to conform to a stereotypical – usually unnaturally thin – image, it’s not surprising that eating disorders are on the rise.

In an article titled, ‘Can Hypnosis End Bulimia?’ published in the Magazine for Hypnosis and Hypnotherapy, Bryan M Knight MSW Phd, says, Hypnosis provides a quick route to the cause of an individual’s bulimia. This is because hypnosis allows direct communication with the sufferer’s subconscious. And the subconscious knows what is at the root of the problem. 

Sometimes this is a single event (terrifying sexual abuse, for example); more often there is a series of traumas or conflicts. Each such event builds on the previous ones until the psychological torment becomes intolerable.” 

The traumas or conflicts Bryan talks about can become reinforced over time by social, media and peer pressures, often resulting in an eating disorder.

Hypnotherapy, a combination of hypnosis and other therapeutic techniques, is increasingly recognized as an effective and side-effect free way to address the underlying causes of eating disorders such as bulimia.

You can read Bryan’s article here.

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