The Benefits of a Comprehensive Team Approach to the Treatment of Eating Disorders

Susan Schrott LMSW

Eating disorders are a serious and complex mental illness that requires a full range of treatment modalities. It is imperative that eating disorder patients receive thorough and often intensive psychotherapy, and that their medical, nutritional and psychiatrist needs are simultaneously addressed. Anorexia, Bulimia, Binge Eating Disorder, Exercise Bulimia and other non-Specific eating disorders affect over five million Americans. The diagnosis of an eating disorder is a psychiatric one yet it requires the attention of numerous other health professionals to address the medical, nutritional and psychiatric problems frequently associated with eating disorders. Therefore, the most comprehensive treatment approach involves a team of professionals, all with expertise in the treatment of eating disorders. It is of utmost importance that all involved in the care and treatment of patients diagnosed with an eating disorder, understand that professional ongoing communication, maintaining appropriate boundaries, and an interdisciplinary approach are an essential part of providing the safest and most effective treatment for patients suffering with eating disorders.

Treating eating disorders requires a multifaceted approach

Unlike other mental illnesses, patients diagnosed with an eating disorder frequently have a whole host of medical and nutritional problems that are a direct result of their eating disorder. Patients and their families need to be informed and understand from the beginning of treatment that all aspects of the patients care must be addressed simultaneously to ensure the greatest potential for recovery while addressing the underlying factors that have contributed to the development of this complicated illness.

A Core team of professionals should include a physician, psychotherapist//psychologist/social worker, nutritionist (registered dietician) and psychiatrist/psycho pharmacologist. It is absolutely crucial that there is a consistent treatment plan among all treating professionals and that regular communication and patient updates are routinely exchanged among the team. Furthermore, the more each member of the team understands his/her role in the treatment plan, the less confusion there is for the patient. These consistent and clear boundaries that are established by the treatment team provide a safe and caring environment for the patient and her family during what is a traumatic time. It must be established from the beginning of treatment who the patient and or her family can turn to with specific questions or concerns knowing that their needs will be met by the appropriate health care professional. It is then that health care professional who remains responsible for coordinating with other members of the team to keep everyone updated and aware of the patients progress, concerns, challenges or successes.

MEDICAL

It is fundamental that patients with eating disorders receive a thorough physical examination by a physician with specific knowledge about the treatment of eating disorders. The medical complications are numerous and often need to be monitored once or twice a week depending on the severity of the symptoms, however, the physician decides the general frequency of visits. Medical monitoring and stability must be a prerequisite for outpatient treatment if medical symptoms are present.

Patients with a diagnosis of Bulimia frequently present with some of the following medical problems:

• Sodium and potassium deficiencies
• Heart palpitations
• Irregular heart beat
• Dental and gum erosion
• Damage to the stomach and esophagus
• Broken blood vessels
• Heart damage
• Irregular bowel movements and constipation due to laxative abuse
• Swollen glands in neck (often referred to as “chipmunk cheeks) as a result of purging

Patients with a diagnosis of Anorexia frequently present with some of the follow medical problems:

• Low blood pressure
• Loss of menstrual cycle
• Dry skin
• Dry and brittle skin and nails
• Intolerance to cold
• Growth of soft hair “lanugos to help insulate the body
• Chemical imbalances in the body
• Heart damage
• Osteoporosis

PSYCHIATRIC:

While monitoring and maintaining patients medically, it is equally important to address any psychiatric problems that might require medication in addition to ruling out other existing psychiatric disorders. The benefits of medication must be considered when treating patients who suffer from any of the following diagnoses as well as suicidal ideation:

• Depression
• Anxiety
• Personality issues that negatively affect self-perception and relationships
• Post Traumatic Stress Disorder
• Obsessive Compulsive Disorder

PSYCHOTHERAPY:

Treating eating disorders require specific knowledge of the underlying psychodynamics that affect patients. Patients binge, purge, restrict, and exercise to avoid feelings of shame, guilt, anger, emotional pain, and a sense of worthlessness. It is the psychotherapist’s role to help patients feel safe while learning to reconnect to feelings that otherwise would be intolerable to experience alone. The therapist must remain non-judgmental, supportive, insightful, creative and patient while allowing patients the time and positive experience with their therapist to integrate and transfer the healing relationship as part of their recovery, enabling them to rebuild damaged self esteem and relationships. Treatment professionals may include a Social Worker, Psychologist, Nutritionist and Psychiatrist. Treatment modalities may include individual psychotherapy, family therapy and group therapy to best address the uniqueness of each patient and many of the following symptoms:

• Low self esteem
• Sense of helplessness
• Loss of control
• Distorted body image
• Impaired interpersonal relationships
• Trauma such as rape, sexual abuse, physical abuse, emotional abuse
• Self mutilating behaviors
• Social and family stressors
• Cultural expectations

NUTRITION

A registered dietician is an essential team member in the safety and recovery of patients. It is the RD’s role to provide nutritional counseling and guidance throughout all stages of treatment as well as being knowledgeable about metabolic changes that occur as a result of an eating disorder. Furthermore, the registered dieticians should be informed of ongoing blood tests and nutritional deficiencies that need to be addressed at all stages of the patients care. Some of the topics that are frequently addressed through nutritional counseling are:

• Erroneous myths and belief systems about food
• Helping patients correct “good” “bad” food thoughts about food choices
• Exploring body image issues
• Reducing ritualized eating behaviors such as spitting, chewing, cutting food into tiny pieces
• Helping patients identify hunger and fullness
• Addressing nutritional deficiencies
• Monitoring weight
• Creating ongoing meal plans as patients nutritional needs change

The road to recovery for many eating disorder patients requires the full attention of caring health care professionals who understand the significance of working as a team to achieve the best outcome for our patient’s safety and long term recovery.