Treatment Methods
How does one know which type of treatment is best for someone? I have a daughter who will be 18 in August, 2006. A year ago we discovered that she was suffering with bulimia and immediately arranged for her to begin psychotherapy with a therapist who deals only with eating disorders. She is also now seeing a nutritional counselor. I just want to be certain that we are providing the "appropriate" therapies for her. I haven't seen any significant changes yet in her "fight" with either eating or the emotional piece.
First, I must congratulate you for immediately helping your daughter by seeking the support of a therapist and dietitian who are skilled in treating eating disorders (and I emphasize skilled in eating disorders!).
Second, you need to know that recovery from an eating disorder often takes a great deal of time and energy. Developing an appropriate treatment plan for a patient with an eating disorder also requires a comprehensive assessment for other psychiatric problems that may be complicating treatment, for example depression, anxiety disorders and other associated conditions that may include tensions in the family. I hope that your daughter’s therapist is open to meeting with you, because family involvement is also helpful for many adolescent patients with eating disorders. At the same time, your daughter’s therapist should be respecting her confidences, of course.
Although I am not too surprised you have seen no real changes as yet, for uncomplicated bulimia nervosa treated with cognitive behavior therapy and sometimes added antibulimic medications, at least a certain degree of improvement often occurs within two months. Again, the fact that your daughter doesn’t seem to be making progress in a year makes the case for a comprehensive re-assessment and for making certain that your daughter is receiving the best available treatment for her overall set of problems and conditions. I am hoping your daughter is engaged in therapy and likes her treatment team. That is important. Bulimia is a coping tool, a fairly effective tool in the short term (meaning at the time of the binge and purge). Sometimes those with bulimia are hesitant to give it up, especially when they feel inadequate to face the real issues in their lives. They will also displace much of their issues on to their body, finding it inadequate (and too fat), rather than facing the fact that they themselves feel inadequate in other arenas of their lives. She needs to learn many, many new coping tools to take the place of binging and purging. She also needs to learn to at least accept, and maybe even like her body. This takes time. I recommend you read “Surviving an Eating Disorder” and “Life Without ED,” both available at www.gurze.com.
Karin Kratina, PhD, RD, LD/N
7/31/2006
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I believe that I have an eating disorder, but I am not sure if I am a compulsive overeater or a binge eater. They sound very similar to me. I have talked to my doctor. about what I think and she just put me on Prozac and said that it should work. It has not. I am a single mother on Medicaid and it is hard to get referred to see a specialist. I cannot afford the treatment that I may need. Do you have any advice or answers for me? Thanks.
Sometimes Prozac helps, but in my experience rarely fixes compulsive eating or binge eating by itself. Since money is an issue, is it possible to find a therapist skilled in these issues who works on a sliding scale? Can you save up some money for therapy? Do you have loving, supportive friends? Can you talk with others who are dealing with these issues?
Meanwhile, you must quit dieting or trying to lose weight right now. It is the process of cutting back your calories that will always cause overeating. Learn to eat enough food to support your metabolism. You most likely need anywhere from 1800 to 2400 calories a day. Every single person who comes to my office has some level of under eating and they often do not believe it. Learn about intuitive eating at the website, www.nourishingconnections.com. Google intuitive eating. Meanwhile, read books on recovery such as “Breaking Free from Compulsive Eating,” “Intuitive Eating,” “Rules of Normal Eating,” and “Beyond a Shadow of a Diet”. Many people find self-guided programs based on cognitive behavior principles to be helpful as well, and careful research has demonstrated that these approaches can be effective. “Overcoming Binge Eating” and “Eating Disorders: The journey to recovery workbook” are examples. All of these books are available from www.gurze.com. Good luck to you.
Karin Kratina, PhD, RD, LD/N
6/10/2006
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My 14-year-old friend is going to rehab for anorexia. She says she'll be leaving when she is "cured". Is there an approximate amount of time that it takes for one suffering from anorexia to get out of rehab?
In-patients stays vary, usually depending on insurance coverage, and can range from 4 weeks to 12 weeks. Some facilities require anorexic patients to stay up to 6 months, and then go through “step-down” programs where they live nearby and continue to participate in the program, but to lesser amounts.
Do not expect your friend to be totally cured from anorexia, even after an extended in-patient stay. Hopefully she will learn while she is there that recovery, though well worth the effort, is a long and often difficult process that can take an extended period of time. While she is at the facility, she will learn how and what she needs to eat. She will also need to gain weight. The closer she is to a “normal” weight when she gets out, the better her chances of full recovery. She will also learn that anorexia is not just about food or weight. It serves as a coping tool that works initially, but soon quits working well and quickly turns into a nightmare. In the program she will have begun to learn alternative coping techniques and ways of dealing with people and the world. But the inpatient phase is only a beginning. There is hard work to do afterwards when your friend and her family will need to see a therapist, a physician, and on occasion, a dietitian. She will need to continue to develop and practice new coping skills until she is able to function without the “crutch” of focusing on food and weight. As you might have guessed by now, this can take quite some time. It is a good bet that she will need to be in therapy for 2 or 3 years and often longer after her in-patient stay.
Karin Kratina, PhD, RD, LD/N
6/10/2006
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My daughter has had anorexia for 3 years and has been in residential treatment twice. Her therapist say she has 'no' issues...as in family breakup, losing a family member, abuse etc. Why can't she seem to beat this? We have given her all our love and support. Is it entirely due to a chemical imbalance? Is that possible? If it is, what kind of research is being done to find a cure for this? I'm at my ropes end.
Your questions highlight fundamental issues confronting individuals with anorexia nervosa, their families and those trying to help them. We still do not know, with any real clarity, what causes anorexia nervosa, or, as importantly, why it can be so hard to conquer once it has begun. Many researchers believe that disturbances involving the biology of the brain must play a role in the persistence of this illness, but no one has yet clearly identified what those disturbances are. A number of research groups are working hard to try to figure this out, and Dr. Tom Insel, the Director of the National Institute of Mental Health, has identified anorexia nervosa as one of the Institute’s priority areas.
B. Timothy Walsh, MD
10/1/2006
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I suffered from anorexia from 14 until 17, progressed to bulimia and anorexia from 17 to 20, declined into just bulimia until around 23, then pulled out of it without much in the way of real counseling ever. Now, at 26 and facing major changes in my life, the thought patterns and in some cases behavior patters have increased and don't seem likely to abate (i.e., odd rules on food and exercise, strong desire to purge about anything, though I have been trying some self coping strategies to avoid it). I feel stupid talking to anyone about this because I don't look eating disordered and I'm not really "clinical" yet. But, I don't want to be again ever. Do eating disorder specialists treat those that are "recovered" but threatening relapse? Will insurance cover this?
Eating disorder specialists DO treat this and it is a good that you are thinking of seeking treatment at this time. Under stress, old coping styles sometimes reemerge, even unhealthy ones such as bulimia. Preventing relapse is a very reasonable clinical goal in your case. Insurance coverage varies a great deal and you would need to check with your carrier about this issue.
James Lock, MD, PhD
1/4/2007
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Hi, I’m 19 yrs old and I have been bulimic for about 2 1/2 years. I’m not in denial or anything but I can’t go to an inpatient program because of my schedule with work and school. I haven’t looked in to any programs but I’m sure that they're all pretty expensive and I can’t afford that either. I was just wondering what other options I might have that would be helpful in my recovery. Thanks.
An inpatient or day hospital program may not be necessary to help you with your bulimia. Although such programs are sometimes necessary, it is also possible that you would respond to an outpatient treatment program of individual cognitive behavioral therapy or CBT. CBT is the best treatment for bulimia and is usually provided on a weekly basis for about 6 months. This option would certainly be less expensive than treatment programs that are based in hospitals.
James Lock, MD, PhD
1/4/2004
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If a parent is questioning whether the treatment they are getting for their child is working or helping, what should they do?
If a parent is questioning the treatment their child is receiving, the parent should make an appointment to meet with the therapist and therapy team (if there is one) to discuss his or her concerns. Often parents are reluctant to do this because they fear they may be seen as questioning the clinician’s judgment or that they will be seen as over involved in their child’s treatment. Sometimes clinicians do feel this way, but a parent has the right and the responsibility to know and understand what treatment is being undertaken and to ask for reasonable updates on the progress being made. This is usually less of a problem for those families who are in family therapy, but even then, there are reasonable questions that might be asked of a treatment team if there is inadequate progress. Of course, eating disorders can be quite difficult to treat, so one of the reasons for parents to meet with clinicians is to get their opinion as to the progress being made.
If after a meeting with the clinician, the parent still feels that treatment isn’t working, it may be necessary to ask for a referral for a second opinion from an expert in eating disorders. This may relieve anxieties about the current treatment, or it may identify new ways to proceed.
James Lock, MD, PhD
1/4/2007
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Long story short, I have been diagnosed anorexic binge-purge type. It has gotten so out of control that is has overtaken my life. My therapist and fiancé are pushing for residential treatment. I can't/won't go because I have two young children I don't want to be away from. I don't want to die from this either. Are there any books, web sites or any other information I can proactively look into to try to help/treat myself. I'm doubting there is and I'm sure I know what the common answer will be, but I just wanted some input, advice, help. I don't know where else to turn. Just wondering. Thanks.
Reaching out for help seems like a big step for you, so kudos to you for taking that risk. As a relatively new mother, I completely understand the dread you feel about going away for treatment. I suspect that your children’s well-being will be less dependent on the quantity of time you have with your children now, and more on the quality of your time with them. If your health is in danger, you absolutely deserve to seek intensive help even if it means being absent from your children at this time. Your loved ones will help your children feel connected to you even in your absence, and I suspect that through your healing you will be able to stay more connected to them – both when you are with them and when you are apart. You know how mentally, emotionally, and physically exhausting and consuming eating disorders are. Your children will benefit immeasurably over their lifetimes from you taking care of yourself. In terms of what you can do, I think finding a compassionate, experienced psychotherapist is the most important step, so that you can begin to understand your needs and desires, and so that you can begin healing. You will be giving your children the gift of modeling self-care. I recommend allowing yourself room to feel not only your pain but also your joy in simple activities and in your loving relationships. Look to others to support you as you take the risk to better understand why and how you rely on your eating disorder so that you may relinquish its grip on you. The hope is that eventually you will be more full and present as a mother, a partner, and a friend.
Catherine Baker-Pitts, LCSW-R
5/1/2007
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