Education

 
TREATMENT MODELS - EDUCATION FOR
INDIVIDUALS, FAMILIES AND PROFESSIONALS

As parents it's important to learn as much as you can about the different treatment modalities. Education is imperative as you begin the journey of procuring treatment for your loved one. This journey will undoubtedly open your eyes to beliefs and attitudes you may have that are not helpful to your child's healing. Treatment for eating disorders is still a specialty. It's important to work with a therapist who specializes in this field. Eating disorders are serious, life threatening conditions and are not just phases of development.

HAES stands for Health at Every Size. This model stresses size diversity and acceptance. It challenges the wide spread belief that thin = health and beauty; and that fat = sickness and undesirability. This model challenges each therapist, medical professional and other providers in the field of eating disorders to examine their own biases concerning size acceptance. This model is essential to teach the families of the client. The process of recovery using this model is described at its core concisely by Karen Kratina, PhD, MPE, RD as: a "return to an eating style most recall from their youngest years - eat when hungry, quit when satisfied most of the time, and go outside and play" 1. HAES is important for all therapists to be familiar with because its concepts agree with our ethical guidelines to "do no harm". In today's fat phobic climate it is easy for a therapist who is not trained in the field of eating disorders to blindly accept a client's belief that they need to lose weight and go on a diet as part of their treatment plan for self care. One of the basic notions of HAES is that increased weight is not an indication of health risks and premature death as the current "War on Obesity" advertises. This correlation is not supported by the literature. By endorsing dieting behavior we will actually be setting up our clients for yet another failed attempt at weight loss that will decrease their self esteem, and increase their risk for eating disorders. What is indicated is to help our clients love and care for the bodies they have, focusing on harmony between their mental, social, spiritual, and physical health.

1: The Journal Health at Every size Voume 19, Number 1 Spring 2005 HAES and Eating Disorders: Using Internally-Regulated Eating as a Recovery Tool - Karen Kratina, PhD, MPE, RD

The Addiction Model views the eating disorder as a disease which can be arrested but not cured. The idea that a person has a disease is used as a positive re frame because it takes away the self blame and feelings of personal failure at recovery. We are finding that eating disorders have large genetic components as do alcoholism and substance abuse. The addictive process begins with dieting and can lead to continued restriction of food, resulting in anorexia. The behavior of denying oneself food can lead to overeating, binging, and then purging, resulting in bulimia. Binge eating, chewing and spitting, compulsive overeating, water loading, and compulsive exercise are behaviors that are described as addictive by many sufferers. Dependence on laxatives, diet pills, or diuretics can cause serious health risks, and death. This model believes that for a percentage of people suffering from eating disorders, certain foods can be as physiologically addictive as alcohol or drugs. Specific foods may be abstained from in this model resulting in abstinence from disordered behaviors. This model also views the addiction as an addiction to the process, or behaviors, rather than any specific food, acknowledging that some foods may be triggers for these behaviors more than others. From this perspective, the intuitive model works well, helping the client be more in tune with their bodies hunger and satiation levels, allowing for differentiation between emotional and physical hunger. This view sees the eating disorder as a disease. It is not the fault of the sufferer. They did not ask for it, nor choose it. The eating disorder can be arrested, but not cured. An individual, who is experiencing abstinence from disordered behaviors, yet continues to have food or body thoughts is able to use these thoughts as triggers for self discovery, as well as spiritual and emotional growth.

The Intuitive Model views the eating disorder as a symptom of loss of contact with a person's intuition and knowledge of their body. The idea that we were all born with the capacity to know when we are hungry and stop when we are full is used as evidence to suggest that we have the capacity to recover these abilities again. The concept of trusting the body is used as a focal point, and allows people to legalize all foods, slowly derailing years of diet mentality where there were good foods and bad foods. The eater is encouraged to eat a variety of foods consciously, discovering what she/he likes, as well as its effects on her/his body, emotions and thoughts. Deciphering physical hunger from emotional, symbolic or "mouth" hunger is foundational to recovery using the intuitive model. Once a person is conscious that their hunger is not physical, food can be viewed as a metaphor for emotional needs. Permission is given to eat even if it is for non physical reasons, discovering the meaning of that food without judgment. This is a positive, encouraging approach that helps break the diet mentality. This approach goes well with a somatic approach, giving the client practice looking inward for their body cues, which also fosters acknowledgment of emotions.

The 12 Step Program has been attributed to the recovery of thousands of people; the OA (over eaters anonymous) twelve step program was adapted from AA for people struggling with food and body issues. The main tenant of the 12 step program is the realization that a person's will power alone is not enough to make or sustain a change. A power greater than ones self needs to be acknowledged and sought. Atheists, Agnostics, and Religious are all welcomed. A higher power is defined by each member. The only thing requested of the member is a desire to stop disordered behaviors, and an openness and willingness to allow their higher power to do for them what they have not been able to do for themselves. Often the disordered eater has numerous examples of "proof that they can not do it on their own." This approach agrees, and re frames it as the corner stone to recovery. Many slogans are used in the 12 step programs that are used much like cognitive behavioral therapy. The peer led meeting has a structured format which allows for the benefit of universality; "I'm not alone"; much like facilitated support groups. Phone calls are encouraged between meetings which allow for one on one support as does the sponsoring component to the program. The following 8 tools are the basics of this program: meetings, literature, anonymity, writing, phone calls, a plan of eating, abstinence, and sponsorship. There are no fees required, although donations are encouraged. Most meetings encourage members to go to professionals such as therapists, registered dietitians, doctors, and psychiatrists for adjunct services. The O.A. program describes itself as non professional.

Maudsley Approach for recovery from AnorexiaThe Maudsley Approach comes from the work of Christopher Dare and Ivan Eisler at Maudsley Hospital in London. This is a family centered model that views the anorexia as a medical condition, and puts the family in the role of care taker of their sick child, a role they have had success with in the past with their child. This is a no-blame model which has had success for a percentage of families dealing with anorexia. Food is viewed as the medicine that the family must dispense daily. It is especially helpful for families with a child or younger adolescent who is tired of the constant obsession with food and is relieved to have the parents take over the responsibility for planning and making all the meals. (Even though there will still be resistance to the parent's role.)

There are three distinct phases to this model:

1. Separating the child/adolescent from the disease. The family aligns together against the disease, parental consistency and follow through is essential, as well as a support for the child when she feels adversarial towards her parents.

2. Compliance with the food plan is the second stage when the client begins to gain weight. At this stage the parents give increased responsibility for eating back to their child as she continues to gain weight. Once the child has gained 95% of her ideal weight without substantial parental guidance, individual therapy should begin.

3. The therapist's role in this model is more of a coach, relying on the parents' expertise and knowledge of their child to figure out how to get their child to eat the foods deemed necessary by the registered dietitian. The therapist guides the family over the rough spots, and acts as a means of support and accountability to the family. The actual therapy with the anorexic does not start until weight goal has been established. This method is not appropriate for families who can not be home for all meals with their child, or create a plan of supervised meals for their child.


EDRS Professional Education - Questions to Ask

About Body/Eating:
What are your eating habits?
Do you skip meals or limit the amount or kind of food that’s acceptable?
Do you have “good” & “bad”; “healthy” & “unhealthy” food categories?
What foods do you put in these categories?
Ask for examples of food they will and will not eat.
Are there foods they believe they can not control if they eat them?
Do they compensate for eating foods that are in their unacceptable category or for eating more than they think is appropriate?
What do they do to compensate?
Do you know when you are hungry, satisfied, or full?
How does your body tell you when you are hungry?
Give examples of the bodies’ “language";
Headaches, irritability, difficulty concentrating, tiredness, stomach pain, nausea, tension, empty feeling, stomach growling.
How does your body tell you when you are satisfied?
Give examples of the bodies’ signals of saiety;
Empty feeling gone, sense of neutral comfort, you may experience a sense of satisfaction, or well being.
How does your body tell you when you’re full?
Give examples of the bodies signals of fullness;
Stomach begins to feel taught, clothes feel  tighter, your energy level decreases, you may feel nauseous, you may experience a sense of anxiety, or thoughts of being “out of control”.
About relatives:
Do any of your family members have eating disorders, or problems with weight, anxiety, depression, addictions, or compulsive behaviors?
Let your patient know that eating disorders come with a “family” of other genetic, inherited conditions; Give examples.
Anorexia, Bulimia, Compulsive Over-eating combined with “yo-yo dieting”, body dissatisfaction, Obsessive Compulsive Disorder, Anxiety, Panic Attacks, Attention Deficit Disorder, & Attention Deficit Hyperactive Disorder, Depression, Bi-Polar Disorder, Substance Abuse, and other addictive behaviors, including self harming behaviors.
Symptoms of eating disorders can sometimes present as somatic complaints, or may be "disguised" as positive changes such as; going on a diet, eating “healthier”, or starting a new exercise regime, sport, or competitive level of play.

Things to watch for:
Combination's of complaints of “acid reflux”, acne, swollen glands, dry skin and hair. Sudden or rapid weight loss, stomach pain that interferes with eating, constipation, “nervous stomach”, drop in energy, or difficulty concentrating. Pay attention when your patient seeks your advice on the latest diet; tells you about a recent decision to become a vegetarian, or vegan. If your patient has started a new sport, or a new exercise regime that is resulting in recurrent sprains, muscle pulls, and strains ask about the level of activity, assess for an obsessive, addictive quality. Pay particular attention to athletes in your practice.