Eating recovery

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Eating recovery refers to the full spectrum of care that acknowledges and treats the multiple etiologies of anorexia nervosa and bulimia, including the biological, psychological, social and emotional causes of the disorder, through a comprehensive, integrated treatment regimen. When successful, this regimen restores the individual to a healthy weight and arms them with the skills and resources needed to maintain a sustainable recovery. Although there are a variety of treatment options available to the eating disorders patient, the intensive and multi-faceted program followed in eating recovery is the appropriate option for individuals who require intensive support and are able to commit to treatment in an inpatient, residential or full-day hospital setting.

Contents

Eating recovery has been associated with increased likelihood of a sustained post-treatment recovery. This carefully orchestrated treatment curriculum incorporates the following tenets to help patients cultivate an understanding of disease-management skills and how to implement those lessons into their post-treatment lives.

Biological/medical treatment

Eating disorders are physically and emotionally destructive. Most individuals with an eating disorder require ongoing medical treatment throughout their recovery. According to the Eating Disorder Foundation, early diagnosis and intervention significantly enhance chances of recovery, while eating disorders that are not identified or treated in their early stages can become chronic, debilitating and life-threatening. [1]

For most people with eating disorders, the medical complications associated with the disease can be successfully treated with a combination of ongoing medical care and monitoring, nutritional counseling and medication. The Eating Disorder Foundation recommends people with eating disorders seek a recovery option that involves clinicians from different health disciplines, such as nursing, nutrition and mental health, a treatment philosophy consistent with the tenets of eating recovery. [2]

Medical issues associated with eating disorders. Extremely medically compromised patients who are at a very low weight will require a more intensive medical intervention. Anorexia patients with a very low body weight (BMI < 13) may need to be stabilized due to medical complications caused by starvation, including liver failure or heart problems. [3] Bulimia patients may need to manage edema, hypokalemia or esophagitis. [3]

Poor nutrition affects the brain’s chemicals and functionality. As a result, extremely low weight patients will have difficulty responding to cognitive therapy without first gaining weight. Medically supervised weight restoration is necessary before psychotherapy or many pharmaceuticals can affect the patient’s behavioral health.

Misdiagnosis of the medical complications of eating disorders is common due to the unique physiology of these patients. Eating disorders can slow a resting heart rate and lower a "normal" body temperature range. [3] For this reason, patients should seek specialized care from a doctor experienced in treating eating disorders.

Mindfulness

During the process of eating recovery, patients integrate mindfulness into every area of their treatment. Mindfulness is a mental state, characterized by concentrated awareness of one's thoughts, actions or motivations. Being "present" in every element of treatment, including meals, therapy sessions, classes or medical treatment helps patients become more receptive to different points of view. It also helps them become less reactive to emotions, instead focusing only on activities occurring in the present moment.

Mindfulness training focused on eating, body image and body awareness can lead the way to health, and recovery by enabling individuals to consciously experience and observe their internal mental and bodily events as well as those external events that are perceived directly through the senses. In eating recovery, mindfulness helps patients calm their minds and understand their self-defeating emotions or mood-dependent behaviors and instead cultivate healthy coping skills. [4]

Mindfulness facilitates two key techniques—mentalizing and building self-awareness

Mentalization in eating recovery takes the concept of mindfulness one step further, often thought of as mindfulness of mind. Mentalization describes a person's ability to understand the mental state of themself and others based on overt behavior. Mentalization is a core challenge among people with eating disorders, and its lack can result in severe emotional fluctuations, impulsivity, and vulnerability to interpersonal and social interactions, particularly in the midst of emotional interaction. [5]

In eating recovery, patients work with their therapists to mentalize, or identify, their own emotions while understanding that others may hold differing points of view. The ability to understand emotions and see situations from more than one viewpoint reduces anxiety and minimizes the need to rely on an eating disorder as a coping mechanism. [1]

Self-awareness refers to an individual's ability to become aware of their own subconscious thinking. [6] Absence of self-awareness is frequently seen in eating disorder patients, causing them to react to situations, feelings and other stimuli emotionally rather than rationally.

By practicing mindful self-awareness, eating recovery learn to examine their thoughts, feelings, memories and bodily sensations from an objective point of view. Patients are encouraged to let go of self-centered thinking to achieve a state wherein individuals are able to observe their thoughts and understand their subconscious motivations—sexual, material, emotional, intellectual, and spiritual. This comprehension builds calmness and patience, minimizing the need to rely on an eating disorder as a coping mechanism. [1]

Motivation

Motivation is the set of reasons that determines why and how individuals engage in particular behaviors. In eating recovery, the goal is to shift patients from emotion-motivated behavior to values-motivated behavior through self-directedness and the construction of values awareness. Patients learn to identify their own core values and direct themselves in behaviors that align with their value systems, while limiting behaviors that do not.

Driving self-directedness. Self-directedness is a dimension of a person's character which has to do with the ability of an individual to control, regulate, and adapt their behavior to the situation at hand in accordance with their own goals, purposes, and values. [7] An individual's inability to curtail eating disorder behaviors stems from low self-directedness. Eating recovery focuses on helping patients engage in self-directed behavior by giving their actions meaning within a values context.

Building values awareness. Self-directedness is difficult, if not impossible, without awareness of core values. Values provide the context for actions and feelings. Without awareness of values, people are often swayed by their emotional responses which may or may not serve their long-range goals and purposes. Under the sway of emotions, eating disorder behavior may become impulsive, "automatic", and mindless. [8]

In eating recovery, clinicians and therapists assist patients in identifying their core values. This approach allows patients to see the "big picture" and engage in behaviors that align with their core values while avoiding behaviors of a conflicting nature.

Mood management

Chronic anxiety is a key trait of individuals with eating disorders, their lives consumed with coping with the emotions that result from anxiety. These emotion-driven moods often elicit negative coping behaviors and narrow the patient's awareness of coping options. These impulsive behaviors can drive mindless, rigid, stereotyped responses such those seen with eating disorders. [1]

In eating recovery, cognitive behavioral therapy and dialectical behavioral therapy are employed to interrupt negative cycles of behavior and replace them with positive, purposeful coping mechanisms.

Cognitive behavioral therapy' or CBT is a psychotherapeutic approach utilized in eating recovery that aims to influence dysfunctional emotions, behaviors and cognitions through a goal-oriented, systematic procedure. Cognitive-behavioral therapy is used to treat the mental and emotional elements of an eating disorder, helping patients change their attitudes about food, eating, and body image, correct poor eating habits, and prevent relapse. [9]

Dialectical behavioral therapy or DBT combines standard cognitive-behavioral techniques for emotion regulation and reality-testing with concepts of mindful awareness, distress tolerance, and acceptance in the treatment of eating disorders. Influenced by Buddhist meditative practice, DBT includes the following key elements: behaviorist theory, dialectics, cognitive therapy, and, DBT's central component, mindfulness.

Seeking recovery

According to the Eating Disorder Foundation, eating disorders are serious and complex illnesses that require the attention of trained professionals. Although those with the disease may have the desire, it is almost impossible for "self treatment" to be effective; in fact, trying to go it alone will likely result in repeated failures. Early detection and intervention has been proven to increase the chance of full recovery. It is essential for the person with the illness to get a professional assessment first, from a practitioner trained in eating recovery. [1]

Related Research Articles

Cognitive behavioral therapy Therapy to improve mental health

Cognitive behavioral therapy (CBT) is a psycho-social intervention that aims to reduce symptoms of various mental health conditions, primarily depression and anxiety disorders. CBT focuses on challenging and changing cognitive distortions and their associated behaviors to improve emotional regulation and develop personal coping strategies that target solving current problems. Though it was originally designed to treat depression, its uses have been expanded to include the treatment of many mental health conditions, including anxiety, substance use disorders, marital problems, and eating disorders. CBT includes a number of cognitive or behavioral psychotherapies that treat defined psychopathologies using evidence-based techniques and strategies.

Borderline personality disorder Personality disorder with strong emotions

Borderline personality disorder (BPD), also known as emotionally unstable personality disorder (EUPD), is a personality disorder characterized by a long-term pattern of unstable interpersonal relationships, distorted sense of self, and strong emotional reactions. Those affected often engage in self-harm and other dangerous behaviors, often due to their difficulty with returning their emotional level to a healthy or normal baseline. They may also struggle with a feeling of emptiness, fear of abandonment, and detachment from reality. Symptoms of BPD may be triggered by events considered normal to others. BPD typically begins by early adulthood and occurs across a variety of situations. Substance use disorders, depression, and eating disorders are commonly associated with BPD. Some 8 to 10% of people affected by the disorder may die by suicide. The disorder is often stigmatized in both the media and the psychiatric field and as a result is often underdiagnosed.

Index of psychology articles

Psychology is an academic and applied discipline involving the scientific study of human mental functions and behavior. Occasionally, in addition or opposition to employing the scientific method, it also relies on symbolic interpretation and critical analysis, although these traditions have tended to be less pronounced than in other social sciences, such as sociology. Psychologists study phenomena such as perception, cognition, emotion, personality, behavior, and interpersonal relationships. Some, especially depth psychologists, also study the unconscious mind.

Binge eating is a pattern of disordered eating which consists of episodes of uncontrollable eating. It is a common symptom of eating disorders such as binge eating disorder and bulimia nervosa. During such binges, a person rapidly consumes an excessive quantity of food. A diagnosis of binge eating is associated with feelings of loss of control. Binge eating disorder is also linked with being overweight and obesity.

Drug rehabilitation is the process of medical or psychotherapeutic treatment for dependency on psychoactive substances such as alcohol, prescription drugs, and street drugs such as cannabis, cocaine, heroin or amphetamines. The general intent is to enable the patient to confront substance dependence, if present, and stop substance misuse to avoid the psychological, legal, financial, social, and physical consequences that can be caused.

Dialectical behavior therapy Psychotherapy for emotional dysregulation

Dialectical behavior therapy (DBT) is an evidence-based psychotherapy that began with efforts to treat personality disorders and interpersonal conflicts. There is evidence that DBT can be useful in treating mood disorders, suicidal ideation, and for change in behavioral patterns such as self-harm and substance use. DBT evolved into a process in which the therapist and client work with acceptance and change-oriented strategies, and ultimately balance and synthesize them, in a manner comparable to the philosophical dialectical process of thesis and antithesis, followed by synthesis.

Art therapy Creation of art to improve mental health

Art therapy is a distinct discipline that incorporates creative methods of expression through visual art media. Art therapy, as a creative arts therapy profession, originated in the fields of art and psychotherapy and may vary in definition.

Emotional reasoning

Emotional reasoning is a cognitive process by which an individual concludes that their emotional reaction proves something is true, despite contrary empirical evidence. Emotional reasoning creates an 'emotional truth', which may be in direct conflict with the inverse 'perceptional truth'. It can create feelings of anxiety, fear, and apprehension in existing stressful situations, and as such, is often associated with or triggered by panic disorder or anxiety disorder. For example, even though a spouse has shown only devotion, a person using emotional reasoning might conclude, "I know my spouse is being unfaithful because I feel jealous."

Marsha M. Linehan is an American psychologist and author. She is the creator of dialectical behavior therapy (DBT), a type of psychotherapy that combines behavioral science with concepts like acceptance and mindfulness.

Self-compassion is extending compassion to one's self in instances of perceived inadequacy, failure, or general suffering. Kristin Neff has defined self-compassion as being composed of three main elements – self-kindness, common humanity, and mindfulness.

Trauma Systems Therapy (TST) is a mental health treatment model for children and adolescents who have been exposed to trauma, defined as experiencing, witnessing, or confronting "an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others". TST focuses on the child's emotional and behavioral needs as well as the environments where the child lives. The treatment model includes four components that are fully described in a published manual. A clinical trial showed that TST is effective in improving the mental health and well-being of children who have been traumatized. TST has also been successfully replicated.

The mainstay of management of borderline personality disorder is various forms of psychotherapy with medications being found to be of little use.

Schema therapy was developed by Jeffrey E. Young for use in treatment of personality disorders and chronic DSM Axis I disorders, such as when patients fail to respond or relapse after having been through other therapies. Schema therapy is an integrative psychotherapy combining theory and techniques from previously existing therapies, including cognitive behavioral therapy, psychoanalytic object relations theory, attachment theory, and Gestalt therapy.

Anorexia nervosa Type of eating disorder

Anorexia nervosa, often referred to simply as anorexia, is an eating disorder characterized by low weight, food restriction, body image disturbance, fear of gaining weight, and an overpowering desire to be thin. Anorexia is a term of Greek origin: an- and orexis, translating literally to "a loss of appetite"; the adjective nervosa indicating the functional and non-organic nature of the disorder. Anorexia nervosa was coined by Gull in 1873 but, despite literal translation, the symptom of hunger is frequently present and the pathological control of this instinct is a source of satisfaction for the patients.

PTSD or post-traumatic stress disorder, is a psychiatric disorder characterised by intrusive thoughts and memories, dreams or flashbacks of the event; avoidance of people, places and activities that remind the individual of the event; ongoing negative beliefs about oneself or the world, mood changes and persistent feelings of anger, guilt or fear; alterations in arousal such as increased irritability, angry outbursts, being hypervigilant, or having difficulty with concentration and sleep.

Cognitive emotional behavioral therapy (CEBT) is an extended version of cognitive behavioral therapy (CBT) aimed at helping individuals to evaluate the basis of their emotional distress and thus reduce the need for associated dysfunctional coping behaviors. This psychotherapeutic intervention draws on a range of models and techniques including dialectical behavior therapy (DBT), mindfulness meditation, acceptance and commitment therapy (ACT), and experiential exercises.

Occupational therapy is used to manage the issues caused by seasonal affective disorder (SAD). Occupational therapists assist with the management of SAD through the incorporation of a variety of healthcare disciplines into therapeutic practice. Potential patients with SAD are assessed, treated and evaluated primarily using treatments such as drug therapies, light therapies, and psychological therapies. Therapists are often involved in designing an individualised treatment plan that most effectively meets the client's goals and needs around their responsiveness to a variety of treatments.

Mode deactivation therapy (MDT) is a psychotherapeutic approach that addresses dysfunctional emotions, maladaptive behaviors and cognitive processes and contents through a number of goal-oriented, explicit systematic procedures. The name refers to the process of mode deactivation that is based on the concept of cognitive modes as introduced by Aaron T. Beck. The MDT methodology was developed by Jack A. Apsche by combining the unique validation–clarification–redirection (VCR) process step with elements from acceptance and commitment therapy (ACT), dialectical behavior therapy (DBT), and mindfulness to bring about durable behavior change.

Dynamic deconstructive psychotherapy (DDP) is a manual-based treatment for borderline personality disorder.

Distress tolerance is an emerging construct in psychology that has been conceptualized in several different ways. Broadly, however, it refers to an individual's "perceived capacity to withstand negative emotional and/or other aversive states, and the behavioral act of withstanding distressing internal states elicited by some type of stressor." Some definitions of distress tolerance have also specified that the endurance of these negative events occur in contexts in which methods to escape the distressor exist.

References

  1. 1 2 3 4 5 Bishop Jr., E. R. (2008). Low Self-directedness, Affect Regulation, and Dialectical Behavior Therapy: Reaching the Difficult Patient with an Eating Disorder. Presented at The Ben Franklin Institute, Summit for Clinical Excellence, Las Vegas, NV, June 5, 2008.
  2. ↑ Bishop, J. R. (2009). The Path to Coherence: Resolving the Mind Body Problem in Eating Disorders. Personal papers, Denver, CO.
  3. 1 2 3 Weiner, K. L. (2008). Psychopharmacology in Treating Eating Disorders. Presented at The Ben Franklin Institute, Summit for Clinical Excellence, Las Vegas, NV, June 5, 2008.
  4. ↑ Linehan, M. (1993). Cognitive-Behavioral Treatment of Borderline Personality Disorder, Skills Training Manual for Treating Borderline Personality Disorder. New York: The Guildford Press.
  5. ↑ Mentalization-Based Treatment for Borderline Personality Disorder: A Practical Guide . (n.d.). Retrieved March 30, 2009, from UCL PSYCHOANALYSIS UNIT : "UCL (Psychoanalysis Unit) Peter Fonagy's Homepage". Archived from the original on 2007-12-31. Retrieved 2007-05-07..
  6. ↑ Cloninger, C. S. (2006). The science of well-being: an integrated approach to mental health and its disorders. World Psychiatry, 5 (2): 71-76.
  7. ↑ Cloninger, C. S. (1993). A psychobiological model of temperament and character. Archives of General Psychiatry, 50 (12), 975-90.
  8. ↑ Siegel, D. J. (1999). The Developing Mind: How Relationships and the Brain Interact to Shape Who We Are. New York: Guilford.
  9. ↑ WebMD. (n.d.). Retrieved March 26, 2009, from Cognitive Behavioral Therapy for Eating Disorders: http://www.webmd.com/mental-health/cognitive-behavioral-therapy-for-eating-disorders.
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