Counselling in LN3

In therapy for eating disorders, patients typically describe their eating and exercise behaviours, their patterns of eating in relation to stress, their beliefs about their body, the ways their eating behaviour affects their relationships, and their desire (or lack of it) to change. Such information helps the therapist understand the origins of the disorder and the role it plays in the patient’s life, important for guiding treatment. Attitudes and feelings about food and eating, body weight, and physical appearance are common topics of discussion throughout treatment.

Once any acute medical or psychiatric emergency is resolved, psychoactive medication is often prescribed, requiring the supervision of a psychiatrist. In addition, patients receive some form of nutritional counselling along with one or more forms of psychotherapy. For adolescents, family-based treatment is empirically validated and considered the first line of treatment; parents and their children meet weekly with a clinician as the adults are coached on how to nourish and psychologically support the young patient. Adults typically receive some form of individual psychotherapy, intended to resolve the cognitive and behavioural disturbances that underlie the disorder and to relieve the mood disturbances that accompany it. In addition, patients may also be helped by group therapy.

The most immediate goal of treatment for eating disorders is to save the life of people who are on a path of starving themselves to death or engaging in eating patterns that are doing irreparable physical harm to their body. Once the acute medical danger is past, therapy is required to understand the nature of the disordered eating and/or exercise patterns, establish healthy eating behaviour, and to tackle the many erroneous beliefs and distorted self-perceptions that underlie eating disorders and continue to pose a threat to health and life. Therapy also addresses the impaired mood that not only accompanies eating disorders but intensifies the danger to health and life.

Therapy can be very helpful for eating disorders—but that can happen only after people recognise they have a condition that must be treated. Especially with anorexia, the distortions in self-image that accompany the disorder can keep people from acknowledging they have a problem. Individuals may in fact see their eating disorder as a badge of self-control. Those with binge-eating disorder may feel too ashamed to seek help. Therapy cannot help those who do not avail themselves of it.

Because of their complexity, recovery from eating disorders is usually a long-term process—measured in months and years— often marked by setbacks and relapse. Some form of help, such as individual or group therapy, may be advisable for much of that time. It is a general rule of thumb that the longer the illness has endured and the dysregulated eating behaviour has taken root, the longer treatment is likely to be needed.