Clinicians are vested with the power to deal with various issues in alignment with the maintenance of wellness among patients. While they do not always succeed in prolonging the lives of the people they meet, their attempts to address significant symptoms and effects yield some positive outcomes in one or the other. People with eating disorders may decide to visit a clinician for assistance, particularly by admitting that they have a problem that needs to be solved. Anorexia nervosa and bulimia nervosa are the most common eating disorders that clinicians are faced with in day to day complaints that align with people’s eating behavior.
Anorexia nervosa is characterized with self-restriction of nutrition and food consumption. The restriction is founded on the perception of fatness which leads one to impose some rules for weight loss (Bezsheiko, 2017). The implication is that one loses some weight or fails to gain weight in alignment with his or her age or height. Bulimia nervosa, on the other hand, is associated with consumption of large quantities of food within a short period in a recurrent manner (Harrington et al., 2015). The patient experiences a strong, uncontrollable urge for food; the reason for overeating. This further yields preoccupations with the uncontrollable weight gain, a factor that leads the patient to inducing various occurrences, such as vomiting or bowel movement in a bid to compensate for overfeeding (Bezsheiko, 2017; Harrington et al., 2015).
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One of the treatment options for people with anorexia nervosa and bulimia nervosa is the utilization of psychoeducation. This involves the adoption of a cognitive-behavioral therapy aimed at the treatment of eating disorders (CBT-ED). The strategy entails stimulation of the patient to change his or her eating patterns as well as beliefs and perceptions about one’s body shape. Again, self-esteem is an aspect that the therapist focuses on in a bid to ensure that the best outcomes are accomplished (Bezsheiko, 2017). The role of the therapist, therefore, is to encourage the patient to be confident about him- or herself and also monitor the patient’s eating habits to undertake an appraisal.
According to Fairburn and Harrison (2003), the effectiveness of the cognitive-behavioral therapy is founded on the identification of specific behaviors and attitudes that affect the patient’s eating habits. This therapy requires the patient to be highly committed to attending 20 sessions which may take place within a timeframe of five months or more. The strategy has proved effective as a third to half of the patients engaged in the therapy attain full recovery (Fairburn and Harrison, 2003). Cognitive-behavioral therapy entails efforts to inform the patient about the adverse health repercussions likely to arise from malnutrition and low weight, which are key aspects for anorexia nervosa (Bezsheiko, 2017). Worth consideration is the fact that the effects of anorexia nervosa, which include low body weight, can be reversed to have the patient leading a normal life. The implication is that there is need to sensitize the patient to engage in various activities aimed at adjusting his or her perception toward the body shape and eating behaviors is necessary.
Another treatment method that a clinician may use is the supportive clinical management of anorexia (SCM). Under this strategy is the family therapy, focused on the treatment of anorexia (FT-AN) as well as family therapy, focused on the treatment of bulimia (FT-BN). SCM involves the utilization of the family resources in seeking recovery for the patient (Bezsheiko, 2017). Where CSM fails to work within a timeframe of four weeks, it is recommendable to adopt the cognitive-behavioral approach (CBT-ED) to enable concentration on the specific behavior of the patient and align the same with the needs for recovery (Fairburn & Harrison, 2003). Nutrition education and nutrition intervention have been emphasized in enabling patients of both anorexia and bulimia nervosa to recover from their poor eating habits. According to The American Dietitic Association (ADA) eating disorders comprise of two complex issues that need to be addressed. The first issue is associated with food and weight while the second one relates to relationships with oneself and others. It is this second issue that affects the patient to an extent of comparing one’s body shape with others around him or her, thus developing a habit of either restricting or boosting the eating behaviors. A focus on food and weight, therefore, without integrating the patient’s involvement in relationships is likely to be harmful rather than therapeutic (ADA, 1994). Medical nutrition therapy entails engagements by the therapist to assess the nutritional status of the patient. It also entails diet therapy counseling and the utilization of specialized dietetic supplements. Both the therapist and the patient must collaborate in adjusting the patient’s behaviors in relation to food and weight (ADA, 1994).
The medical nutrition therapy comprises of the education and experimental phase. The education phase involves provision of information that may enable the patient in his or her choice of nutrition. The interactions between the therapist and the patient are brief and based on facts (ADA, 1994). The experimental phase, on the other hand, may involve extensive interactions in a bid to expose the patient to counseling aimed at boosting relationships. The therapist, in this case, is part of a treatment team involved in various disciplines. The registered dietician consults with a psychotherapist to explore the emotional issues faced by the patient in alignment with changes in behavior or weight (ADA, 1994). The dietician may also involve the family members of the patient who could be resourceful in enabling the recovery of the patient. This involvement becomes part of collusion efforts to alleviate the family’s frustration at mealtimes as the dietician takes the role of monitoring the eating behaviors. Involvement of the family members also ensures that their suggestions are integrated in meal planning, nutritional prerequisites, and techniques for addressing inappropriate behaviors in alignment with changes in food and weight status of the patient.
Brewerton and Costin (2011) suggest the need for follow-up in the therapeutic endeavors aimed at ensuring the recovery of people with eating disorders. In their study for long term follow up of patients after undergoing treatment in a residential facility, they report significant improvement for patients of Anorexia nervosa and Bulimia nervosa.
A major issue that arises in dealing with the patients of anorexia and bulimia nervosa is the fact that some patients may need to be hospitalized in intensive care unit due to severe outcomes of their disorders (Bezsheiko, 2017). The need to collaborate with family members is another issue of significance. As a clinician, collaboration with family members would weigh more than any other issue, particularly because they are the primary caregivers and, therefore, most likely to understand the condition of the patient. As per the statement by the ADA (1994), a consideration of the relationships in which the patient is involved is critical as a focus on food and weight alone may not yield the anticipated recovery of a patient with any kind of eating disorder. Other issues that may arise in the course of treating the patient may be easier to address where relations with the family members are intact. Of great significance is the need to ask for suggestions regarding various issues and integrating the same in the treatment procedures to ensure the satisfaction of the patient and his or her kinship.
References
American Dietitic Association (1994). Position of the American Dietitic Association: Nutrition intervention in the treatment of anorexia nervosa, bulimia nervosa, and binge eating. Journal of the American Dietitic Association, 94 (8), 902-920.
Bezsheiko, V. (2017). New recommendations for management of eating disorders (anorexia nervosa, bulimia nervosa) from NICE. NICE, 3 (2), 1-4.
Brewerton, T. D. & Costin, C. (2011). Long-term outcome of residential treatment for anorexia nervosa and bulimia nervosa. Eating Disorders, 19, 132-144. Doi: 10.1080/10640266.2011.551632.
Fairburn, C. G, & Harrison, P. J. (2003). Eating disorders. The Lancet, 361, 407-416.
Harrington, B. C., Jimmerson, M., Haxton, C. & Jimerson, D. C. (2015). Initial evaluation, diagnosis, and treatment of anorexia nervosa and bulimia nervosa. American Family Physician, 91 (1), 46-53.
