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Getting well from an eating disorder is usually always associated with ambivalence: on the one hand, the patient wants to get rid of the eating disorder, on the other hand, one wants to keep it. This ambivalence is in large due to the fact that eating disorder is not only a problem, but also a "solution" to problems. 

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When treating an eating disorder, it is important to focus on the underlying causes of the eating disorder. The treatment must take into account that the eating disorder provides a form of coping with life problems that the patient currently does not have better solutions for.

It is therefore not appropriate to force the person to eat more food, or to try to scare the person into thinking better. 





 

Treatments for eating disorders

Here are some selected findings from the research on the treatment of eating disorders, but this overview must be taken with reservations. The key for the individual patient is to have a course of treatment that is adapted to the patient, and that takes into account what the relevant predisposing, triggering and maintenance factors are for the individual.

A major challenge in treatment is to create motivation for change, and to find alternative ways to deal with emotions and life problems than having to use body and food.





It is a lack of research evidence about which treatments have the (best) effect in the treatment of eating disorders, but an overview of the knowledge status regarding the prevention and treatment of eating disorders can be found here (Norwegian) and here (English).

The family is an important resource in the treatment of eating disorders

Individual studies suggest that the family plays a major role in improving the health of the person affected by an eating disorder. Involving parents in the treatment is claimed to be the key to recovery from an eating disorder. Meta-studies provide some support that family-based therapies can be particularly effective, but more and better studies are needed to be able to draw firm conclusions.

 

  1. Example: Ida (15)

    The nurse and the family have reacted to the fact that Ida has become very thin in recent months. Her parents take her to the family doctor with questions about whether she is ill, how ill, whether there is anorexia. Ida sits cross-legged on a chair farthest away from the doctor, says nothing, reluctantly agrees to get herself weighed and measured. Two weeks later, her mother calls for a new appointment. All three are coming, the parents are very worried. Blood samples are taken from Ida. How serious is it? The outlined diet plan has not been feasible. Ida says she has no problem and underscores: "I will not eat more anyway!"

    The doctor refers her to a child and adolescent psychiatric outpatient clinic. There is the long wait before entering treatment. The parents are upset and scared and turn to a privately practicing psychologist who can receive them. In the first hour, Ida says that she does not understand the meaning of this, she has no problems, she believes. For the second hour she does not come. Therefore, it is relevant to work for a period with the parents alone, which in such a context is family therapy. The psychologist contacts the doctor with the parents' consent and is informed of the somatic results of his examinations. Together they discuss the situation over the phone.

    The parents get help with their own attitudes to Ida's eating, to her emotional regulation and to age-appropriate boundaries. The psychologist's task is primarily to give them back the belief in their own competence in the parental role. 

    Later, Ida comes along out of sheer curiosity, and the family interaction can be made visible. Ida's emotionally charged statement "You do not love me, you judge me only by what I do from homework and get grades - not from who I am!" leads to a common wonder about relationships they were not aware of before. The next step is discussions of possible changes in this interaction. And family therapy later turns to individual therapy. The goal is to promote motivation for change and provide ego-supportive therapy. The parents participate when needed and based on a professional assessment. In the course of a year, Ida's meal routines change and she gains some weight. At the same time, a more satisfactory social and emotional development follows.

 

Cognitive behavioral therapy is a method with good effect in eating disorders

Research support has been found for that Cognitive behavioral therapy (CBT) can have a beneficial effect in the treatment of eating disorders, at the same time as there is a need for more and better research in this area as well.

 

  1. Example: Trine (27)

    Trine has lived with eating problems for 13 years. In the last seven years, these have manifested themselves in a severe bulimia. She goes to work every day. The rest of the day and the weekends she spends binge eating with subsequent vomiting, about 3 - 10 times a day. This puts strains on her relationship. Thus, it is her partner who has arranged her to meet with the doctor.

    In the GP's office, Trine is sweet and gentle, talks willingly, seemingly open, but somewhat chaotic. They agree on referral her to an adult psychiatric outpatient clinic. There, she gets individual conversations with a cognitive behavioral therapy approach. First, the symptoms are assessed using a registration form that Trine must fill out daily. All food and drink she consumes must be registered, including the situations where overeating and vomiting occur. Alternative behavior rather than overeating and vomiting are explored so that Trine will have an experience of control and mastery in her food chaos.

    Trine's partner is involved at the very beginning of the therapy. This is important because both share the notion that Trine just has to get along. In this phase of therapy, the psychoeducational element becomes important, to teach both about symptoms and how negative automatic thoughts maintain the symptoms.

    Eventually, Trine's therapy expands from weight and food to a focus on the personal and functional meaning of the symptoms. Trine assumed that by maintaining the symptoms, she would be guaranteed a connection to her partner. She was afraid he would leave her. As long as she was sick, she knew he would support her. Through therapy, they were able to jointly process and change this misinterpretation.

    This is how Trine's therapy alternates between individual conversations and couple conversations, where the theme in both contexts is identification and change of negative automatic thoughts and misinterpretations, and the modification of such thoughts.

    After a year of this therapy, both Trine and her partner developed a greater understanding of her condition. She managed to correct the misunderstanding that her partner would only support her when she was ill. He showed great commitment in her recovery process, which in itself had a reducing effect on her overeating and vomiting frequency. Her daily life was less and less controlled by eating problems.

 

Physical activity can be used in the treatment of eating disorders

In a new book, researcher Solfrid Bratland-Sanda writes about how negative exercise habits can be turned into something positive. She believes people with eating disorders must be physically active.

Instead of thinking that you must, should and should exercise, patients must be helped to have a healthy relationship with activities that are adapted to each individual, says Bratland-Sanda in an interview with NRK.

 

  1. Example: Exercise helped Linn Bæra (31) to recover from the eating disorder

    Linn Bæra tells her story to BT.no. She says that she developed an eating disorder, and that physical exercise became a way to maintain this disorder. This became especially obvious after she suffered an injury that meant she should train less - something she could not do.

    - I got a lot of pain, but the physical pain was more manageable than the diffuse internal pain.

    The exercise eventually got out of control. Nothing was good enough, neither the number of kilos she lifted, how often or how long she trained. At the same time, she had lots of rules that she had to follow, including going up stairs instead of using the elevator. In addition to the fact that the training regime became more and more rigid and compulsive, she cut back on food.

    One day she sank down at work. Her body and head could no longer take it. She needed help. Fortunately, she came to a psychiatrist shortly afterwards.

    Twice a week, for two years, she went to the psychiatrist. Together, they addressed the underlying reasons why she was ill. They also addressed the training. For Bæra, it just became an important part of getting well again.

    - Winning back the exercise gave me several important contributions. It helped me thrive in my body again, regardless of weight and shape. It gave me a place where I could find mastery and challenges and an arena to build self-confidenc. In addition, the social aspects of exercise gave me joy. When I had the eating disorder, I isolated myself. Now I found new arenas where I could be myself, says Bæra.

 

Some forms of eating disorders require extensive treatment

An article from Modum Bad shows that treatment for eating disorders generally leads to many people receiving good help and recovering from their illness. However, there are some subgroups of patients who need a more comprehensive and tailored treatment in the fight against eating disorders.

Special mention is made here of the group of patients with personality disorders and a background with severe trauma.

It is important that at the start of treatment this patient group is examined for personality disorder and post-traumatic stress disorder, says psychologist and researcher Karianne Rasmussen Vrabel at the Research Institute Modum Bad has in her doctoral project followed up patients with eating disorders for a five-year period after admission to Modum Bad.

It is also relevant to uncover any dissociative disorders in the patient, which may be a particular risk where there is a known trauma history and / or where the patient suffers from self-harm.

  

Eating Disorders: Not Just a Girl Disorder

Psychologists at Solvang DPS (a Norwegian specialized psychiatric treatment facility) talk about eating disorders and what type of treatment may be necessary.

They say that there has been a marked increase in eating disorders in recent years, and that increased media-created body focus seems to be a significant explanation for this.

Eating disorders are not just a girl disorder. The psychologists' experience from work in the field of children and adolescents is that the ratios are approximately 1 to 3; that is, there are three times as many girls who are referred on the basis of an eating disorder - but there are many boys who also have this disorder, without getting referred to treatment.

 

Treatment for severe anorexia: The first aim is to gain body weight

Psychologists emphasize that in the case of anorexia nervosa, gaining a normal eating pattern is an important part of the treatment.

Once you have a severe anorexia, the underweight will in itself create vicious circles that make the eating disorder self-sustaining - regardless of what is the reason why you first developed an eating disorder. It is therefore an inexorable part of the treatment that the body weight has to go up, because without food it is not possible to function in life.

Without increasing body weight, the person can actually die from the disorder.

The treatment should therefore first focus on gaining weight, and it is a demanding path for the patient to go:

It gets worse before it gets better. As long as you can go in peace with underweight, there is not much fuss, but when it is taken seriously that you have to gain weight, then there will only be more fuss. When young people hear this and have to deal with the fact that you have to start eating again, this first creates a lot of anxiety and insecurity, and then they need a lot of support from us and from their parents, the psychologists say.

They talk about the importance of involving the parents in the treatment, and all the way make sure to have them on the team.

Gradually, the focus is shifted from food and weight to relationships, emotions, and self-regulation - and the treatment gradually turns more toward psychological methods that can also help to build self-image, ability to regulate one's own difficult emotions, and enhance problem-solving skills.

 

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