Therapy for an eating disorder
Synonyms in a broader sense
- Anorexia nervosa
- Bulimia nervosa
- Binge eating
- Psychogenic hyperphagia
The therapeutic options for eating disorders are complex.
In the following, some general therapeutic approaches will be shown, which can be used for both Anorexia, bulimia as well as the Binge eating disorder be valid.
The most important points to be answered first are 3 questions:
- How much does the disorder affect me? (Psychological strain)
- Can I imagine getting help from a therapist and carrying out the therapy recommended for me? (Therapy motivation)
- Am I ready to change myself and my previous behavior? (Motivation to change)
These questions should be asked right at the beginning because there are many patients who e.g. suffer, but are only very limited in their motivation to change. Others hardly suffer from their disorder. Therapeutic intervention is not advisable here, as therapy can be discontinued at any time.
However, if all three questions lead to the result that both the patient and the therapist agree on the purpose and necessity of a therapy, one can start planning and implementing the therapy.
The 11 point therapy plan
In my experience, the first step is the extensive one Providing information (Psychoeducation) shown. Here you should give the patient a.o. inform about eating habits in general but also about body-related characteristics. One of these peculiarities can be found in the so-called "set point" theory. This means that the weight cannot be changed at will. Rather, the body (apparently) has a kind of internal "scale with fat measurement" that "preprogrammes" an individual weight for us. So if we forcibly move away from this weight, there are clear (by no means always good) changes.
A target weight should be set with the patient at the beginning of therapy. The so-called. Body mass index (BMI). This is calculated as follows: body weight in kg / body height in square meters
A BMI of 18-20 should apply as the lower limit. The upper limit is a BMI (body mass index) of approx. 30.
Creation of a course curve. The course of the weight since the occurrence of the disturbance should be visible in this course curve. This course can then be put in context with certain life events.
The patient should create so-called eating logs in which both internal (thoughts and feelings) and external trigger situations (going out to eat with the family etc.), but also their own problem behavior (e.g. laxative abuse etc.) are recorded. Over time it is possible to "filter out" the critical situations in the patient's life, so that concrete behaviors or approaches for these situations can be planned.
To normalize the weight, the conclusion of a treatment contract has proven itself especially in the inpatient area. As already mentioned before, eating disorders lead to great fears and misperceptions, so that patients sometimes cannot fully adhere to the therapeutic framework despite motivation and suffering.
I believe I can say from my experience that a large number of patients tried at least once to cheat, lie or otherwise cheat during treatment. (As a rule, an anorectic patient does not have that much problem drinking one to two liters of water on the known weighing day in order to briefly satisfy the therapist without risking real weight gain). For this reason so-called contract management is extremely useful. Here, for example, a minimum weight gain is required every week (usually 500-700 g / week).On the one hand, benefits (free exit, phone calls, etc.) are linked to compliance with the contract, and on the other hand, the continuation of therapy. Repeated breaches of the contract must lead to termination (... in my opinion, however, always with a prospect of re-introduction, as everyone should have more than one option ...).
Furthermore, the declared goal in therapy must be eating behavior
to normalize. For this purpose, various control techniques are discussed with the patient (e.g. no hoarding of food, etc.) and the planning of alternative behavior in stressful situations. Other possibilities are stimulus confrontation in the company of the therapist, as well as the cue exposure exercise, in which a patient is "exposed" to a typical food until he loses the desire for it.
Identification and processing of underlying problem areas
The underlying conflicts of the eating disorder vary greatly from person to person. However, some are more common with these disorders, such as Self-esteem problems, extreme striving for performance and perfectionism, strong need for control and autonomy, increased impulsiveness, problems in relation to other people, such as Problems of delimitation or assertion in the family area. Often the problems only become apparent when the primary symptoms (starvation, binge eating, vomiting, etc.) are reduced.
Depending on the type of conflict, the options for dealing with problem areas can be to improve the general problem-solving ability or to develop new skills (e.g. improving social skills through self-confidence training). If the conflict relates to the interaction with important caregivers, these (family, partner) should be included in the therapy.
Cognitive techniquesThat means learning new trains of thought and leaving the old "beaten track" of thought are of great importance in the therapy of people with eating disorders. The questioning of distorted attitudes, the black and white thinking, the checking of convictions against reality should only find their focus in the middle of the therapy, when the eating behavior has already normalized somewhat.
The processing of the body schema disorder means that the patient is instructed to deal more with his own body. Many practical exercises can be carried out here. (Massage, breathing exercises, mirror confrontation, pantomime etc.)
In parallel to the above therapeutic procedures, one should also think about supportive drug therapy. Here you can make use of the known effects (and side effects) of various drugs. For example, it is known that tricyclic antidepressants can lead to an increase in appetite, whereas so-called SSRIs tend to have an appetite-suppressing effect.
Finally, of course, you also have to talk to the patient about relapse prophylaxis, i.e. the prevention of relapse. For this reason you should discuss possible "dangerous" situations with him and confront him step by step. This should lead to a gradual withdrawal of the therapist so that the patient finally receives confirmation that he can master the situations on his own.