Treating – Dealing with Eating Disorders
Eating disorders are very difficult to treat, not only because of their seriousness, but also due to the fact that individuals who suffer from these conditions refuse to acknowledge the problem. This denial often makes it difficult for the patient and the treatment team to co-operate.
Results are much better when treatment begins at an early stage, before the disorder becomes a habit and a way of life. In particular, patients under 18 years of age who suffer from an eating disorder for less than 3 years respond better to treatment.
Patience and commitment are of outmost importance, since it will take at least several months before any therapeutic results/effects become evident. Most patients will need psychotherapy, which is always adapted to their individual needs and given by an experienced, specialized therapist. We know that family therapy (especially for adolescents) and psychotherapy based on cognitive and behavioral principles are particularly effective. Some patients will also need drug treatment, with the aim to deal with possible coexisting conditions, such as depression or anxiety. Medical treatment may also help to reduce binge eating episodes. Treatment is closely monitored by a specialized psychiatrist.
The role of a dietician is also important. Hospitalization is recommended in a few cases, either when the patient’s health is at great risk or when all other treatment methods have failed. In this case, the hospital unit must specialize in eating disorders, offering a well-structured monitoring program and follow-up treatment.
Treating anorexia nervosa is a difficult task. It requires a multidisciplinary approach, regular medical monitoring, application of a nutrition program and psychological treatment both for the patient and family. As regards the treatment of bulimia nervosa, it consists in a combination of nutrition programs and constant self-monitoring, which are aimed at promoting awareness of one’s disturbed eating behavior. As in anorexia nervosa, outpatient treatment failure or severe medical complications are indications that the patient should be hospitalized.
Psychological Interventions For Eating Disorders
The following text describes some of the main psychological interventions which are recommended for treating eating disorders. It should be noted, however, that psychological interventions presuppose both the patient’s medical monitoring and the restoration of his/her physical health and body weight, preferably prior to the intervention or simultaneously with it. In no case should weight be given only to the psychological intervention, neglecting the patient’s physical health and medical monitoring.
1) Cognitive Behavioral Therapy (CBT)
Cognitive Behavioral Therapy is based on the model of the respective therapy which was created for treating depression (e.g. Beck 1991). The treatment of eating disorders on the basis of the CBT model has the following characteristics:
- Time-limited therapy consisting of 15-22 sessions that take place within a few months period. Each session lasts one hour.
- CBT sessions are often based on an agenda jointly agreed between therapist and patient.
- Therapy is fairly structured and focused on the gradual solution to specific problems related to the eating disorder.
- Emphasis is put on the present, not on the patient’s distant past/history.
Therapist and patient work together in order to:
A. Define a mutual comprehension of the patient’s problems
B. Recognize the impact of these problems on the patient’s thoughts, behaviors and feelings, as well as on his/her everyday activities.
- The therapist takes up an active role in guiding the patient during therapy
- During the sessions, the therapist asks the patient a series of questions (Socratic Questioning) in order to help him/her comprehend his/her dysfunctional thoughts and
2) Psychodynamic Psychotherapy Inspired by the Psychoanalytic Theory
Given that eating disorders most commonly develop in puberty, the psychodynamic approach sees in the development of these conditions the disruption, not to say the arrest of growth. In other words, instead of coming into adulthood, adolescents who suffer from an eating disorder return to childhood. One of the core goals of psychodynamic psychotherapy pertains to the completion of both the physical and psycho-emotional development process. Psychodynamic psychotherapy is a long-term therapy (usually lasting at least 2 years), which is focused on the development of a relationship between therapist and patient.
During the therapy, the therapist focuses on:
- Encouraging gender identity acceptance
- Promoting body image acceptance
- Disengaging the patient from his/her family
- Enhancing personal autonomy
Given that psychodynamic therapy is carried out on an individual basis, parallel parent/couple therapy is recommended.
3) Family Therapy
Family therapy focuses on the two-way relationship between the development of an eating disorder and family dynamics. In other words, it deals with eating disorders as conditions both influenced by and influencing interfamily relationships and family life. The result of this process is a vicious circle in which the patient and his/her family are trapped.
The main features of this dysfunctional family process that stems from eating disorders and plays a highly important role in the persistence of the condition are the following:
- Development of an extremely close, almost symbiotic relationship between patient and mother
- Weakening of the role of the father in the family
- Parental criticism towards the suffering child/adolescent
- Patient role either as a go-between between parents or as the only great problem in the family.
Family psychotherapy mainly aims to:
- Help parents support the suffering child
- Limit parental criticism towards the suffering child/adolescent
- Strengthen the role of the father in the patient’s life and in family life in general
- Encourage parents to adopt a loving yet firm and at times strict behavior towards the patient and his/her eating habits
- Gradually enhance personal autonomy
All family members participate in family therapy sessions. Family therapy lasts at least 1 year.