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Topic of the Month January: Nutrition as Therapy
Allowing yourself to enjoy food again
The patients suffer from perception
disorder. They see problem areas
where hardly any fat is present;
© panthermedia.net/Cliff Blank
People who develop anorexia turn into downright hunger artists over time. At first they reduce their regular food intake, later they almost completely stop eating – deliberately and by choice without any physical reasons. In extreme cases the affected person even tries to appease his/her stomach with filling, indigestible objects, like for instance a piece of cotton wool soaked in orange juice. But by the time even a layperson realizes that this is an eating disorder that requires treatment, a lot of time may pass and even a physician has a hard time diagnosing this illness, particularly in its beginning stages. On the one hand that’s because it has become quite rare that patients visit their family doctor on a regular basis so that a drastic weight loss can often go unnoticed, and on the other hand because the affected person rarely admits that a systematic refusal to eat is the reason for this weight loss. That’s why general practitioners oftentimes treat symptoms of anorexia, such as for instance a weak immune system or low blood pressure without really identifying the real cause. This could occasionally lead to misdiagnosis as one anorexic young woman happily reports in her Pro-ana blog : due to her weakened immune system, her doctor recommended for her to engage in more endurance sports. From the girl’s point of view this is therefore a free pass from her doctor to lose even more weight by exercising.
The weight is not the only deciding factor
But how is anorexia being diagnosed and what hard-to-miss signs are there? Doctor Katrin Imbierowicz from the Hospital and Clinic for Psychosomatic Medicine and Psychotherapy, University of Bonn, Germany, treats anorexia patients and points out that there is no one diagnostic criterion like for instance body weight for these patients: “The point in time from which anorexia must be treated can not just be decided based on body weight alone. Even though it states in the ICD (International Statistical Classification of Diseases and Related Health Problems), that a BMI (body mass index) of 17.5 or under indicates the clinical presentation of anorexia, there are definitely patients who already present anorexic dietary patterns before they reach this BMI marker. That is to say, throughout their entire day they think about the subject of weight and starve themselves accordingly. These people obviously require treatment, because eating disorders in particular have a strong tendency to turn into chronic diseases and should therefore be treated as early and soon as possible.“
Yet particularly an early start of treatment is often nearly impossible, since the affected person on the one hand hides her disease from her environment and on the other hand especially at the onset of the illness rarely wants to be treated.
Anorexics eat hardly anything; © panthermedia.net/Anastasia Fisechko
Body and mind have to be put into balance again
What does a treatment plan for anorexia nervosa look like? Once again, according to Doctor Imbierowicz you have to look at the individual patient. The treatment starts by physically stabilizing the patient again: “A meal plan is individually designed for the patient. To do this we first create an eating protocol from every patient to be able to get a general idea of what their current nutritional situation looks like and which foods, if any, are still being consumed. Normally you notice that foods with lots of fats or carbohydrates are being avoided. Our first goal is therefore to normalize the menu again, meaning to once again include all food groups into the daily diet. The second goal then is to get the patient to actually eat regularly again – that is to say eating three main meals and two snacks.“ The latter happens under therapeutic supervision, where cooking as a group – meaning the preparation of meals by the patients themselves – has also proven to be very important.
It’s essential to meet the patient where they are presently at to be able to set realistic treatment goals for them. To reach these goals, patients and therapists also conclude contracts. These goals include a specific weekly weight gain, usually about 500 grams, which needs to be met to receive certain perks such as for example a visit home on the weekends. For most anorexic patients however, this step towards weight gain is a very difficult one, which is why according to Imbierowicz most therapy dropouts occur at this point.
- Potential psychological factors for the onset of anorexia nervosa:
- (repeated) sexual abuse
- Over conforming social behavior / no knowledge about your own needs
- Alcohol addiction in the family
- Incidences of affective disorders within the family
- “Mother hen complex“, the family is overly protective of its offspring
- Conflicts with the parents
The following familial causes could also exist:
If the patients stay on, there are talks during group therapy on the agenda as well as one-on-one talks with mentoring psychologists. This way for example, body-image disorders – as is generally well-known, the patients perceive themselves as being too heavy even if the mirror shows a very different image – are being addressed and patient and therapists work towards a more realistic self-image.
A universal therapy has yet to be found and unfortunately not all of the patients can be helped, which is why there also continue to be tragic fatalities. Research projects are therefore still necessary. One study that is currently being conducted and that is overseen by the University of Heidelberg, is counting for example on a systematic training of flexible behaviors to promote lasting behavior modification. Only the future will show whether this can work. Though one thing is certain: anorexia is a treacherous and severe illness that requires a very long treatment. That’s why physicians, therapists and patients need to have a lot of staying power.
Simone Ernst (Translated by Elena O'Meara)
*Pro-ana stands for pro anorexia, a movement by mostly young girls who personalize anorexia and live according to Ana‘s directives (e.g. letters from Ana). On the websites there are usually also BMI calculators and so-called Thinspiration pictures, meaning photos of extremely thin people, usually celebrities. Frequently these pictures are even altered and retouched to make people appear even slimmer.