Anorexia/Bulimia – Treatment

For all patients there will be both medical treatment as well as psychoanalysis. Some people respond better to group therapy were others respond better to one-on-one therapy. Depending on the situation, your therapist may even suggest family therapy. It may take several attempts at different types of therapy before the patient finds something that works. Here are list of different types of therapies that a person with an eating disorder might have:

Setting Goals

No matter which therapy is decided upon, the patient, along with trained professionals, will establish a goal. To simply say that the patient needs to gain weight and eat healthy is not enough. These goals must be written down and be attainable. To be effective, they also must be goals that the patient buys into. Simply going through the motions is not enough. This can be the biggest struggle.

Medication

Because many people who are experiencing eating disorders also suffer from depression, antidepressant medication may be prescribed in the early stages of treatment. However, if the patient has gone to the point where they are in starvation, the doctor may hold off using antidepressants until there is some weight gain, as starvation can increase depression.

Some studies show that antidepressant medication may also be a long-term way of helping to prevent relapse. If the person with the eating disorder starts slipping into depression again, there is more of a risk they could also slip into their old habits.

A doctor may also prescribe other medications that have shown to help with eating disorders. But medication alone should not be used to treat an eating disorder.

Cognitive Behavior Therapy or CBT

Working together with a therapist, the patient identifies their irrational behavior and the illogical thinking they have associated with eating, weight, and food. Obsessive-compulsive behavior will also be explored. This type of treatment is very beneficial for people who have ritualistic behaviors such as those who suffer from bulimia.

Psychodynamic Therapy

The goal of psychodynamic therapy is for the patient to achieve a better understanding of the psychological reasons behind their eating disorder and what motivates them to this destructive behavior. Through this type of therapy the patient can see how their thought processes today have been shaped and informed by the past.

This type of treatment does not start until the therapist has assessed the patient to see where they are at in the disease.

Feminist Psychodynamic Psychotherapy

Feminine social conditioning is explored in this type of psychotherapy. During therapy, the therapist gives a voice to the patient and explores their thoughts about their self-image and how it compares to societal standards. In this type of therapy, the therapist acts as the vehicle to help the patient expose their own feelings about image and intimacy rather than giving the patient all the answers.

Interpersonal Therapy

Originally used to treat depression, this type of therapy has been modified to also help patients with eating disorders. In this therapy, the patient looks at how they interact with the people around them so they may understand conflicts that may contribute to the continued pattern of behavior. While these conflicts may not have caused the eating disorder, they may impede or contribute to the eating disorder.
The goal of this type of short-term therapy is to identify behavior patterns and not specifically address the eating disorder itself.

Family Therapy or Marital Therapy

There is some debate on where the focus lies for family or marital therapy. While the patient might see this as therapy with their family or spouse present, the therapist and family members may view this as therapy for all those involved. Many times a person with an eating disorder will have a higher success rate at recovery when the entire family or those that live in the immediate home participate in therapy. This is certainly true for children with eating disorders as this type of therapy can help educate not only the child but the family members as well.

The problem with family or marital therapy is that sometimes a family member does not buy into the idea that they need therapy. They view the eating disorder as being the problem of the person who has the eating disorder. This is true to an extent. But many times there are underlying factors that have contributed to this person having an eating disorder.

Not only does the person with the eating disorder sometimes exhibit fear of exposing personal problems, but so do family members. Still this can be a highly effective way of treating the patient as well as educating the family members.

Psychoanalysis

Psychoanalysis is the most intensive of therapies. With this therapy, the patient will see a therapist five times per week over the period of many years. During this time, the patient will delve deep into their psyche to discover how they arrived at the point they are at. From there, they will be learn behaviors, examine thoughts and dreams and talk openly about their feelings.

This type of in-depth therapy is not for everyone. In fact, many people shy away because of the fear of delving too deep. However, it can be highly effective.

Focal Psychoanalytical Psychotherapy

In this therapy the therapist is not directing the patient at all and no advice is given. Instead, the patient focus is on the behaviors, symptoms and problems in regards to what happened in their past and their experiences with their family. The patient then tries to find meaning in that and how it associates with the eating disorder.

Dialectic Therapy or DBT (Cognitive Behavior Therapy)

DBT is a somewhat new approach to therapy where the patient observes and finds meaning in their emotional reaction to things that happened in their past, helps them find validation of those feelings and then come to accept them and make a change. This type of therapy is especially good for people who experienced post traumatic stress or who have suicidal tendencies.

Supportive Psychotherapy

Nearly all the psychotherapy treatments available to people with eating disorders have a supportive element to them. However, the goal of this type of therapy is to help relieve the anxiety associated with the eating disorder and what is happening to the patient. Through encouragement, reassurance, and pointing out the patient’s individual strengths, the therapist can help the patient find adaptive defenses to the anxiety.

Nutritional Therapy

Since the goal of treatment is to help a patient with an eating disorder gain weight to a healthy level, nutritional therapy is vital. In this therapy the patient will learn how to stabilize their eating habits.

Rarely will a dietitian deal with just the issues of food. Instead, the dietitian will take a whole body approach and educate the patient about body image as well as nutrition and the risks associated with having an eating disorder. The dietitian will also touch upon the patient’s fears of gaining weight.

Because many young girls are still in their early teens when they develop eating disorders, a dietitian may decide to work with the family by shopping for food, coming to the home and preparing food, and sitting down for a meal with the family.

Psycho-Educational Therapy

Rarely is this type of therapy available all by itself. Many times psycho-educational therapy is included in other types of therapies. However, a more intensive educational therapy may be needed to help the patient and the family understand the different definitions of the illness, why a person develops an eating disorder, nutritional and medical issues, and sociocultural issues that may have contributed to the patient’s body image.

Addiction Model

Because many people who have eating disorders also suffer from low self esteem and depression, there is a high amount of alcohol and drug addiction associated with eating disorders. Having an addiction outside of the eating disorder presents a challenge to the health care professionals working with a patient. Which do you treat first? How do you treat both the addiction and the eating disorder together?

Many therapists find the 12-step program for alcoholics and drug addicts too restrictive to be effective. However, more medical professionals are incorporating the 12-step program with nutritional, psychological, and behavioral therapies with success.

Self-Help

As a first step, many patients with eating disorders will try to help themselves through their disorder. But even for those who want to help themselves, it is difficult to go it alone. People who have eating disorders need support and communication between family, friends, and their doctor to be successful. Since so many things play into whether or not a person has an eating disorder, it can be dangerous if the person tries to hide and “self medicate.”

This private type of support group can mean the difference between having some help and having no help, especially if the patient is resistant to formal treatment. If the initial health danger from the eating disorder is not present, the patient can set up a support group with family and friends to help them through the process of healing.

It is important, though, that you do this under the advice of a healthcare professional or formal support group adviser. A support group adviser can help steer the patient towards self-help manuals and online web sites that offer support.

Expressive Therapy

Finding an outlet for what troubles you can be an effective therapy for people with eating disorders. This is particularly helpful for the patients who have a difficult time expressing themselves by using their own words. There are many mediums the patient can use to help express themselves without words. Drama, drawing, painting, dance and movement are all effective ways to express feeling without using words.

Light Therapy

For years people with seasonal affective disorder or SAD have used light therapy to help them deal with the depression they feel during the winter months. Some people with SAD also have eating disorders. Light therapy has been an effective means of improving the patient’s mood and has helped to decrease binging and purging that sometimes happens with people who have SAD. Each light treatment can last as long as four weeks.

As you can see, there are many different types of therapies that professional have been using to help treat people with eating disorders. No one treatment will work for everyone.

Even when a person is successful with treatment, it doesn’t guarantee that the person will continue to remain successful in their treatment. Relapses are common with eating disorders, sometimes with devastating affects because now the patient has more knowledge.

This is why when a person goes into treatment, the patient must have the support of those around them. Without that support, it is too easy for the patient to slip back into old habits. By educating family members and friends in anorexia and bulimia, it would be more difficult for the person with the eating disorder to hide their disease if a relapse does occur.