Eating Disorders: A Multidisciplinary Approach
As a therapist who specializes in treating adolescents, I have experience working with Eating Disorders (ED). Eating disorders are hard to recognize because they usually affect perfectionist, OCD-type teens. So the initial presentation is that they have a happy, healthy life, they do great in school, they often have friends, and they will say everything is fine. However, the way ED adolescents cope with stress is with eating habits. Some red flags are: excessive exercise, isolation, taking small bites, pushing food around on plate, eating very slowly, focusing on food, weight and body, frequent trips to the bathroom, hiding food in room, vomiting after eating, trips to the grocery store before or after school or work, dunking food, cooking food to a crisp, eating quickly and drinking lots of water.
An ED can make a teen feel isolated and disconnected. This can have a negative impact on many important relationships. This is a very dangerous disorder, as ED has the highest rate of death of all the mental disorders, approximately 20% of those with anorexia die. For this reason, I want to stress that while therapy is important, therapy alone is not enough to treat a teen with ED.
To properly treat an ED, requires a multidisciplinary team consisting of:
A) a psychologist or therapist, B) a physician, C) a dietician/nutritionist, D) a psychiatrist, and E) a family therapist. A team is crucial for the following reasons:
A) Psychologists or therapists help the client with the underlying causes; an eating disorder is not all about food! They work with the patient on relationship skills, developing healthy coping mechanisms, challenging negative cognitions and core beliefs about self, and learning assertiveness skills. They help the patient to reach the goals of cessation of binge eating and/or purging behaviors, cessation of eating disordered ideation including body image disturbance and dissatisfaction, and re-establish social engagement.
B) Medical doctors play the important role of monitoring vitals, monitoring weight, and running important blood tests. They help the patient to reach the important goals of nutritional rehabilitation, weight restoration, medical stabilization, and prevention of serious medical complications and death, and resumption of menses (where appropriate).
C) Dieticians/nutritionists develop an eating plan based on the teen’s particular eating patterns. They help the patient to restore meal patterns that promote health and social connections.
D) Psychiatrists can evaluate if medication is required. Not all Eating Disorders are treated with medication. Having a psychiatric evaluation doesn’t necessarily mean medication. However, some symptoms, depression and suicidal ideation, can improve with medication if needed/indicated.
E) The role of the family therapist is important because parents/guardians are the help-seekers for adolescents. Families often feel responsible and guilty. It is important to help them understand that they did not cause the eating disorder, but they can be supportive during treatment. The family also needs to learn how to help the child overcome the eating disorder and to recognize when the child is talking and when the eating disorder is talking for the child.
Unfortunately, I cannot predict who will live and who will die with an eating disorder and so the treatment must be the same for everyone. There are three types of eating disorders, Anorexia, Bulimia, and Eating Disorder NOS. There is a lot of denial around eating disorders and parents often think their child has eating problems but not severe enough to warrant treatment. However, there is much shame involved in the disorder and lots of hiding of symptoms. Some clients need to be hospitalized, some need in-patient treatment, some need outpatient treatment. A thorough evaluation will help make that determination.
The information in this article was taken from the AED Report 2012, Academy For Eating Disorders www.AEDWEB.ORG. For more information, please visit their website and read the complete AED Report 2012.