Synonyms in a broader sense
- Anorexia nervosa
- Anorexia
- Anorexia
- Bulimia nervosa
- Bulimia
- Binge Eating
- Psychogenic Hyperphagia
- Anorexia
Therapy
The therapeutic options for eating disorders are manifold. In the following some general therapeutic approaches will be shown, which apply to Anorexia, Bulimia as well as Binge Eating Disorders.
Requirements
As the most important points 3 questions are to be clarified first: These questions should be asked right at the beginning because there are many patients who, for example, suffer but have very limited motivation to change. Others hardly suffer at all from their disorder. In this case, therapeutic intervention is not advisable, since therapy can be interrupted at any time.
However, if all 3 questions lead to the result that both patient and therapist agree on the sense and necessity of a therapy, one can start with the therapy planning and therapy implementation.
- How much does the disruption affect me? (suffering)
- Can I imagine being helped by a therapist and having the therapy recommended to me? (Therapy motivation)
- Am I ready to change myself and my previous behavior? (motivation for change)
The 11 points therapy plan
Point 1: In my experience, the first step to be taken is to provide extensive information (psychoeducation). Here, the patient should be informed 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 theory states that weight cannot be changed at will. Rather, the body (apparently) has a kind of internal “scale with fat measurement” that “pre-programs” an individual weight for us. So if we move away from this weight by force, clear (by no means always good) changes occur.
Point 2: A target weight should be set with the patient at the very beginning of the therapy. The so-called Body Mass Index (BMI) is helpful here. This is calculated as follows: body weight in kgheight in m squared.
A BMI of 18-20 should be the lower limit. The upper limit should be a BMI (Body Mass Index) of approx. 30. point 3: Creation of a curve.
This curve should show the progress of the weight since the occurrence of the disorder. This progression can then be related to certain life events. Point 4: The patient should prepare so-called eating protocols, in which both internal (thoughts and feelings) and external trigger situations (eating out with the family etc.
), but also the patient’s own problem behavior (e.g. laxative abuse etc.) are written down. With time, it is possible to “filter out” the critical situations in the patient’s life, so that one can plan concrete behavior or approaches for these situations.
Point 5: In order to normalize the weight, the conclusion of a treatment contract has proven to be particularly useful in inpatient care. As mentioned before, eating disorders cause great anxiety and misperceptions, so that despite motivation and the pressure of suffering, patients are sometimes unable to fully comply with the therapeutic framework. I think I can say from my experience that a large part of the patients tries to cheat, lie or otherwise cheat at least once during the treatment.
(An anorexic patient usually has no real problems to drink one or two liters of water on the well-known weighing day in order to satisfy the therapists for a short time without risking a real weight gain). For this reason the so-called Contract – Management is extremely useful. Here, for example, a minimum weight gain is required every week (usually 500-700 gweek).
Compliance with the contract is linked to benefits (free exit, telephone calls, etc.) as well as the continuation of the therapy. Repeated violation of the contract must lead to termination (… in my opinion, however, always with a perspective of reappearance, since everyone should have more than one possibility…).
Point 6: Furthermore, it must be the declared goal of the therapy to normalize the eating behavior. For this purpose, one discusses with the patient different control techniques (e.g. no hoarding of food etc.) and the planning of alternative behaviour in stressful situations.Further possibilities are the stimulus confrontation accompanied by 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.
Point 7: Identification and treatment of underlying problem areas The conflicts underlying the eating disorder are individually very different. However, some of them occur more frequently in these disorders, such as problems with self-esteem, extreme striving for performance and perfectionism, a strong need for control and autonomy, increased impulsiveness, problems in relationships with other people, such as problems of demarcation or assertiveness in the family. Often the problems only become apparent when the primary symptoms (hunger, eating fits, vomiting etc.)
are reduced. Depending on the nature of the conflict, the possibilities for dealing with the problem areas can lie in improving the general ability to solve problems or in building new skills (e.g. improving social competence through self-confidence training). If the conflict relates to the interaction with important reference persons, these (family, partner) should be included in the therapy.
Point 8: Cognitive techniques, i.e. learning new ways of thinking and leaving the old mental “trails”, are of great importance in the therapy of eating disorders. The questioning of distorted attitudes, black and white thinking, the examination of convictions in relation to reality should only find its focus in the middle of the therapy, when the eating behaviour has already normalized somewhat. Point 9: The treatment of the body schema disorder means that the patient is instructed to deal more with his own body.
Here many practical exercises can be carried out. (massage, breathing exercises, mirror confrontation, pantomime etc.) Point 10:Parallel to the above mentioned therapeutic procedures, one should also think about a supportive drug therapy.
Here, one can make use of known effects (and side effects) of different drugs. For example, it is known that tricyclic antidepressants can increase appetite, whereas the so-called SSRIs have a more appetite-suppressing effect. Point 11: Finally, one must of course also talk to the patient about relapse prophylaxis, i.e. the prevention of relapse.
For this reason, one should discuss possible “dangerous” situations with him and confront him with them step by step. This should lead to a gradual withdrawal of the therapist, so that the patient finally gets the confirmation that he can master the situations on his own.
