Eating Disorder treatment

What are eating disorders?

I usually distinguish between the following types, although in real-life individuals usually present a little less "tidy":

• anorexia nervosa (AN)
• bulimia nervosa (BN)
• other specified feeding or eating disorder  (OSFED)

There is also avoidant restrictive food intake disorder (ARFID) and binge eating disorder.

Individuals with AN have a distorted view of their weight/shape, illogical and obsessive thoughts about food and eating. They can exhibit extreme anxiety around eating certain types of food or in severe cases eating anything at all. Individuals with AN will restrict their food, engage in excessive exercise or get rid of food through purging as a way of avoiding weight gain.  Some individuals with AN will deny completely that there is anything wrong with them (this is known as 'anosognosia'). Historically, individuals with AN were portrayed as frail and emaciated; however this is inaccurate and individuals can be diagnosed if they have lost a significant amount of weight even though technically they remain in the healthy weight range. What is often puzzling to others is that an individual with AN can be in a very poor physical state but can perform well in other areas of their life, for example at school. We now know that there is a large biological/genetic component to AN. Individuals who are predisposed to AN often share common characteristics, such as high levels of perfectionism.

Individuals with BN have similarly obsessive, irrational and distorted thoughts and views about food, eating and their bodies. They tend to engage in a cycle of dietary restriction and subsequent binge eating. These binges are often compensated in some shape or form, usually by vomiting or laxative/diuretic use.

OSFED is an umbrella term for difficulties that cause distress and have an impact on someone's functioning but do not quite reach the criteria for AN or BN. This does not mean that OSFED is a less serious eating disorder or does not require treatment.

For more information, including on ARFID and orthorexia please click here.

 

How do I know if there is a problem?

Unfortunately there are still a lot of myths and false truths in regards to eating disorders and not all medical professionals are up to speed with the most recent research. It is not unusual for an emerging eating disorder to be overlooked and a family may given false reassurance along the lines of "it's just a phase".

Trust your gut. You are best placed to evaluate whether your loved one's behaviour is normal or whether have been changes. If in doubt you should seek advice from a suitably qualified clinician in order to rule out an emerging eating disorder or, if necessary, to get treatment as early as possible.

Possible warning signs to look out for:

• Skipping meals, making excuses to not eat or claiming to have eaten already
• Cutting out certain foods or food groups for a sustained period of time (such as sweets, crisps, fats, carbohydrates)
• Not eating in front of others or in social situations
• Eating much smaller meals or leaving substantive parts of a meal for a sustained period of time
• Hiding food
• Obsessive weighing (e.g. daily or regularly after meals)
• Distress around particular foods (e.g. desserts)
• Reading food labels, calorie-counting, weighing foods
• Preoccupation with weight loss or healthy eating including overuse of apps such as MyfitnessPal or social media in particular Instagram
• Obsessive exercise
• Mood changes or social withdrawal

 

The consequences of having an eating disorder

Eating disorders, in particular AN and BN, are life-threatening illnesses and have the highest mortality rate of all psychiatric illnesses.

Physical effects include weakness, dizziness, fainting, fatigue, constipation, bloating, and stomach pains. Over time more serious problems can develop, such as low blood pressure (hypotension), slow heartbeat (bradycardia), irregular heartbeat, electrolyte imbalances, skin disorders, and stomach ulcers.

Long-term, often irreversible, consequences include osteoporosis (bone loss), liver disease, kidney disease, a weakened heart muscle, and infertility.

There is a high risk of sudden heart failure, as well as a risk of self-harm and suicide.

An eating disorder will have a large number of psychological effects. This is why using logic and rational arguments rarely work.

Many individuals with eating disorder describe an 'eating disorder voice' that can be incessant and extremely unpleasant. This can make eating very difficult.

Individuals may also experience high levels of shame and anxiety (every meal may feel like having to 'bungee-jump' off a bridge).

 

What type of treatment is there?

Eating disorders are largely brain-based illnesses and many of the symptoms observed are caused by malnutrition. This is why it is so important to prioritise adequate nutrition in the first instance in order to improve brain functioning. A malnourished brain cannot work. In recent times family-based treatment (FBT) has become the treatment of choice, because it does exactly that.

FBT is the recommended first-line intervention in a number of countries, including the UK. FBT is sometimes also referred to as family therapy for anorexia nervosa (FT-AN) and although there are subtle differences between FBT and FT-AN they are in essence very similar treatments.

FBT consists of three phases. In Phase 1 parents take charge of the young person's eating and support them to eat enough in order to gain weight/to normalise their eating. In Phase 2 the responsibility is gradually handed back to the young person. Phase 3 addresses residual issues and how to get normal adolescent development back on track.

Research has shown that in particular adolescents with anorexia nervosa get better more quickly with FBT, have a more complete recovery and relapse less often.

FBT does not blame the parents for their child's eating disorder. In fact, FBT is very clear that parents are usually the young person's best asset in terms of returning them to health.

Eating disorders are treatable illnesses and the prognosis is good if the illness is caught early on and is treated aggressively.

For most young people FBT works better than an individual approach — twice as well. But it doesn’t always work and some parents may not want to do FBT, for whatever reason. In this case it is possible to consider individual treatments, but this requires careful consideration and a weighing up of the pros and cons.

In my private practice I specialise in FBT but I am also trained in enhanced cognitive behaviour therapy for eating disorders (CBT-E). I also use principles informed by dialectical behaviour therapy.

I can work flexibly depending on need, ranging from one-off consultations to providing the full FBT (or CBT-E, if applicable) treatment package. I specialise in providing treatment via videoconferencing. I can also provide second opinions and consultation/supervision to other professionals.

I have completed certification in FBT with Kristen Anderson and I am now a certified FBT practitioner.

Please note that appropriate medical monitoring is vital in eating disorder treatment. I am not qualified to give medical or dietetic advice.