By MidlevelU Intern and Aspiring Nurse Practitioner Ashley Prince
This week is National Eating Disorder Awareness Week. It’s a time when activists try to bring more attention to this often hushed about issue, call for the de-stigmatization of mental illness, criticize the devil that is Photoshop, and encourage others to seek treatment and help. This is all great, eating disorders are definitely way up there on the list of uncomfortable things to talk about, but one thing I’ve noticed is that there isn’t a lot of advice for clinicians in treating their patients.
So, I thought it might be useful to share my experiences being treated for anorexia in hopes that they can help you help your future patients.
Tip #1: When it comes to eating disorders, there’s a lot more than anorexia and bulimia. I’m going to be talking mostly about anorexia, because that is my personal experience. But, in addition to these players, there’s binge eating disorder, orthorexia, and eating disorders not otherwise specified. Be aware of these other possibilities in treating your patients.
Tip #2: Watch out for the warning signs. Before an eating disorder becomes obvious, patients often use vegetarianism, veganism, gluten-free, or another diet that eliminates food groups to explain their new behavior. If your patient has dropped a dangerous amount of weight and blames a new diet, it’s a clear sign that something is up.
Tip #3: Eating disorders aren’t about food. This concept is strange, but true. I fell into anorexia not because I thought I was fat, but because I thought I wasn’t good enough and somehow looking like a skeleton would fix that. In order to truly treat the eating disorder, you need to figure out the root of the cause and straighten it out. Which brings me to…
Tip #4: Eating disorders wreak havoc just as much, if not more, on the mind as the body. They are usually classified under the umbrella category of anxiety disorders, which also have a high comorbidity with depression. I mean, think about it- happy people don’t starve themselves. To successfully treat the eating disorder, make sure you have a list of tried and true referral sources such as psychiatrists and psychologists for your patients. Once the mind is right, the body follows.
Tip #5: Make sure the parents are involved if the patient is young. As a clinician, you can only do so much during a 20 minute appointment every so often. The parents are there day to day and can make sure the treatment plan is being followed, because trust me, the patient will try to cut every corner and break every rule in the book. I put my parents through hell, but they saved my life.
Tip #6: Weigh anorexic patients backwards. It’s great when treatment starts to take hold and the patient begins to gain weight. But even though recovery has started, visualizing and quantifying the weight gain can still be very triggering. Weighing the patient backwards so they don’t see the number on the scale is a great way to keep focus on all the other positive aspects of recovery.
Tip #7: Scare tactics don’t work. If your patient is deep into the illness, they know the consequences. They know that they may never be able to have kids, that they could be ripped out of school for an inpatient center, even that they could die. They don’t care. One thing that does help is reminding the patient of all they can do when they recover. I couldn’t play volleyball, a sport that I loved. Having something to look forward to or hang on to was an excellent motivator.
Tip #8: Don’t take the patient’s word for it when it’s time to stop treatment. Patient compliance in treatment is low; we’re smart, we figure out what the doctors want to hear and how to fake it just enough to pass for being recovered. But ending treatment too early can have disastrous consequences. Make sure your BS meter is in high gear and all parties involved in the treatment plan agree that the patient is recovered before you consider it.
What questions do you have about treating patients with eating disorders? Let me know by posting a comment!
Also, check out these great sites for more eating disorder resources: