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Medical method for eating disorders treatment MEDICAL METHOD FOR EATING DISORDERS TREATMENT
Eating disorders push patients to extremes. The anorexic girl becomes severely emaciated. The bulimic eats huge amounts of food and then takes drastic measures to rid herself of it. Treatment tries to restore moderation, to even things out once again.
Think again of the image of an out-of-control car careening down a hill. One way to help restore control would be to steer onto a more level driving surface, to flatten out the hill-in other words, to somehow change the physical component of the problem.
That's what I mean by medical treatment: therapy designed to correct the physical things that have gone wrong.
The body is a biological organism. Each function operates within a certain range. For example, a person normally breathes between ten and twenty times a minute. The heart beats between forty and seventy times a minute. The exact numbers depend on a lot of variables-activity, stress, overall health, and so on. At certain moments these rates may speed up or slow down, but over time they stay pretty much the same. The slope of the "biological hill" is gentle.
Not so in someone with an eating disorder. For her, the slopes labeled "hunger" and "satiety" are pretty steep. It doesn't take much of a push to set her rolling down that hill. As we have seen, the push can come in the form of emotional stress or a neurochemical imbalance. Medical treatment brings the biological problem back under control.
In anorexia, the first medical priority is to stop weight loss. The patient needs enough calories, not just to keep the body working, but to stop depleting its energy reserves.
Ideally, the patient will agree to eat voluntarily. As her doctor, I work with her to design a diet she can tolerate, both in terms of types of food and amounts to be consumed. Re-feeding at too fast a pace can cause heart problems. Moderation is the key.
An anorexic girl who is not in immediate medical danger and who agrees to begin eating may be treated outside the hospital. Should she continue to lose weight or fail to gain enough weight during the next phase of treatment, she may require hospitalization.
The next step is to begin restoring weight. Unless starvation is reversed, its effects on behavior and mood-bizarre eating habits, impaired concentration, social withdrawal, and so on-will only persist. As long as they do, other forms of therapy don't stand a chance.
Restoration is also necessary because, as we have seen, anorexia reflects a phobia about weight. The fear won't really diminish until the patient confronts the very thing that makes her afraid. Unless and until she actually gains weight, any therapy directed at helping her cope with her fear is all theoretical-just talk.
Restoration doesn't mean the patient has to return to the highest weight she reached before the disorder took hold; it might be about 90 percent of that figure. Together we hammer out an agreement for weight gain. This agreement includes a list of the rewards granted for success and the consequences imposed for failure. Consequences include confinement to her bed, no social activities, and so on.
Weight restoration means eating enough calories so that excess energy can be stored in the body. It also involves eating the right balance of nutrients. Sometimes dietary supplements can be very helpful if the patient isn't yet eating enough of certain foods. There are some medications that in a few cases might help speed up a return to normal weight, either directly, by affecting eating-control centers in the brain, or indirectly, by reducing the anxiety surrounding eating. We'll look at some of these options in a moment.
Bulimia is a different story. Patients are at risk not from starvation but from the metabolic havoc their eating patterns cause. Changing the slope of the hill means breaking the cycle of bingeing and purging.
Bulimic behavior often arises from, or is reinforced by, bad habits. Therapy shows the patient how to break those habits. It teaches her the facts about food and helps her explore her feelings about eating and her body. Many patients can work on these goals without being hospitalized.
Sometimes, though, patients need the tightly structured medical environment of a hospital. Such an environment allows them to focus on their problem with the help of an experienced and supportive staff. They can work on the basic changes in thinking and lifestyle needed to free themselves from their habit.
No matter where treatment occurs, some patients may benefit from the careful use of medications.
One caution: There is no "magic pill" for eating disorders. Much as I might like to, I can't sit down and write you a prescription guaranteed to cure your disorder in two weeks or even two years. Medications may help-sometimes they help a lot. But they aren't enough by themselves. At best they are just one part of a complete program of therapy.
Each patient is unique. Her illness springs from specific biological, social, and familial circumstances. Her thoughts and actions, and thus her symptoms, are hers alone. Similarly, she may respond to certain medications differently from another patient who has what appears to be the same disorder.
Some doctors believe drugs play only a minor role in treating eating disorders, but as a clinician, and as a practical person, I believe in using all the tools that work. In more than a few cases, I've seen medications produce a great deal of improvement over a fairly short time.
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