Eating Disorders - fieldi
Eating Disorders - fieldi
Eating Disorders - fieldi
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ical activity to a normal level. If she is exercising too much, she needs<br />
to realize that she is using exercise as a way of purging, and this<br />
behavior should be addressed.<br />
Lesson 5: Prevention of Bingeing/Purging<br />
Recovery Through Nutritional Counseling 29<br />
By the fifth lesson, the patient has usually realized that the way she<br />
used to treat her body was self-destructive. She understands how<br />
her body coped during starvation or during episodes of bingeing<br />
and possibly also purging. But knowing is one thing and doing<br />
something about it another. I have frequently heard: “I feel motivated<br />
to change my habits. I realize I have to eat—it is the only way<br />
out—but I just cannot get myself to do it. This self-destructive<br />
behavior has become the only way I know to take care of myself<br />
that feels safe.”<br />
At this point the nutritional therapist needs to tune in to the<br />
struggling patient in her efforts to eat. By changing the food plan<br />
according to what she can handle for the time being, she will feel listened<br />
to and accepted. The anorexic patient may be more likely to<br />
try harder if the recommended intake is reduced, and the bulimic or<br />
compulsive overeater may want it reduced or increased, depending<br />
on her earlier habits. After the adjustment has been made and she<br />
feels somewhat more comfortable with the suggested food plan, she<br />
is ready to try again. If it is still too difficult, the reason for not being<br />
able to follow the food plan should be addressed. This may be done<br />
by asking four consecutive questions:<br />
1. What is going on?<br />
2. How does that make you feel?<br />
3. Does eating help? Does it solve the problems?<br />
4. What can you do instead?<br />
With the first question the patient has to open up to a situation<br />
or an incident that recently had an effect on her, like “My<br />
boyfriend did not call” or “My father expects me to get an A on my<br />
math test” or “My poor mother, she is so unhappy.” To answer the<br />
next question—”How do you feel about that?”—I show her a list<br />
(vocabulary of feelings) containing one hundred feelings typed in
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