Can Self-Help Help My Eating Disorder?

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If you have bulimia nervosa, binge eating disorder, or subclinical versions of either of these, self-help may be beneficial.  Through the use of a manual, workbook, or web platform, a sufferer can work through a series of steps to learn about their problem and develop skills to overcome and manage their disorder.  Self-help, however, is not recommended for anorexia nervosa given the special medical needs of patients with this disorder.

Research shows that the enhanced version of cognitive behavioral therapy (CBT-E) is the treatment of choice for individuals with bulimia and binge eating disorder; outcome studies show that approximately 65% of people recover after 20 sessions of psychotherapy.  However, not everyone needs a full course of CBT-E to recover from binge eating disorder, bulimia, and other forms of disordered eating.  Researchers have proposed that individuals who have eating disorders start with the least-intensive appropriate treatment and then progress to more intensive treatments if there is no improvement.  In this stepped-care model, the starting point is self-help.

Self-help for eating disorders may be especially beneficial for those who cannot find a specialist treatment or for those who have difficulty accessing treatment.  Compared to other treatments, self-help is cost-effective.   It is also flexible and can be done on one’s own time.

In pure self-help, the patient works through the material entirely independent of the guidance of a professional.  In contrast, guided self-help consists of self-help plus the support of another person or facilitator who may not be a professional eating disorder therapist.  This support person can be, for example, a lay person or former sufferer; support can be delivered in a variety of formats, such as in-person, over the phone, by text message, or over the internet.

  The frequency of support can vary, but is usually less intensive than weekly psychotherapy. 

Pure self-help and guided self-help for eating disorders have proven effective for subsets of individuals with bulimia nervosa, binge eating disorder, and OSFED (Other Specified Feeding & Eating Disorder).  Of these, there is the most support for its use among  individuals with binge eating disorder.  There is more support for guided self-help than pure self-help.  Self-help has also been shown to be superior to no treatment. 

In 2013, Rutgers University’s Counseling Center began routinely offering guided self-help for eating disorders after a graduate student’s research proved this was a feasible and effective model.  In a two-year study Zandberg, the student trained a group of seven graduate psychology students who in turn provided guided self-help treatment to 38 students diagnosed with either bulimia nervosa or binge eating disorder. The support, which was based on cognitive behavioral therapy principles, was offered in 10, 25-minute sessions.  At the end of the 12-week program, 42 percent of the subjects experienced no binge episodes and 63 percent no longer met criteria for an eating disorder.

Should You Try Self-Help?

If you are underweight, have recently lost a significant amount of weight, or are suffering from anorexia or similar problems, self-help is not recommended – it is imperative that you seek professional help.  If you are experiencing disordered eating, binge eating disorder or bulimia nervosa, it is best to start by seeking medical and professional mental health treatment.  However, if specialized treatment is not available and/or your problem is not severe, you may want to start with one of the resources below.  Even if you are in some sort of treatment, you may want to consider one of the self-help resources as an adjunct; though it’s a good idea to discuss recovery-oriented books with your treatment team.

Most clinical trials for eating disorders (regardless of treatment studied) show that if there is no improvement by week 4, the individual is less likely to benefit from that treatment.  Thus, if after giving self-help a try, you are not showing progress by week 4, you should seek additional help or a higher level of treatment.  It is important to remember that many individuals do no not make a full recovery with self-help interventions alone.  This is not a reason to feel ashamed.  Eating disorders are pernicious and sometimes intractable illnesses. 

Recommended Reading

  • Overcoming Binge Eating (Fairburn, 1995), a truncated version of CBT-E treatment, is the self-help manual most frequently used in randomized controlled trials of guided self-help.  It has demonstrated effectiveness for bulimia nervosa, binge eating disorder, and EDNOS (eating disorder not otherwise specified, the predecessor diagnosis to OSFED) across multiple studies.  An updated version was published in 2013.  Overcoming Binge Eating has two sections. The first contains psycho-education about eating disorders and the second a six-step self-help program. Each step includes specific homework tasks (e.g. self-monitoring, regular eating, problem-solving) and checklists that allow participants to monitor their progress.
  • Overcoming Disordered Eating – Part A and Overcoming Disordered Eating – Part B comprise a self-help program available free for download for users worldwide through the Center for Clinical Interventions (CCI) of Western Australia.  CCI workbooks, made available as user-friendly pdf files, address a number of mental health disorders.  The eating disorder workbooks also closely follow the evidence-based CBT-E protocol.
  • (Apple & Agras, 2007).  This workbook also closely follows the CBT treatment manual for bulimia and binge-eating.  


DeBar, L., Striegel-Moore, R., Wilson, G.T., Perrin, N., Yarborough, B.J., Dickerson, J., Lynch, F., Roselli, F., & Kraemer, H.C. (2011).   Guided self-help treatment for recurrent binge eating: Replication and extension.  Psychiatric Services, 62, 367-373.

Ghaderi, A. and Scott, B. (2003). Pure and guided self-help for full and sub-threshold bulimia nervosa and binge eating disorder British Journal of  Clinical Psychology.  42 (3), 257-69.

Stefano, S., Bacaltchuk, J., Blay. S., Hay, P. Self-help treatments for disorders of recurrent binge eating: a systematic review.  Acta Psychiatrica Scandinavica, 113(6), 452-9.

Sysko, R. & Walsh, B.  (2008).  A critical evaluation of the efficacy of self-help interventions for the treatment of bulimia nervosa and binge eating disorder.  International Journal of Eating Disorders, 41, 97-112.

Zandberg, L.J., & Wilson, G.T. (2013).Train-the-Trainer: Implementation of cognitive behavioral guided self-help for recurrent binge eating in a naturalistic setting.  European Eating Disorders Review, 21, 230-237.

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