How to Treat Eating Disorders
A sad, personal experience prompted extensive research on this topic. It is hard to relate, but I will briefly describe the successful outcome below. The most current treatments for people with eating disorders are discussed here.
Current eating disorder treatments include:
- Family therapy
- Interpersonal therapy
- Dialectical behavior therapy
- Psychodynamic therapy
Please note: The fact is that some people with eating disorders respond to simple interventions such as guided instruction and self-help techniques. By relating my account below, I am in no way implying that you should take on treatment for an eating disorder on your own, especially if the disorder is well-established. Intensive, long-term treatment by a team of professionals is absolutely necessary to achieve permanent recovery in most cases. I did my research and was fully prepared to undertake hospitalization if I had not discovered the problem very early on and taken personally severe measures in an attempt to correct the disorder. Only because my daughter quickly resumed normal eating did I not pursue the following.
Normal treatment includes a combination of medical, nutritional, and psychological therapies as determined by professionals:
Force-feeding is normally only undertaken if the patient is dehydrated or at risk of heart problems or organ failure. The force-feeding takes place in a hospital in fluid form. Calories are increased from about 1500 to 3500 per day. In a surprising number of cases, some secondary biological and psychological disturbances are reduced once body weight is restored.
Either way, normally the patient will be attended by an on-going (in and out-patient) team of a physician, a nutritionist, and a psychologist. Permanent recovery is normally not reached without family, group, and individual counseling since the individual and others involved need to understand why the eating disorder began.
The Maudsley Model is most often used in family therapy and is shown to contribute greatly to the patient's return to mental health. This model includes 10-20 family sessions spaced over 6-12 months. All of the family members are seen together and initially, parents are coached to find effective ways to control their child's eating behavior before total responsibility is handed over to the adolescent (adolescence or young adulthood being the most common periods of onset.)
Interpersonal therapy focuses on the behavior and interactions a patient has with family and friends. This therapy usually finds greatest success in cases of those with bulimia and binge-eating disorders. Within interpersonal therapy, CBT (Cognitive Behavior Therapy) is often used. This form of therapy focuses on:
- enhancing motivation to change
- replacing unhealthy dieting with regular and flexible patterns of eating
- reducing an unhealthy concern about body weight and shape
- preventing relapse
DBT (Dialectical Behavior Therapy) is a form of CBT that is especially effective in treating people with tendencies to damage themselves. It focuses on producing self-acceptance and then change. Patients agree to do homework to practice new skills, including filling out daily "diary cards" to track more than 40 emotions, urges, behaviors, and skills, such as lying, self-injury, or self-respect.
In Hypnosis, the goals are to:
- help the patient figure out the psychological origins of their behaviors so as to deal with the emotional aspect of the problem.
- break negative behavior patterns and institute new, positive eating habits and attitudes.
- improve self-image, self-esteem, and confidence.
- establish a connection between the mind and body’s natural rhythms.
- give back to the patient control over their lifestyle, including nutrition.
Psychodynamic therapy is based on the assumption that a person is having emotional problems because of unresolved, generally unconscious conflicts, often stemming from childhood. The goal of this type of therapy is for the patient to understand and cope better with these feelings by talking about the experiences.
The patient's treatment team will likely choose a combination of the above therapies to assist someone with an eating disorder.
My Personal Experience
As a parent, you probably can relate to the terror you feel if you discover that your child has a serious, life-threatening illness. That was the case with my teenage daughter.
My first indication that something was wrong was when I happened past her bathroom and heard her vomit. I knew she wasn't sick, and slowly the realization hit me. I couldn't believe it. She was purging. I waited until she opened the door, and said, "We need to talk."
As a single mom, and my daughter being an only child, I have always been very careful not be to judgmental, to build her self-esteem, and to keep the lines of communication open. But this was different. This had to stop immediately, even if it did hurt our relationship, her life was at stake.
From our discussion, I learned that she believed (or was telling herself) that what she was doing was normal and was not damaging her health. There was no convincing her with talk or argument, and I couldn't determine if she really knew the risks to her behavior or not, so I spent several hours creating a list of questions from research I did on the internet. The questions were things like: How much do you weigh? What is the normal weight range for a female of your height. Why is your weight so much less? How many calories do the experts recommend you consume per day? How many calories are you consuming - make a list of what you eat in an average day. Create 3 menus that meet the requirements of the FDA pyramid (now a plate). Define purging. What do the experts have to say about the dangers of purging? What do they say are the causes of this behavior? Do any of these apply to you? What happens to your body, biologically, when you don't consume enough healthy calories? What are the recommended treatment options for girls who over-restrict their intake or who purge? Describe the concept of body image and how current media can affect our perceptions of our appearance.
The questions continued for 3 single-spaced pages. I found her car keys (she was 17) and handed her the list of questions and told her that I needed to know that she was educated on the matter so that I would know how to proceed from that point. I also stated that her answers must come from reputable sources. She was furious and really let me have it (verbally) - lots of harsh words and accusations that I had to ignore. I finally said, you know what, I really don't care if you don't like me anymore or not, I could never forgive myself if I let you die. You're going nowhere and doing nothing else until you thoroughly complete these answers and we talk about them so that I know for sure you are educated on the subject.
It took her an entire day, and the finished product was 10 pages long. We talked about the answers, so I felt confident she knew what she was doing to herself. I asked her what she thought a good plan of action was. She just cried and said she'd eat more. I suggested counseling, but she was adament that she would not partake in therapy, so I said, okay, I will trust you to start eating better, but we will weigh you every day, and if there is no improvement, you will go to counseling. If you refuse, I'll have you committed involuntarily.
She, of course, hated me during this time, which was excruciating to endure, compared to our past relationship. We checked her weight every day, and she started gaining a bit, so I slacked off and quit checking her weight. Then we went on a trip to Cancun with her grandma and a friend of my daughter's. When I saw her in her bikini I was shocked. My daughter is a beautiful, normally thin girl, but what I saw was just ugly and skeleton-like.
We enjoyed the rest of our trip, but when we got home, I talked to her about her backtracking and that I was taking her to see a counselor. The reaction included lots of screaming, very nasty speech, lots of door slamming, and refusals to go. Now, it's true, I couldn't pick her up and put her in the car, but I did say that the alternative was that I could call the authorities to come get her. (I, of course, kept her car keys.) The entire 45-minute drive to the counselor was torture. I had to just let her rant and cry. At one point, she threatened to get out of the car (we were going 55mph). I said, it sounds like you are suicidal, and now I will for sure have you committed. She backed down and just sulked the rest of the way to the counselor, who she chose to see alone.
We made an appointment for a follow-up visit, but apparently the thought of that (perhaps embarrassment from her peers?) caused her to suddenly change her ways. She started eating, very low fat, but she was eating. We didn't talk about it any further, I just quietly kept the fridge stalked with health foods.
Since my daughter was eating without purging, I didn't require that she go to the follow-up counseling appointment, so I took it for her. The counselor described what I had done as a mini-intervention. She also said that it probably worked because I did it very early into the eating disorder, not allowing long-term patterns to set in.
After a time, my daughter and I, of course, resumed our relationship and we didn't refer to the event any further. Four years later, and she has not had a relapse, and is doing well in college.
That mini-intervention was the hardest thing I've ever had to do and took a lot out of me, including many sleepless nights and constant gut-wrenching worry, but you can imagine how glad I am that I took the hard line on this issue.