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HerSHenSon

Eating disorders have historically been characterized as an illness 
affecting adolescent, middle- to upper-class, able-bodied, white female 

individuals; thus, early academic research tended to dismiss the prevalence of  
eating disorders in people who fell outside these categories—such as people 
with disabilities (Striegel-Moore & Bulik, 2007; Striegel-Moore & Smolak, 
2001; Tiggeman & Lynch, 2001). Although studies and clinical observations 
suggest that individuals with physical disabilities are actually at increased risk 
for developing eating disorders, there is little awareness of  how to treat and 
prevent eating disorders among this population (Gross, Ireyes, & Kinsman, 
2000). Unique stressors, such as body-image disturbances due to the disability, 
feelings of  lack of  control due to dependency on others, and an emphasis 
on weight maintenance to sustain mobility, make people with disabilities 
particularly vulnerable to eating disorders (Gross et al., 2000). Treatment 
and prevention, however, are particularly difficult due to accessibility issues, 
stigma, diagnosis errors, and physical and medical limitations. 

Examining current therapeutic interventions, it is clear that there is a 
lack of  available treatments for individuals with both an eating disorder and a 
physical disability. Music therapy shows promise as an intervention for these 
comorbid conditions (Heiderscheit, 2009; Hooper, 2007; Weiss, 2013). For 
both client groups, the most common goal is feeling more in control and 
improving self-understanding (McFerran, 2010). These goals align with one 
of  the main purposes of  music therapy: identity formation (McFerran, 2010). 
This article seeks to demonstrate that music therapy shows promise as a 

The Promise of Music Therapy: Understanding and 
Treating Individuals With Comorbid Eating Disorders 
and Physical Disabilities

Kimberly Hershenson

Research has historically dismissed the prevalence of  eating disorders in 
people with disabilities, yet studies and clinical observations suggest that 
individuals with physical disabilities are at increased risk for developing 
eating disorders. Due to this discrepancy, there is little awareness of  how to 
treat eating disorders among this population. Self-understanding is a key 
component in treating both individuals with physical disabilities and individuals 
with eating disorders. With this finding, this article seeks to demonstrate 
that music therapy is an effective treatment option for those with both an 
eating disorder and a physical disability due to its focus on self-understanding.

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© 2016 Hershenson. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits the user to copy, distribute, and transmit the work provided that the original author(s) and source are credited.

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HerSHenSon

valuable technique for treating individuals with both physical disabilities and 
eating disorders as it addresses goals common to both of  these comorbid 
diagnoses. 

Eating Disorders and People with Physical Disabilities
For the purposes of  this article, physical disability is defined as “a 

congenital disease, acquired illness, or trauma that leaves a person with a 
physical limitation that lasts at least one year” (Tsan-Hon, Pi-Sunyer, & 
Laferrère, 2005, p. 321). The fifth edition of  the Diagnostic and Statistical Manual 
of  Mental Disorders identifies three main types of  eating disorders: anorexia 
nervosa, bulimia nervosa, and binge eating disorder (American Psychiatric 
Association, 2013). Having a physical disability is often stressful, chaotic, and 
unpredictable; as such, individuals with disabilities may use calorie restriction 
as a distraction, stress management tool, or means of  control (Roosen & 
Mills, 2014). These behaviors are so common that having a physical disability 
is a higher risk factor for developing an eating disorder than having a mental 
illness such as depression or anxiety (Roosen & Mills, 2014). For example, in a 
survey of  71 women diagnosed with spina bifida or rheumatic illnesses, more 
than 20% of  respondents showed symptomology of  eating disorders (Gross 
et al., 2000). In comparison, 9.4% of  the United States population suffers 
from an eating disorder (National Eating Disorders Association, 2014).1  

Early feeding problems (e.g., difficulty consuming solid foods or liquids 
due to a physical impairment and/or behavioral issue) are common for those 
with disabilities and may constitute a risk factor for later eating disorders 
(Schwarz, Corredor, Fischer-Medina, Cohen, & Rabinowitz, 2001). Due to 
fears and limitations regarding food consumption, children feel isolated and 
misunderstood, which can have a detrimental impact on the child and may 
later lead to a diagnosed eating disorder (Chatoor, 2009; Natenshon, 2016).

Obesity rates for adults with physical disabilities are approximately 53% 
higher than for adults without physical disabilities (Tsan-Hon et al., 2005). 
More than 50% of  adults with physical disabilities have concerns about their 
weight, often leading to unhealthy eating behaviors such as restricting food 
intake (Roosen & Mills, 2014). Silber, Shaer, and Atkins (1999) looked at 
five individuals diagnosed with spina bifida. They all were overweight prior 
to their diagnoses and had been advised by their health care professionals 
to lose weight in order to improve their mobility. Dieting and the resulting 
weight loss they experienced became a source of  power for them that could 
compensate for their neurological limitations and deflect attention from 
1According to the National Eating Disorders Association (2014), there are 30 million people 
in the United States with an eating disorder, out of  a total population of  318.9 million as of  
2014 (United States Census Bureau, 2014). 

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social problems associated with their spina bifida diagnoses (e.g., job losses, 
lack of  independence, etc.). Eventually, all five individuals were diagnosed 
with an eating disorder. 

Furthermore, physical disability is often considered a burden, and people 
with disabilities may therefore feel that they are inconveniencing others (Silber 
et al., 1999). For these people, the pressure to become thinner goes beyond 
conforming to social norms: It affects whether or not somebody will take 
care of  them (Roosen & Mills, 2014). Karin Hitselberger (2013) writes in her 
blog “Claiming Crip” that she has often been told to be thin in order to make 
it easier for others to care for her. She has restricted fluid intake for as long 
as she can remember because she worries about inconveniencing and feeling 
dependent upon others for survival. When she was younger, she would not 
drink fluids at school because she was afraid of  untrained aides taking her 
to the bathroom. Today, she says she still restricts fluids, “usually because 
I’m not sure if  the bathroom is going to be accessible, but also because I 
don’t want to ask my friends for help” (Hitselberger, 2013, p. 40). When she 
started struggling with limiting 
food intake as well, her therapist 
dismissed her concerns, saying 
that as long as she was careful, 
it was fine. Hitselberger could 
not imagine anybody telling an 
able-bodied person not to eat 
or drink, but people such as 
her therapist often encourage her behavior. Because bodies with physical 
disabilities differ from what many consider mainstream, able-bodied people 
often have difficulty understanding that those with physical disabilities may 
also have body-image issues.

Psycho-Social-Cultural Risk Factors
Individuals with disabilities often discuss two different areas of  pressure 

from society: the culture of  thinness, meaning that thin bodies are preferable 
to fat bodies, and the culture of  ableism, meaning that able bodies are 
preferable to disabled bodies (Roosen & Mills, 2014). This double stigma 
often leads to restrictive dieting in order to try to fit in with society (Roosen 
& Mills, 2014). The media rarely highlights images and experiences of  
those with disabilities, and this shortcoming strongly influences body image 
(Minges, 2014). People with disabilities rarely receive positive feedback 
about their bodies and physical abilities, are aware that their bodies do not 
fit typical standards of  physical ability, and commonly feel inadequacy, body 

“Because bodies with physical 
disabilities differ from what many 

consider mainstream, able-bodied people 
often have difficulty understanding that 
those with physical disabilities may also 
have body-image issues.”



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disconnection, fear, and shame (Minges, 2014). Hitselberger (2015) writes:
I hated the way my body would jerk and spasm because of  my cerebral 
palsy. I hated the scars left on my body from surgeries meant to fix me. 
Most of  all, I hated going to the doctor and hearing what was still wrong 
with me, wrong with my body….I wanted to blend into the walls and 
disappear (p. 52).

In order to deal with these issues, a person with disabilities may develop 
an eating disorder or other unhealthy coping mechanisms as a means to gain 
control and punish the body for failing to function at the same level as an 
able-bodied individual (Minges, 2014). 

Barriers Toward Diagnosis and Treatment
Most mental health professionals are not familiar with treating people 

with disabilities (Minges, 2014). Many individuals with disabilities fear 
judgment for discussing body image issues and have a history of  feeling 
marginalized, which makes developing rapport a challenging task (Froehlich-
Grobe, Nary, VanSciver, Washburn, & Aaronson, 2012; Minges, 2014). 
Health care professionals and caregivers must also navigate the individual’s 
medical and physical limitations (e.g., balancing the disability-related need 
for an enema with a history of  laxative abuse), avoid attendant service errors 
(e.g., making negative comments about the body), and ensure accessibility 
(e.g. making treatment centers wheelchair accessible) (Froehlich-Grobe et al., 
2012). Many people with disabilities underutilize preventative health care due 
to such barriers as transportation and finances (Roosen and Mills, 2014).

Diagnosing eating disorders in people with disabilities is often difficult. 
Health care professionals often attribute all issues to the physical disability, 
including weight loss. One common way to diagnose an eating disorder is 
through Body Mass Index (BMI). However, a person with a physical disability 
may have bone or muscle loss or be of  a short stature, making an accurate 
BMI reading nearly impossible (Roosen & Mills, 2014). 

Stigmatization also plays a major role in diagnosing an eating disorder 
in a person with a physical disability. In accordance with Goffman’s (1963) 
theory of  social stigma, in which individuals with disabilities are classified 
as undesirable, rejected stereotypes, these people possess attributes that 
discount them from meeting mainstream, socially constructed standards of  
beauty (Roosen & Mills, 2014). The resulting false belief  is that people with 
disabilities do not care about their appearance and would never restrict their 
diet to meet these standards. 

Clinicians need to be aware that clients with physical disabilities may be 
at risk of  developing an eating disorder. This knowledge must influence the 
quality of  nutritional counseling such patients receive and the assessment 



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of  any sudden weight loss they experience (Silber, Shaer, & Atkins, 1999). 
This author believes that having a physical disability coupled with an eating 
disorder presents additional challenges that traditional therapy may not 
effectively address. 

Music Therapy for People With Physical Disabilities
Unlike an eating disorder, recovery from a physical disability is often 

impossible. With disability comes a social and political identity and a 
distinctive worldview and culture (Straus, 2014). Brown (2013) found that 
the culture of  disability is characterized by “hope, endearment, [and] ability” 
(p. 1). Instead of  seeking to normalize people with disabilities, music therapy 
may enhance their indigenous culture, acknowledge their struggles, and 
promote self-expression (Straus, 2014). 

Music therapy is a successful therapeutic intervention allowing persons 
with physical disabilities to achieve physical, emotional, and social goals 
(Hooper, 2007). Scientific evidence increasingly indicates that rhythm 
stimulates and organizes muscle responses (Weiss, 2013). Music may also 
provide a distraction from pain or discomfort associated with some physical 
disabilities (Hooper, 2007). Since music therapy uses musical interaction as a 
conduit for nonverbal communication, it is a useful technique for individuals 
who are unable to communicate or verbally express their emotions (Gold, 
Voracek, & Wigram, 2004). Treatment requires empowering people with 
disabilities by shifting how they view the disability (Roosen & Mills, 2014). 
This author believes that an important step in reducing body image issues is 
to develop a sense of  connection with one’s own body.  

According to Hooper (2007), music therapy incorporates different 
musical formats to achieve individualized treatment goals. Musical 
instruments develop range of  motion, hand grasp strength, and nonverbal 
self-expression. Singing improves oral motor skills, pulmonary functioning, 
breath control, rate of  speech, articulation, and pronunciation. Analyzing 
music and lyrics provides opportunities to share personal thoughts and 
experiences. For a person with disabilities, music therapy is an important way 
to increase independence, self-confidence, and self-esteem (Peters, 1987). 

Music Therapy for People With Eating Disorders
Just as music therapy is beneficial for individuals with physical disabilities, 

it is also a useful treatment for eating disorders. Eating disorder symptoms 
are typically a means of  coping with stressful or anxious feelings, and music 
therapy provides new adaptive coping skills (Robarts & Sloboda, 1994). 
Listening, relaxation, guided imagery, songwriting, music analysis, and active 
music making are all musical ways of  coping. Music provides a way for the 



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individual to discuss emotions and access repressed feelings or experiences 
while examining his or her sense of  self  (Robarts and Sloboda, 1994). 

Heiderscheit (2009) describes several types of  music therapy treatment 
for eating disorders. Song analysis helps clients share their stories by listening 
attentively to a song’s lyrics, tonality, rhythm, instrumentation, and form. 
Another approach, song autobiography, asks clients to select important 
moments in their lives and identify songs that express these moments, thereby 
obtaining a better understanding of  their lives. In addition, songwriting brings 
many issues—such as the challenges of  an eating disorder, resistance to 
treatment, and acceptance—to the surface. Finally, guided imagery in music 
helps explore underlying issues. As the music begins, clinicians lead clients 
through a brief  relaxation and then ask what they are experiencing. Clinicians 
then move into imagery, which often includes metaphors that allow clients to 
feel their emotions and begin to recover.
 Music Therapy for People With a Physical Disability 

and an Eating Disorder
Given the research, music therapy holds intriguing possibilities for 

individuals struggling with eating disorders and individuals with physical 
disabilities. As there are no current evidence-based practices addressing 
treating individuals with both conditions, music therapy seems to be the most 
promising intervention for this comorbidity at present. The viability of  music 
as a treatment in such cases is even more evident in the following clinical case 
study of  a man diagnosed with both cerebral palsy and anorexia nervosa. 
Case Example

Ryan B. is a 24-year-old graduate student (Ryan B., personal 
communication, July 14, 2015). Ryan was diagnosed with cerebral palsy at 
age 3 and used a walker-frame or scooter to move around. At school, people 
imitated his walking and called him “crip.” He had no real friends and felt 

excluded and lonely. As a result, 
he became very depressed. He 
dreaded going to school every 
day and wanted to “disappear.” 
Thinking that if  he lost weight his 
peers would no longer make fun 
of  him, Ryan developed an intense 
fear of  eating and getting fat. At 
age 17, he was diagnosed with 

anorexia nervosa and soon after was admitted to an inpatient eating disorder 
treatment center. During his stay, he had regular therapy sessions, but as the 

“[Ryan] attributes his recovery to 
music therapy because it gave him a 

way to tell his story. By sharing songs in 
sessions, he recognized that his cerebral 
palsy had made him feel out of control 
of his body, but as he began to lose 
weight, it felt as if he was somehow 
reclaiming control.”



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only patient with a physical disability, it was difficult for him to talk about 
the root causes of  his eating disorder. After his release from treatment, he 
continued to struggle and relapsed at age 22. 

Ryan was eventually referred to a music therapist. He attributes his 
recovery to music therapy because it gave him a way to tell his story. By 
sharing songs in sessions, he recognized that his cerebral palsy had made him 
feel out of  control of  his body, but as he began to lose weight, it felt as if  he 
was somehow reclaiming control. This concept was something he had never 
been able to verbalize. Through continued music therapy sessions, Ryan 
learned new coping skills and now feels that his eating disorder and cerebral 
palsy have been blessings in disguise. Both make him different, which he now 
realizes is a strength. 

Conclusion
 Individuals with physical disabilities are at an increased risk of  developing 

eating disorders (Roosen & Mills, 2014). With regard to people with both 
an eating disorder and a disability, there must be more representation in 
research, greater competency among health care professionals, and treatment 
options that better address their experiences. Music therapy is an effective 
treatment option in treating those with both an eating disorder and a physical 
disability due to its focus on self-understanding, a key component in treating 
those with this comorbidity (Heiderscheit, 2009; Weiss, 2013). It is therefore 
likely that music therapy is a useful intervention for people with a comorbid 
diagnosis. 

References
American Psychiatric Association. (2013). Diagnostic and statistical manual of  mental disorders (5th ed.). 

Washington, DC: Author. 
Brown, S, E. (2013). What is disability culture? Disability Studies Quarterly, 22(2), 34-50.
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Sadock, & P. Ruiz (Eds.), Kaplan & Sadock’s comprehensive textbook of  psychiatry (Vol. II, 9th ed., pp. 
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Froehlich-Grobe, K., Nary, D. E., VanSciver, A., Washburn, R. A., & Aaronson, L. (2012). Truth be told: 
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Goffman, E. (1963). Stigma: Notes on the management of  spoiled identity. Englewood Cliffs, NJ: Prentice-Hall.
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Kimberly Hershenson began her career as a professional ballerina training with 
the Joffrey Ballet. She is a graduate of  New York University’s Tisch School of  the 
Arts. She received her Juris Doctorate from Pace Law School, where she served as 
President of  the Sports and Entertainment Law Society, and her Master of  Laws in 
Intellectual Property from the Benjamin N. Cardozo School of  Law. While practicing 
intellectual property law in New York City, Kimberly served as Pro Bono legal 
counsel for Retorno, the largest Jewish rehab center in the world. She was elected 



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to the Junior Board of  the National Eating Disorders Association and served as a 
mentor at Mentor Connect, the first global eating disorder mentoring community to 
women in recovery from an eating disorder. In 2015, Kimberly was elected as Mentor 
Connect’s Executive Board Chair. Music will always remain a passion for Kimberly, 
but helping those with addiction issues is her life mission. Kimberly will graduate 
in May 2016 from the Columbia School of  Social Work’s 16-month program. She 
is currently President of  the Substance Abuse and Recovery Caucus and recently 
organized a standing-room-only speaking engagement featuring author, Iron Chef  
America winner, and recovered substance user Jesse Schenker. Her greatest pride 
is being a wife to her amazing husband, Evan, and a mother to her 1.5-year-old 
daughter, Atara.




