Eating disorder developments (Malte)

I recently attended a seminar related to eating disorders. The contributors to this interesting event were a consultant endocrinologist, a consultant in child and adolescent psychiatry and a team of people who provide an eating disorders service.

This team consisted of a specialist nurse, consultant psychiatrist, trainee psychologist and clinical service manager. The seminar took place in the UK and gave a good example as to how support and advice is now given to those suffering from any eating disorder.
Four disorders were identified: anorexia nervosa, which presents weight loss and fear of weight gain; bulimia nervosa, which presents cycles of binge-eating then purge behaviours, usually vomiting; atypical eating disorders known as EDNOS, which includes all other types of disorders related to eating; and finally binge-eating disorder in which there is no purging behaviour.

It was emphasised that most eating disorders develop between the ages of 15-25 and affect between two to six per cent of young adult women. Eating disorders are most common among women but 10 per cent of sufferers are men; they also occur across all socio-economic and ethnic groups.
It is seen that most eating disorders are about food, weight and shape, but they can also be seen as a way of coping with life and difficult feelings, a way of exerting control of the body and even a response to unresolved stress which may have been of many years duration.

This team of people works with local GPs who refer patients to them. Each referral is assessed and a range of engagement and motivational work together with individual therapy is begun.
The aim is to avoid admission where possible; obviously those with severe difficulties may require admission to hospital. However, generally, the mode of treatment is preferred to take place as outpatient rather than inpatient. This is seen as a way of enabling the sufferer to take control and with the help of family and friends to conquer this illness.

In order to succeed, it is necessary to develop self-motivation, personal goals for all patients, meal time support, snacks and therapeutic groups. In addition to a personal plan to help set their own goals, the medical team monitors the patient weekly. They provide a nutritional and community group.
The psychologist explained that they follow National Institute for Health and Clinical Excellence guidelines for cognitive behavioural therapy and in groups discuss body image and motivation. The occupational therapist has the task of engaging the sufferer on other points in life. For example, many of them have lost focus on education, work or life in general, so if this can be re-engaged and hobbies or even voluntary work introduced, this will help with focusing life on real goals.
Interestingly, the occupational therapist also engages the sufferer in cooking groups, shopping, preparing food and assesses how they would manage at home. Hence the importance of treating everyone as an outpatient to ensure they can manage in the ‘real world’ rather than in a clinical environment inside a hospital. Staff will even attend home at meal times to ensure guidelines and advice are followed.
The team explained that there is evidence for the benefit of arts therapy with people with eating disorders, therefore creative expression is encouraged. This could manifest as involvement in dance, drama, art, creative writing, all of which provide a vehicle to explore, or express, related emotional issues.

The team explained that sufferers of eating disorders may have difficulties in verbalising their concerns and could use colours, for example, to express themselves. The team has even pre-empted the development of disorders by going into schools and colleges to work with children on creative expression.
The consultant in child and adolescent psychiatry explained that disorders are occurring in younger children. Unbelievably, they are even seeing disorders; the youngest they have encountered was five years old. They believe this is connected to the pressure from the media and society in general for a perfect body image. Apparently, many young children see themselves as fat and are very aware of size and image.

The consultant emphasised the key to success was family therapy, especially in the younger children. The link to this was attending home during meal times. The belief is that medication is not the way forward with young people, although in severe cases there may be exceptions.
She gave an example of one sufferer who refused to travel in a car. After some discussion and therapy sessions it was discovered that her sister always took a chocolate bar with her when they travelled and the sufferer was convinced that she would be inhaling the calories from the chocolate bar when her sister unwrapped it and ate it in the confines of the car.
The importance of psychological work was emphasised, especially exploring the dynamics of the family. The working method is to make anorexia the enemy. To do this they are encouraged to see anorexia,and not the young person, as deceitful, a liar, mistrustful, manipulative and accuse anorexia of splitting the family.

They avoid everyone arguing and encourage concentration on the real issue of the ‘anorexic minx’. This ‘minx’ takes over at meal times, leisure, school or work time. It takes over the young person’s life and the family’s life.

A very interesting way of looking at the illness is to see this ‘minx’ as initially a friend, it looked after them, it helped them, made them feel better, was there for them when others failed them and gave the sufferer a sense of control. Then… it took over, made them feel sick, cold, frail, confused, afraid, weak and finally made them feel out of control, it became their enemy but they didn’t realise it.
Based on this premise, the idea is to take back control from anorexia, see it as the enemy and fight it. Ultimately, we have to be on the winning side of what has developed into a war.
It is an interesting and revolutionary way of dealing with this dreadful disorder.
kathryn@maltanet.net

Source: http://goo.gl/ROHWR