Greta Noordenbos is a Senior Researcher in the Department of Clinical Psychology, Leiden University, the Netherlands. Founder of the Dutch Commission for the Prevention of Eating Disorders, she has contributed to health policy in the field and has co-edited Dutch language titles Handbook of Eating Disorders (2008) and The Prevention of Eating Disorders (1998).

• About the Author x Foreword xiAcknowledgements xiiIntroduction 1When have Eating Disorder Patients Recovered? 2Can All Patients Recover from their Eating Disorder? 3Recovered Patients as Guides and Role Models 3Content of the Book 3A Book for Both Clinicians and Clients 4How Therapists and other Professionals may Use this Book 4How Eating Disorder Patients may Use this Book 5How Parents, Partners and Friends may Use this Book 61 Problems in the Period before the Eating Disorder 7Introduction 7Lack of Self-Esteem and Negative Self-Evaluation 8Compliant and Pleasing Behaviour 8Hiding Real Thoughts and Opinions from others 9Sensitivity to the Needs of others 10Perfectionism and Fear of Failure 11Inner Criticism and Negative Self-Evaluation 11Impaired Identity Development 12Stages in the ego and identity development 13Negative Body Attitude 13Questionnaire about problems in the period before the eating disorder 14Questions about problems and risk factors 15Summary 152 First Stage: Extreme Dieting 17Introduction 17How does an Eating Disorder Start? 17Differences Between Healthy and Extreme Dieters 19Questions about your reasons for going on a diet 19From Healthy to Extreme Dieting 20Questions about your dieting patterns 21Why Continue Dieting? 22Eating Disorder or Identity Disorder? 23Control over Food and Body 24Denial of Problems 25Summary 263 Negative Consequences of Eating Disorders 27Introduction 27Losing Control over Eating Habits 27The Trap of Extreme Dieting 29Eating Disorder: From Friend to Enemy 29Rigid Rules and Obsessive-Compulsive Behaviour 30Indoctrination and Brainwashing 31Inner Criticism and Critical Voices 32The Toxic Effects of Starvation 35Depression and Suicidal Thoughts 36Questionnaire about psychological consequences 37Isolation 38Questionnaire about social consequences 39Physical consequences 39Questionnaire about physical consequences 41Summary 424 Turning Point and Motivation for Recovery 43Introduction 43The Deep Pit 44Turning Point 45Ambivalent Motivation for Change 47Fear of Asking for Help 48Questionnaires to Improve Motivation for Treatment 50Questionnaire about improving eating habits 50Motivation for Physical Recovery 51Questionnaire about motivation for physical recovery 51Motivation for More Self-Esteem 52Questionnaire about motivation for more self-esteem 52Motivation for a more Positive Body Attitude 52Questionnaire about motivation to improve body attitude 53Motivation for Better Emotion Regulation 53Questionnaire about motivation for better emotion regulation 53Motivation for Better Social Relationships 54Questionnaire about motivation for improving social relationships 54Motivation for Reducing Financial Problems 55Questionnaire about motivation for reducing financial problems 55Summary 565 Normalizing Eating Habits 57Introduction 57Overcoming the Fear of Increasing Food Intake 58Changing Cognitions about Food 60Three Regular Meals a Day 62Regular Mealtimes 63Reduction of Binges 64Reduction of Purging 66Healthy and Sufficient Food 68Reduction of Laxatives, Diuretics and Slimming Pills 69A: Stopping the laxatives immediately 69B: Gradual reduction of laxatives 70Drinking Water and other Liquids 70No Extreme Exercising 71Treatment of Comorbidity 72Questionnaire about improving eating habits 72Summary 736 A Positive Body Attitude 74Introduction 74Not Feeling Fat 74No Longer Obsessed by Food and Weight 76Being Able to Listen to Feelings of Hunger and Satiety 77Developing a Positive Body Attitude 79Assignment: Focus on positive aspects of your body 81Assignment: Positive body evaluation 81Learning Defence Strategies against Teasing 82Assignment: Defence against teasing 83Losing the Urge to Diet 84Assignment: Strategies to feel better 85Questionnaire about a better body attitude 86Summary 867 Physical Recovery 88Introduction 88Normal and Stable Weight 88Regular Periods 90Normal Body Temperature 91Normal Heartbeat and Pulse 91No Anaemia 92No Constipation 93No Problems with Bowels and Stomach 94No more Swollen Salivary Glands and Sore Throat 94Healthy Skin 95Healthy Teeth 95Enough Sleep 96Enough Energy 97Reduction of Osteoporosis 98Questionnaire about physical recovery 99Summary 1008 Developing More Self-Esteem 101Introduction 101More Self-Esteem 101Assignment: Training positive thinking 103Empowering Yourself 104Become More Assertive 104Assignment: Becoming more assertive 105Less Emphasis on Pleasing others 106Having Less Fear of Rejection 107Assignment: Defending yourself against critical comments 108Showing Less Compliant Behaviour 108Assignment: Listening to one’s own feelings and desires 109Having Less Perfectionism and Fear of Failure 110Questionnaire about improving psychological well-being 111Summary 1129 Expressing Emotions 113Introduction 113No Longer Avoiding Negative Emotions 114Assignment: Feeling and expressing emotions 115Reduction of Critical Thoughts and Inner Voices 116Assignment: Defence against inner critical thoughts 118Assignment: Developing ideal compassion image and feelings 119Recognizing and Expressing Emotions 120Dare to Express Different Opinions 122Assignment: Coping with different opinions and conflicts 123No Longer Feeling Depressed 124Questionnaire about improving emotion regulation 126Summary 12610 Improving Social Relations 127Introduction 127Learning to Trust other People 128Participating in Social Activities 129Education and Career 131Intimate Relations 134Pregnancy and Children 136Questionnaire about developing better social contacts 137Summary 13711 The Most Important Questions and Answers about Recovery 139Introduction 139When have Eating Disorder Patients Recovered? 139How many Patients Recover from their Eating Disorder? 140Why do Not All Patients Recover? 141How can the Recovery Rate Increase? 142Do All Patients have a Relapse? 142How long does it Take to Recover from an Eating Disorder? 143What are the Important Goals for Treatment? 144Which Treatments are Most Effective? 144What Makes a Good Therapist? 145Summary 14612 Checklist for Full Recovery 148Introduction 148A. Questionnaire about healthy eating habits 148B. Questionnaire about positive body attitude 149C. Questionnaire about physical recovery 149D. Questionnaire about psychological recovery 150E. Questionnaire about coping better with emotions 150F. Questionnaire about better social relationships 151Conclusion 152References 153Index 159

"Overall, this is a very readable book that will be useful to both early-career and experienced clinical psychologists who want to develop strategies for their clinical work and understand the service-user position whilst benefitting from up-to-date research and developments in the eating disorder field."   (The British Psychological Society, 1 August 2013)

Greta Noordenbos is a Senior Researcher in the Department of Clinical Psychology, Leiden University, the Netherlands. Founder of the Dutch Commission for the Prevention of Eating Disorders, she has contributed to health policy in the field and has co-edited Dutch language titles Handbook of Eating Disorders (2008) and The Prevention of Eating Disorders (1998).

• About the Author x Foreword xiAcknowledgements xiiIntroduction 1When have Eating Disorder Patients Recovered? 2Can All Patients Recover from their Eating Disorder? 3Recovered Patients as Guides and Role Models 3Content of the Book 3A Book for Both Clinicians and Clients 4How Therapists and other Professionals may Use this Book 4How Eating Disorder Patients may Use this Book 5How Parents, Partners and Friends may Use this Book 61 Problems in the Period before the Eating Disorder 7Introduction 7Lack of Self-Esteem and Negative Self-Evaluation 8Compliant and Pleasing Behaviour 8Hiding Real Thoughts and Opinions from others 9Sensitivity to the Needs of others 10Perfectionism and Fear of Failure 11Inner Criticism and Negative Self-Evaluation 11Impaired Identity Development 12Stages in the ego and identity development 13Negative Body Attitude 13Questionnaire about problems in the period before the eating disorder 14Questions about problems and risk factors 15Summary 152 First Stage: Extreme Dieting 17Introduction 17How does an Eating Disorder Start? 17Differences Between Healthy and Extreme Dieters 19Questions about your reasons for going on a diet 19From Healthy to Extreme Dieting 20Questions about your dieting patterns 21Why Continue Dieting? 22Eating Disorder or Identity Disorder? 23Control over Food and Body 24Denial of Problems 25Summary 263 Negative Consequences of Eating Disorders 27Introduction 27Losing Control over Eating Habits 27The Trap of Extreme Dieting 29Eating Disorder: From Friend to Enemy 29Rigid Rules and Obsessive-Compulsive Behaviour 30Indoctrination and Brainwashing 31Inner Criticism and Critical Voices 32The Toxic Effects of Starvation 35Depression and Suicidal Thoughts 36Questionnaire about psychological consequences 37Isolation 38Questionnaire about social consequences 39Physical consequences 39Questionnaire about physical consequences 41Summary 424 Turning Point and Motivation for Recovery 43Introduction 43The Deep Pit 44Turning Point 45Ambivalent Motivation for Change 47Fear of Asking for Help 48Questionnaires to Improve Motivation for Treatment 50Questionnaire about improving eating habits 50Motivation for Physical Recovery 51Questionnaire about motivation for physical recovery 51Motivation for More Self-Esteem 52Questionnaire about motivation for more self-esteem 52Motivation for a more Positive Body Attitude 52Questionnaire about motivation to improve body attitude 53Motivation for Better Emotion Regulation 53Questionnaire about motivation for better emotion regulation 53Motivation for Better Social Relationships 54Questionnaire about motivation for improving social relationships 54Motivation for Reducing Financial Problems 55Questionnaire about motivation for reducing financial problems 55Summary 565 Normalizing Eating Habits 57Introduction 57Overcoming the Fear of Increasing Food Intake 58Changing Cognitions about Food 60Three Regular Meals a Day 62Regular Mealtimes 63Reduction of Binges 64Reduction of Purging 66Healthy and Sufficient Food 68Reduction of Laxatives, Diuretics and Slimming Pills 69A: Stopping the laxatives immediately 69B: Gradual reduction of laxatives 70Drinking Water and other Liquids 70No Extreme Exercising 71Treatment of Comorbidity 72Questionnaire about improving eating habits 72Summary 736 A Positive Body Attitude 74Introduction 74Not Feeling Fat 74No Longer Obsessed by Food and Weight 76Being Able to Listen to Feelings of Hunger and Satiety 77Developing a Positive Body Attitude 79Assignment: Focus on positive aspects of your body 81Assignment: Positive body evaluation 81Learning Defence Strategies against Teasing 82Assignment: Defence against teasing 83Losing the Urge to Diet 84Assignment: Strategies to feel better 85Questionnaire about a better body attitude 86Summary 867 Physical Recovery 88Introduction 88Normal and Stable Weight 88Regular Periods 90Normal Body Temperature 91Normal Heartbeat and Pulse 91No Anaemia 92No Constipation 93No Problems with Bowels and Stomach 94No more Swollen Salivary Glands and Sore Throat 94Healthy Skin 95Healthy Teeth 95Enough Sleep 96Enough Energy 97Reduction of Osteoporosis 98Questionnaire about physical recovery 99Summary 1008 Developing More Self-Esteem 101Introduction 101More Self-Esteem 101Assignment: Training positive thinking 103Empowering Yourself 104Become More Assertive 104Assignment: Becoming more assertive 105Less Emphasis on Pleasing others 106Having Less Fear of Rejection 107Assignment: Defending yourself against critical comments 108Showing Less Compliant Behaviour 108Assignment: Listening to one’s own feelings and desires 109Having Less Perfectionism and Fear of Failure 110Questionnaire about improving psychological well-being 111Summary 1129 Expressing Emotions 113Introduction 113No Longer Avoiding Negative Emotions 114Assignment: Feeling and expressing emotions 115Reduction of Critical Thoughts and Inner Voices 116Assignment: Defence against inner critical thoughts 118Assignment: Developing ideal compassion image and feelings 119Recognizing and Expressing Emotions 120Dare to Express Different Opinions 122Assignment: Coping with different opinions and conflicts 123No Longer Feeling Depressed 124Questionnaire about improving emotion regulation 126Summary 12610 Improving Social Relations 127Introduction 127Learning to Trust other People 128Participating in Social Activities 129Education and Career 131Intimate Relations 134Pregnancy and Children 136Questionnaire about developing better social contacts 137Summary 13711 The Most Important Questions and Answers about Recovery 139Introduction 139When have Eating Disorder Patients Recovered? 139How many Patients Recover from their Eating Disorder? 140Why do Not All Patients Recover? 141How can the Recovery Rate Increase? 142Do All Patients have a Relapse? 142How long does it Take to Recover from an Eating Disorder? 143What are the Important Goals for Treatment? 144Which Treatments are Most Effective? 144What Makes a Good Therapist? 145Summary 14612 Checklist for Full Recovery 148Introduction 148A. Questionnaire about healthy eating habits 148B. Questionnaire about positive body attitude 149C. Questionnaire about physical recovery 149D. Questionnaire about psychological recovery 150E. Questionnaire about coping better with emotions 150F. Questionnaire about better social relationships 151Conclusion 152References 153Index 159

"Overall, this is a very readable book that will be useful to both early-career and experienced clinical psychologists who want to develop strategies for their clinical work and understand the service-user position whilst benefitting from up-to-date research and developments in the eating disorder field."   (The British Psychological Society, 1 August 2013)

Greta Noordenbos is a Senior Researcher in the Department of Clinical Psychology, Leiden University, the Netherlands. Founder of the Dutch Commission for the Prevention of Eating Disorders, she has contributed to health policy in the field and has co-edited Dutch language titles Handbook of Eating Disorders (2008) and The Prevention of Eating Disorders (1998).

• About the Author x Foreword xiAcknowledgements xiiIntroduction 1When have Eating Disorder Patients Recovered? 2Can All Patients Recover from their Eating Disorder? 3Recovered Patients as Guides and Role Models 3Content of the Book 3A Book for Both Clinicians and Clients 4How Therapists and other Professionals may Use this Book 4How Eating Disorder Patients may Use this Book 5How Parents, Partners and Friends may Use this Book 61 Problems in the Period before the Eating Disorder 7Introduction 7Lack of Self-Esteem and Negative Self-Evaluation 8Compliant and Pleasing Behaviour 8Hiding Real Thoughts and Opinions from others 9Sensitivity to the Needs of others 10Perfectionism and Fear of Failure 11Inner Criticism and Negative Self-Evaluation 11Impaired Identity Development 12Stages in the ego and identity development 13Negative Body Attitude 13Questionnaire about problems in the period before the eating disorder 14Questions about problems and risk factors 15Summary 152 First Stage: Extreme Dieting 17Introduction 17How does an Eating Disorder Start? 17Differences Between Healthy and Extreme Dieters 19Questions about your reasons for going on a diet 19From Healthy to Extreme Dieting 20Questions about your dieting patterns 21Why Continue Dieting? 22Eating Disorder or Identity Disorder? 23Control over Food and Body 24Denial of Problems 25Summary 263 Negative Consequences of Eating Disorders 27Introduction 27Losing Control over Eating Habits 27The Trap of Extreme Dieting 29Eating Disorder: From Friend to Enemy 29Rigid Rules and Obsessive-Compulsive Behaviour 30Indoctrination and Brainwashing 31Inner Criticism and Critical Voices 32The Toxic Effects of Starvation 35Depression and Suicidal Thoughts 36Questionnaire about psychological consequences 37Isolation 38Questionnaire about social consequences 39Physical consequences 39Questionnaire about physical consequences 41Summary 424 Turning Point and Motivation for Recovery 43Introduction 43The Deep Pit 44Turning Point 45Ambivalent Motivation for Change 47Fear of Asking for Help 48Questionnaires to Improve Motivation for Treatment 50Questionnaire about improving eating habits 50Motivation for Physical Recovery 51Questionnaire about motivation for physical recovery 51Motivation for More Self-Esteem 52Questionnaire about motivation for more self-esteem 52Motivation for a more Positive Body Attitude 52Questionnaire about motivation to improve body attitude 53Motivation for Better Emotion Regulation 53Questionnaire about motivation for better emotion regulation 53Motivation for Better Social Relationships 54Questionnaire about motivation for improving social relationships 54Motivation for Reducing Financial Problems 55Questionnaire about motivation for reducing financial problems 55Summary 565 Normalizing Eating Habits 57Introduction 57Overcoming the Fear of Increasing Food Intake 58Changing Cognitions about Food 60Three Regular Meals a Day 62Regular Mealtimes 63Reduction of Binges 64Reduction of Purging 66Healthy and Sufficient Food 68Reduction of Laxatives, Diuretics and Slimming Pills 69A: Stopping the laxatives immediately 69B: Gradual reduction of laxatives 70Drinking Water and other Liquids 70No Extreme Exercising 71Treatment of Comorbidity 72Questionnaire about improving eating habits 72Summary 736 A Positive Body Attitude 74Introduction 74Not Feeling Fat 74No Longer Obsessed by Food and Weight 76Being Able to Listen to Feelings of Hunger and Satiety 77Developing a Positive Body Attitude 79Assignment: Focus on positive aspects of your body 81Assignment: Positive body evaluation 81Learning Defence Strategies against Teasing 82Assignment: Defence against teasing 83Losing the Urge to Diet 84Assignment: Strategies to feel better 85Questionnaire about a better body attitude 86Summary 867 Physical Recovery 88Introduction 88Normal and Stable Weight 88Regular Periods 90Normal Body Temperature 91Normal Heartbeat and Pulse 91No Anaemia 92No Constipation 93No Problems with Bowels and Stomach 94No more Swollen Salivary Glands and Sore Throat 94Healthy Skin 95Healthy Teeth 95Enough Sleep 96Enough Energy 97Reduction of Osteoporosis 98Questionnaire about physical recovery 99Summary 1008 Developing More Self-Esteem 101Introduction 101More Self-Esteem 101Assignment: Training positive thinking 103Empowering Yourself 104Become More Assertive 104Assignment: Becoming more assertive 105Less Emphasis on Pleasing others 106Having Less Fear of Rejection 107Assignment: Defending yourself against critical comments 108Showing Less Compliant Behaviour 108Assignment: Listening to one’s own feelings and desires 109Having Less Perfectionism and Fear of Failure 110Questionnaire about improving psychological well-being 111Summary 1129 Expressing Emotions 113Introduction 113No Longer Avoiding Negative Emotions 114Assignment: Feeling and expressing emotions 115Reduction of Critical Thoughts and Inner Voices 116Assignment: Defence against inner critical thoughts 118Assignment: Developing ideal compassion image and feelings 119Recognizing and Expressing Emotions 120Dare to Express Different Opinions 122Assignment: Coping with different opinions and conflicts 123No Longer Feeling Depressed 124Questionnaire about improving emotion regulation 126Summary 12610 Improving Social Relations 127Introduction 127Learning to Trust other People 128Participating in Social Activities 129Education and Career 131Intimate Relations 134Pregnancy and Children 136Questionnaire about developing better social contacts 137Summary 13711 The Most Important Questions and Answers about Recovery 139Introduction 139When have Eating Disorder Patients Recovered? 139How many Patients Recover from their Eating Disorder? 140Why do Not All Patients Recover? 141How can the Recovery Rate Increase? 142Do All Patients have a Relapse? 142How long does it Take to Recover from an Eating Disorder? 143What are the Important Goals for Treatment? 144Which Treatments are Most Effective? 144What Makes a Good Therapist? 145Summary 14612 Checklist for Full Recovery 148Introduction 148A. Questionnaire about healthy eating habits 148B. Questionnaire about positive body attitude 149C. Questionnaire about physical recovery 149D. Questionnaire about psychological recovery 150E. Questionnaire about coping better with emotions 150F. Questionnaire about better social relationships 151Conclusion 152References 153Index 159

"Overall, this is a very readable book that will be useful to both early-career and experienced clinical psychologists who want to develop strategies for their clinical work and understand the service-user position whilst benefitting from up-to-date research and developments in the eating disorder field."   (The British Psychological Society, 1 August 2013)