Treatment for Eating Disorders
Treatment of anorexia/bulimia is difficult for a number of reasons:
- In the early stages of an eating disorder people often deny there is anything wrong with them.
- It is not just the food. A person with an eating disorder will very often also suffer from depression, anxiety and lack of self worth. Eating disorders are complex.
- There is no universally agreed treatment path or magic medication that provides a cure.
Anorexia and bulimia can be treated and different treatments may be appropriate for different people.
For successful treatment, the person must be at the stage where they accept they want to have anorexia/bulimia out of their life. They will almost certainly need family and friends to help them.
People with more serious anorexia/bulimia often need care in a hospital, ideally in a special unit for people with anorexia and bulimia. Currently this is only available publicly in Wellington and Christchurch. Dunedin has a private in-patient facility, Ashburn, and occasionally the Health Boards fund patients to go there. A few Auckland cases have been sent to Sydney for treatment.
Treatment involves more than changing the person's eating habits. People with anorexia generally need counselling for a year(s) so they can work on changing the feelings that are causing their eating problems.
Family and friends
The most important thing that family and friends can do to help a person with anorexia/bulimia is to love them.
Many people with anorexia often claim they feel safe, secure and comfortable with their illness. Their biggest fear is eating food. There are lots of different reasons, it may be gaining weight is seen as loss of control or it may be feeling overwhelmed by the thought of eating. Because they may deny they have a problem people with anorexia will beg and lie to avoid eating and gaining weight, which is like giving up the illness. Family and friends need to support the person through the painful process of letting go of the eating disorder and accepting that there is a better life than one controlled by food.
There are many different treatment options. Unfortunately no one treatment works for all cases. Sometimes it is a matter of trying one treatment after another.
Maudsley Approach
The Maudsley approach is designed for young children and adolescents and believes neither the parents nor the child are to blame. In Maudsley treatment parents play a key role in helping their child recover .Parents are considered experts on their child. Initially parents are encouraged and empowered by the therapist to normalize their child's eating while providing compassionate, non-judgmental support. The child's challenging anorexic behaviours are regarded as symptoms of the illness and mostly out of their control. Food is considered the medicine-frequently as weight returns patterns of anxiety and other anorexic behaviour diminish. Maudsley requires significant family input.
Once their child's physical health is restored the family works with the Maudsley therapist to return control over eating to the recovered child. In the final phase the focus shifts to helping the child establish a healthy adolescent identity.
EDS use the Maudsley approach for younger people.
For more information, see: www.maudsleyparents.org and www.eatingwithyouranorexic.com. These include medical journal articles on eating disorders, a parents forum and family stories. ("A Description of Maudsley Approach" by Le Grange and Lock)
Cognitive Behaviour Therapy
Cognitive behavioural therapy is based on the assumption that anorexia/bulimia develops in response to life stresses. Treatment is aimed at confronting the individual's fears and avoidance behaviours and cultivating new problem-solving skills. It also aims to increase awareness of negative thought processes and to change them. Cognitive techniques are used to encourage patients to evaluate and challenge their automatic thoughts, examine their underlying assumptions, and replace them with realistic beliefs and actions based on reasonable self-expectations.
Narrative Therapy
The narrative approach views the anorexia or bulimia as an external influence rather than part of the person. In this way the therapist and parents can join forces with the person to expose the problem rather than allowing anorexia/bulimia to pit a professional or loved one against the person. (Recommended reading "Biting the Hand that Starves You", by David Epston)
Prescription medicines
Some patients with anorexia are helped by taking medicine that makes them feel less depressed. These medicines are prescribed by a GP or psychiatrist and are used along with counselling. Anorexia nervosa in some ways resembles other major psychiatric disorders, such as depression and obsessive-compulsive disorder, because people with anorexia exhibit some of the symptoms of these disorders (for example obsessive behaviour, lack of enjoyment from life, and severely distorted perception of reality, in this case, of the body). This has led to the use of antidepressants for anorexia, because these drugs are first-line treatments for OCD and depression. Medications may be used in conjunction with a multidisciplinary approach that includes nutritional interventions and psychotherapy
Mandometer
The Mandometer philosophy is based on the belief that anxiety, depression and obsessive feelings are caused by irregular eating (i.e. anyone can develop an eating disorder if they diet and lose significant amounts of weight). These symptoms fade and ultimately disappear as the person takes control and begins to eat normally.
The Mandometer Treatment is a programme that teaches patients how to eat normally. A Mandometer is a small device which weighs the food and helps the person eat at a normal speed. This method is supported by thermal treatment; restrictions on physical activity and social skill rebuilding. No psychoactive drugs are used. There are clinics in Sweden, America and Melbourne.
For more information see www.mandometer.com
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