Improving the track record of treatment success in eating disorders requires the adoption of an integrated approach.
Psychopharmaceuticals have been shown to aid in some reduction of some psychotic and depressive symptoms and in some weight gain. But their effect is limited. Selecting from a wide range of modalities and therapies to include with medications is crucial to improving your patients' prognosis and chances of experiencing the true pleasure and joy of sharing a table of food and drink with friends, family, and themselves.
Achieving that degree of recovery isn't easy. And the statistics bear that out. Among all psychiatric illnesses, anorexia nervosa is the most dangerous. Anorexic patients have 12 times the normal death rate of other psychiatric patients.
Unlike other psychiatric patients, many anorexic patients are reluctant to be treated. They hide, preserving their precious personal space and keeping physicians, psychotherapists, and other caregivers at bay. In addition, the Internet offers opportunities to converse with fellow patients on weight-loss strategies and other self-destructive behaviors and to gather information--even legitimate research results--which they use to justify their resistance to eating.
With such obstacles, treating these patients can often feel like a swimming up a fast-moving river. But equipped with patient education materials and the methods of cognitive-behavioral, interpersonal, and psychodynamic psychotherapies, you can increase the likelihood of overcoming such swift currents and high dams.
While somewhat overlooked, patient education should be the first step in therapeutic engagement. Teach patients about the detrimental effects of starvation and/or bingeing and purging. Tell them about ways to care for themselves. Enlighten them about how their condition has caused them to lose pleasure in their lives and has drained them of physical energy. Help them realize that their intellectual capacity and ability to make decisions have diminished. Talking about these issues initiates a change in their perspectives, attitudes, and internal object relation paradigm away from their symptoms.
Telling them about conscientious objectors who stage starvation protests can also be helpful. For example, informing them of Ancel Keyes' study of men who fasted for up to 8 weeks in protest against the country's involvement in World War II and their experience can help patients see the reality of their condition and self-destructive behavior. …