Eating disorders such as anorexia and bulimia are serious psychological conditions that require specialized treatment.
If an eating disorder is suspected, it is important to seek the appropriate treatment immediately. The longer a person engages in eating disorder behavior without treatment, the more difficult it can for the person to recover.
It is essential to see a psychologist or psychotherapist that specializes in the treatment of anorexia and bulimia. There are many well-intentioned therapists that attempt to treat eating disorders. However, without specialized training and knowledge, general therapists are not able to provide effective treatment and may unknowingly make the conditions worse.
When a patient is initially seen by an eating disorders specialist, a comprehensive eating disorders assessment is conducted to determine the diagnosis and develop a treatment plan. This assessment should evaluate the following areas:
- Weight History
- Dieting Behavior
- Daily Intake
- Binge and Purge Behavior
- Exercise Behavior
- Emotional Reactions to Eating Disorder Behaviors
- Menstrual History
- Body Image
- Medical Complications
- Mood Disorders
- Treatment History
- Family History
- Readiness for Change
Therapy for eating disorders should include a multi-disciplinary team of specialists who understand the cognitive, behavioral, emotional, medical and nutritional needs of the patient. The therapist typically coordinates a treatment team that consists of a dietician specializing in eating disorders, a physician who provides medical monitoring and a psychiatrist who prescribes any necessary medications for mood-related disorders. Other physician specialists may be involved if the eating disorder has resulted in medical complications.
Effective treatment will help the patient:
- Determine why the eating disorder started
- Understand the reasons why the eating disorder exists
- Develop coping skills for the feelings or problems the eating disorder copes with
- Reach their normal weight range with well-balanced caloric intake
- Learn to eat without having to control food, weight or exercise
- Stop restricting, bingeing or purging
- Develop healthy self-esteem
- Accept their normal weight through improved body image
- Tolerate uncomfortable emotions
- Be more flexible in their thinking and behavior
- Face their fears of weight gain and/or being out of control
- Resolve underlying issues that contributed to the eating disorder
Treatment for eating disorders is typically a long-term process that can take years. Not only does treatment need to focus on the eating disorder behaviors, most patients have other diagnostic issues, such as depression, anxiety, obsessive compulsive disorder or post traumatic stress disorder, that also require treatment. Research shows that, on average, eating disorder patients have at least three other diagnoses in addition to the eating disorder.
A common misconception is that if a patient’s depression, trauma issues, family problems, etc., are resolved the eating disorder will go away on its own. When anorexia or bulimia is diagnosed, it needs to be treated with appropriate psychological interventions. Because they are conditions in and of themselves, regardless of what other problems they are being used to cope with, they need specialized treatment.
Even though treatment can be a long, difficult process, it is important to know that full recovery is possible. Even people who have suffered for years with eating disorders are capable of recovery. When we start treatment with a new patient, we work from the philosophy that this person can and will be able to reach full recovery.
“Recovery” means that a person can learn to eat normally, maintain a healthy weight range, accept their body, deal with feelings, know their needs and have them met, assert themselves and not have their days controlled by diets, fear of food or body hatred. Different from alcoholism or drug addiction in which the person is recovering, but never recovered, we believe a person can completely overcome an eating disorder and that it can eventually be a thing of the past.
Relapse is part of the recovery process with eating disorders. Patients with anorexia or bulimia typically do not follow a straight line of continual improvement once treatment begins. Often times patients are not ready to let go of the eating disorder, so treatment focuses on developing readiness and helping patients determine why it is worth working on getting better. Once a person starts working on change, some things will get better and other things may get worse. Treatment helps facilitate and manage the balance between the ups and the downs with the goal of continuing to build on the ups in order to minimize and overcome the downs.
Treatment and recovery often require hospitalization. Hospital treatment may be necessary to intervene on significant or chronic eating disorder behaviors so a patient can be nutritionally and medically stabilized. It may also be necessary during the course of treatment so the eating disorder can be managed while a patient is working on difficult emotional issues like physical, emotional or sexual traumas. It is not unusual for eating disorder patients to be hospitalized several times during their recovery process.
Working on recovery takes a lot of effort, patience and perseverance. Weight is only one indicator of recovery, it is not the determinant of recovery. When an eating disorder patient reaches a healthy weight range, there is still a lot of work to do on body image, identity, self-esteem, sexuality and normal eating and exercise, among other issues, in order to prevent relapse.
If treatment ends prematurely simply because a weight range has been reached, the potential for relapse is quite high. Eating disorder patients need to learn how to live in a body that feels very foreign at a normal weight in order to maintain progress, continue with the recovery process and reach the point where they can accept their bodies and themselves.