Eating disorders include anorexia, bulimia, and paroxysmal overeating (Binge Eating). As well as the so-called non-other-specified disorders. These include compulsive overeating, cleansing disorder, “nocturnal eating” syndrome, atypical anorexia, and bulimia.
A brief overview of eating disorders.
Table. “A brief description and differential diagnosis of eating disorders.”
An important characteristic of eating disorders is that they are characterized by temporary instability of clinical syndromes and a change in clinical signs over time.
In this regard, for the diagnosis and planning of therapy, the level of disturbance, rather than the picture of the disorder, will be practically more significant.
You should pay attention while collecting information for the initial diagnosis::
- – Nutrition restrictions. How the patient’s eating behavior is organized: avoiding meals, a particular type of meal, a history of dietary nutrition from the first episode.
- – Psychological concern about food.
- – Excessive preoccupation with body weight.
- – Concern about body shape (whether it determines behavior and impoverishes other areas of life).
- – Fear of gaining weight.
- – The frequency and intensity of uncontrolled overeating.
- – The intensity and frequency of possible compensatory methods (inducing vomiting, taking laxatives, diuretics, debilitating physical activity, etc.).
- – Violation of the perception of internal processes, bodily experiences.
- – The presence of supervaluable ideas associated with the ideal image.
- – Negative attitude towards the image of one’s own body.
- – Personal characteristics.
- – Somatic condition analysis.
The knowledge of comorbidity can help to realize how a particular symptom of an eating disorder affect in the life of the paient. What stabilize / compensate for the manipulation of food and body in their experience. Concomitant may be depressive, anxiety, affective disorders, PTSD.
I often meet the formation of symptoms due to traumatic events in practice with bulimia and paroxysmal overeating, when an eating disorder is secondary to trauma. This awareness helps to determine the role and meaning of the symptom.
- From what it protects.
- From what new experience it saves, refrains the person.
- Notice how, through a relationship with food, the client organizes life experiences to compensate the trauma.
For therapy planning, it is also important to diagnose whether a person is suffering from depression, anxiety spectrum disorders, panic attacks. These are frequent satellites of eating disorders.
Initial interventions while planning therapy should be focused on the current problems of the client.
Bodily sensations. Hunger. Saturation.
An important aspect in the treatment of eating disorders is the painstaking work of restoring sensitivity.
Firstly, sensitivity to bodily sensations, as well as to hunger and satiety.
With bulimia, paroxysmal overeating and obsessive gluttony, a specific detachment from the body is observed. It is as if the feeling of oneself is shifted inward and does not coincide with the real bodily boundaries.
Therefore, in therapy it is important to constantly pay attention to bodily processes – tension, flexibility, movement, a sense of coordination and activity through the body. When the client experiences and realizes emotions, he gets the opportunity to appeal to the body and acquire the ability, as it were, to combine sensory experience with bodily reactions. He also learns to bring inner experiences closer to physical boundaries with the environment.
Secondly, sensitivity to the experience of disgust.
Regulary, these patients learn to dislike themselves only, their own bodies and actions. Their early experience is organized in such a way that aggression towards the indigestible, disgusting is impossible. And instead of rejecting the inappropriate, they begin to feel self-loathing, which translates into shame.
Identification with one’s own body, with shame, with disgust and aggression towards it, makes it possible to bring alienated complex emotions to the border of contact.
Working with retroflection is associated with bodily tension and the ability to get angry and express aggression outside, instead of attacking the “shameful and disgusting” part of your body.
Thus, to restore the ability to be disgusted with stranger and to see the difference between it and what is suitible for you.
Than it comes to experimenting, trying to refuse, saying “no” to what does not fit.
In eating behavior, the return of sensitivity makes it possible to “tune” the intuitive, natural cycle of nutrition. That is, to regulate food and its amount based on a sense of physiological hunger and the needs of the body.
The ability to saturation is also restored (formed) during therapy. It is associated with the ability of the client to notice the adequacy of contact with the therapist, the awareness of the desire to move away, to increase the distance or to stay close. In this part, it is important to clarify what makes it difficult to follow one’s own needs, how the client stops the freedom of approaching and distance, as they choose “eat when you’re full”.
The described work on the restoration of sensitivity allows you to navigate your own needs, choose the right distance, reject indigestible, take what suits you and become more open to new experiences.
In eating behavior, it is selectivity in the choice of food, the ability to taste, bite or “spit”, to enjoy the taste.
In this case, perhaps the most important condition for successful work is the creation of a trusting relationship in therapy. This is an experience of such trust, in which again you can decide to feel and show your vulnerability. Based on this, the client will be able to be more open in relationships without compensation by eating behavior and detachment from their physicality next to the therapist.
Thus, through a new way of relationships in therapy, a new way of eating behavior is gradually being formed. .
Literature:
- Binge Eating. Kognitive Verhaltenstherapie bei Essanfällen, Beltz, 2011.
- International Classification of Diseases of the 10th revision (ICD-10).
- Diagnostic and Statistical Manual of mental disorders (DSM-5).
- Francoise Dolto “The unconscious image of the body.”
- Marion Woodman “The Owl Was Before the Baker’s Daughter.”
- Peter Philippson “Self in a relationship.”
- Gerard Schweck “Volunteer gallery owners. Essays on the processes of complacency.”
- John Crystal, Integration and Self-Healing. Affect, Trauma, Alexithymia.”