Eating Disorders - fieldi

Recovery Through Nutritional Counseling 19
THE TREATMENT TEAM
In the middle of this century, eating disorders like anorexia nervosa
and bulimia nervosa were treated mainly with psychotherapy (Bayer
et al. 1983). Because our knowledge, understanding, and awareness
of these disorders have increased in the last two decades, the demand
for improved treatment naturally follows.
In some cases of severe anorexia where the body weight has
dropped because of starvation and the patient is malnourished or
dehydrated to the point where she is unable to function, immediate
help is required to prevent death. Today this help should consist of a
multimodal treatment program involving medical consultation,
pharmacotherapy, individual therapy, group therapy, family and marital
therapy, and nutritional counseling (Johnson and Connors 1982).
In some instances, hospitalization is essential as part of the program.
The symptoms of the severely bulimic patient are usually less
threatening but can include the risk of cardiac arrest resulting from
electrolyte imbalances, dehydration, and, frequently, ipecac syrup
abuse (Andersen 1988). Overdoses of laxatives or abnormally low
potassium levels have frequently caused the bulimic patient to end
up in the hospital emergency room. In addition to the anorexic
patient’s treatment team (physician, psychiatrist, therapist, and dietitian),
a dentist is often consulted to treat enamel erosion in the
bulimic patient caused by acidity during self-induced vomiting
(Reiff and Reiff 1992). A detailed description of symptoms appears
in the first paper in this book, in Diane Mickley’s description of the
illnesses that comprise eating disorders.
Because an eating disorder generally is the symptom of underlying
emotional problems, these problems have to be acknowledged
and resolved in order for the patient to recover. The psychotherapist
is crucial in helping the patient, but that does not mean that the
chaotic eating behavior will magically disappear when emotional
problems are resolved. A dietitian who has an understanding of the
psychodynamics of eating disorders is the most qualified person to
address issues related to food- and weight-related behavioral change
(Reiff and Reiff 1992).
Challenging as it may seem, it is important to remember that