Therapist's Guide to Clinical Intervention - Sigmund Freud

EATING DISORDER (EDO)
Due to the overlap in symptoms and the blending of features from more than one diagnosis
of Eating Disorder, the goals and objectives will be presented as one section instead of separated
according to the specific diagnosis.
The central features of Anorexia are refusal to maintain adequate body weight, distorted
body image, fear of becoming fat, amenorrhea, eating/food rituals, and excessive exercise.
An anorectic may experience feelings of power associated with restricting food.
The central features of Bulimia include recurrent episodes of binge eating and purging, the
use of laxatives/diuretics, efforts to diet/fast, and an excess concern with body shape and
weight. The binge-purge cycle is initiated by binge eating. This provides relief because the
individual ceases to dwell on anything except the food and how to get it down. This behavior
replaces all other thoughts, behaviors, and feelings. The purging is initiated to "undo"
the consequences of binging. When the binge-purge cycle is over, the bulimic briefly regains
control with associated feelings of competence and increased self-esteem. There are no
longer any feelings of guilt for having eaten so many calories. The person is on a high or
numbed out, feeling relaxed and drained by the behavior.
Due to the relationship of EDO behaviors to physical etiology and consequences, it is
important to refer the person to a physician initially (and monitoring if necessary) to rule
out the presence of organic problems such as those associated to the endocrine system, gastrointestinal
complications, cancer, hypothalamus brain tumor, electrolyte imbalance, assessing
the need for hospitalization, etc.
When working with individuals diagnosed with an EDO, be aware of the possibility of a
general problem with impulse control. Compulsive behaviors can be oriented around stealing,
sex, self-destructive behaviors, and substance abuse. It is not uncommon for individuals
diagnosed with an EDO to trade compulsions (even the EDO behaviors) when they are in
treatment and are making efforts to alter their behaviors. Be alert to the comorbidity of
mood disorder and personality disorder with these individuals, with the associated complications
to the clinical picture.
Goals 1. Medical stability
Treatment Focus
and Objectives
2. Assess for referral for medication evaluation
3. Improve coping
4. Facilitate appropriate autonomy
5. Improve body image
6. Improve rational thinking
7. Improve interpersonal relating
8. Improve communication
9. Improve self-esteem
10. Identify feeling states
11. Differentiate between internal sensations and emotional states
12. Family intervention
13. Self-monitoring
14. Assess psychiatric status and safety
1. Inadequate Nutrition
A. Evaluation by physician/dietitian to determine adequate fluid intake and number
of calories required for adequate nutrition and realistic weight. These professionals
will have to monitor the medical side of the disorder. For the therapist to
become involved, serious complications must arise in the therapeutic relationship.
18 1. Treatment Planning: Goals, Objectives, and Interventions