Eating Disorders - fieldi

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ical activity to a normal level. If she is exercising too much, she needs to realize that she is using exercise as a way of purging, and this behavior should be addressed. Lesson 5: Prevention of Bingeing/Purging Recovery Through Nutritional Counseling 29 By the fifth lesson, the patient has usually realized that the way she used to treat her body was self-destructive. She understands how her body coped during starvation or during episodes of bingeing and possibly also purging. But knowing is one thing and doing something about it another. I have frequently heard: “I feel motivated to change my habits. I realize I have to eat—it is the only way out—but I just cannot get myself to do it. This self-destructive behavior has become the only way I know to take care of myself that feels safe.” At this point the nutritional therapist needs to tune in to the struggling patient in her efforts to eat. By changing the food plan according to what she can handle for the time being, she will feel listened to and accepted. The anorexic patient may be more likely to try harder if the recommended intake is reduced, and the bulimic or compulsive overeater may want it reduced or increased, depending on her earlier habits. After the adjustment has been made and she feels somewhat more comfortable with the suggested food plan, she is ready to try again. If it is still too difficult, the reason for not being able to follow the food plan should be addressed. This may be done by asking four consecutive questions: 1. What is going on? 2. How does that make you feel? 3. Does eating help? Does it solve the problems? 4. What can you do instead? With the first question the patient has to open up to a situation or an incident that recently had an effect on her, like “My boyfriend did not call” or “My father expects me to get an A on my math test” or “My poor mother, she is so unhappy.” To answer the next question—”How do you feel about that?”—I show her a list (vocabulary of feelings) containing one hundred feelings typed in
30 Recovery Through Nutritional Counseling alphabetical order. She is surprised that there are so many feelings. I now ask her to highlight the ones that describe her mood. This makes her feel slightly better, not only because I can now empathize with her since I know how she feels but also because she herself has a name for these uncomfortable feelings. Patients are often elated to find a vocabulary that finally describes what they have been coping with. The third question has two parts. There is a short-term question: Does restricting or eating help? Does it make you feel better? In most cases, the answer is yes! Not everyone knows why but, after some thought, most patients admit that restricting or eating numbs those painful feelings they just realized they had had. We call that emotional restricting or eating, as opposed to physical eating, which is when we eat because of hunger. The second part of this question deals with the long-term picture: Does restricting or eating solve the problem? We agree that it does not, so now she needs to address the last question: What can I do instead of restricting or eating? It is hoped that appropriate brainstorming will lead to suggestions about what to do. Deep down, filled with fear, the anorexic knows that she needs to eat and face her blocked feelings. For the bulimic and the compulsive overeater, suggestions might include exercising, attacking a long-awaited project (cleaning a closet), calling someone, writing about it, or just accepting it. In order to “just accept it,” patients have found it helpful to analyze realistically the situation that caused the feelings. This analysis helps the patient realize that her feelings are frequently based on personal assumptions about what others would think or say about her—rather than reality. The patient eventually will become somewhat aware of these new, often painful feelings that can be overwhelming and try to get in touch with them. The therapist and nutritionist will communicate with each other regarding focus and content in order to coordinate this part of emotional relearning. Learning how to deal with new feelings frequently leads to continuous restriction or binge eating. The patient comes to realize slowly how she unconsciously has been responding to mental discomfort. She is now more ready than ever to listen to suggestions on prevention. How can she help herself not to eat or overeat/binge over emotional issues? After some brainstorming, anything is worthwhile practicing. With the bulimic
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editor BARBARA P. KINOY EATING DISO
Page 4 and 5: Eating Disorders New Directions in
Page 6: To our patients’ children and gra
Page 9 and 10: viii Contents 3. Psychiatric Consul
Page 11 and 12: x Foreword Although serious deficie
Page 14 and 15: preface In 1994, in the first editi
Page 16 and 17: Preface xv psychological hazards to
Page 18 and 19: Preface xvii partial, complete, or
Page 20 and 21: acknowledgments We wish to acknowle
Page 22 and 23: contributors Debra Bader, CSW, BCD:
Page 24 and 25: Eating Disorders
Page 26 and 27: Introduction diane w. mickley I am
Page 28 and 29: Introduction 3 needs of patients wh
Page 30 and 31: Introduction 5 therapy or on medica
Page 32 and 33: 1 Medical Aspects of Anorexia and B
Page 34 and 35: Medical Aspects of Anorexia and Bul
Page 42 and 43: 2 Recovery Through Nutritional Coun
Page 44 and 45: Recovery Through Nutritional Counse
Page 46 and 47: Lesson 1: Daily Caloric Need and Me
Page 56 and 57: patient who binges, it may be helpf
Page 58 and 59: and allowing herself to consume a l
Page 60 and 61: Figure 2.3 Typical Hunger and Food
Page 62 and 63: herself. She frequently feels hopel
Page 74 and 75: 3 Psychiatric Consultation with Eat
Page 76 and 77: Psychiatric Consultation 51 standab
Page 78 and 79: Psychiatric Consultation 53 difficu
Page 80 and 81: Psychiatric Consultation 55 Obsessi
Page 82 and 83: 4 A Family Systems Perspective on R
Page 84 and 85: A Family Systems Perspective on Rec
Page 90 and 91: she calls her mother and tells her
Page 102 and 103: 5 Relationship to Food as to the Wo
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iors—somehow to integrate the fra
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treatment, Theresa wanted to see an
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Relationship to Food as to the Worl
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6 The Therapeutic Use of Humor in t
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The Therapeutic Use of Humor 91 Amy
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The Therapeutic Use of Humor 93 was
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The Therapeutic Use of Humor 95 ass
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The Therapeutic Use of Humor 97 Ron
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Jodie’s Story 99 capacity to make
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Jodie’s Story 101 house and a ter
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Jodie’s Story 103 She did not do
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adness. The dream also revealed tha
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8 Eating Disorders and Managed Care
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Eating Disorders and Managed Care 1
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Eating Disorders and Managed Care 1
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Cognitive-Behavioral Therapy and Ot
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10 The Nurse’s Role in a Pilot Pr
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The Nurse’s Role in a Pilot Progr
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The Nurse’s Role in a Pilot Progr
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11 Individual Psychotherapy: A Long
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Individual Psychotherapy 135 Such p
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Individual Psychotherapy 137 empath
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weight and shape, as well as change
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Individual Psychotherapy 141 vomiti
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Individual Psychotherapy 143 During
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Individual Psychotherapy 145 and re
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Individual Psychotherapy 147 Mitche
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Young Adult Women 149 to surface an
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Young Adult Women 151 with their at
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Young Adult Women 153 ing; in fact,
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Young Adult Women 155 doomed, and a
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part of a treatment team where the
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13 Recovery margaret goldkopf-woodt
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Recovery 161 I can appreciate both
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Recovery 163 meant. I certainly cou
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Recovery 165 ate other uncomfortabl
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Recovery 167 connection between my
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Recovery 169 safe place, and our ow
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Recovery 171 My pregnancies and mot
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Recovery 173 They seem to be living
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Recovery 175 Self-disclosure remain
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nel. All that I feared, the hurts I
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Afterword 179 surprisingly rapidly
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Afterword 181 With eating disorders
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Treatment helped me to face life, i
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AA/BA. See American Anorexia/Bulimi
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37; prevention of, 29-31; rigid die
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problems and, 19; events triggering
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Keel, P. K., 180 Keller, H., 133 Ke
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Psychoeducational group therapy, 12
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112-20; IPT, 121-22; psychoeducatio
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