Eating disorders are complex problems in which both the physical and psychological health of a person are intricately linked.
Overcoming an eating disorder therefore requires both medical and psychological help. Treatment should never focus exclusively on eating and weight issues nor should it ignore these. Effective treatment may include any of the following:
Attention to medical and nutritional needs
Psychological counselling or psychotherapy
Provision of adequate information about the disorder and its consequences (physical, psychological and social)
Access to support
For treatment to be effective, a person with an eating disorder needs to really want to get better. This can take time and cannot be forced.
No one form of treatment works for everyone
Eating disorders are caused by many different factors. For each individual there will be a different group of factors underlying and sustaining the disorder. Ideally, all those involved in the treatment of a person with an eating disorder will work together as a team and treatment will be tailored to the individual's needs. Where possible, treatment goals should be negotiated rather than imposed.
The earlier treatment begins, the greater the chance of a successful outcome
Delay in recognising the disorder and getting appropriate treatment can lead to long-term problems and result in the need for more intensive treatment. Treatment can be relatively straightforward once the eating disorder is recognised and help is sought in the early stages. Early intervention is especially important in the case of children as eating disorders in children can become severe very rapidly.
Many people with eating disorders find it difficult to ask for help and may feel very unsure about accepting it. They may be reluctant to admit to the seriousness of their problem and feel frightened of the consequences of seeking help. They may also feel ashamed of the disorder, may try to disguise it and may be unforthcoming about important symptoms. These are some of the factors that can delay access to appropriate help.
Treatment is available in a number of forms though access to services varies throughout the country. Access to public health services is usually by referral from a medical source (GP, paediatrician, Area Medical Health Officer, clinical psychologist). Health Boards provide treatment via their Mental Health Services to those in their catchment area. A multidisciplinary approach is recommended.
The Family Doctor or GP
The GP plays a crucial role in the diagnosis of an eating disorder and in the referral of a person for treatment. In some cases, particularly when treatment is sought at an early stage, a GP with a good knowledge of eating disorders may be able to attend to all aspects of treatment. Some GP's will take a more active role in treatment than others. In many cases the GP will make the decision to monitor medical aspects and refer a person on for other aspects of treatment.
Counselling or psychotherapy
This can take many different forms including one-to-one counselling or psychotherapy, cognitive behavioural therapy (CBT), cognitive analytic therapy (CAT), group therapy, family therapy or a combination of these. The aim is to address the psychological factors that are underlying and sustaining the disorder, to explore problems around self-esteem, problems related to self perception and body image, interpersonal relationships, autonomy, etc., with a view to facilitating self acceptance and ultimately change. Family involvement in therapy is considered especially valuable, particularly for younger people. Access to public services generally requires a referral.
Nutritional counselling/ dietary advice
This type of help can be very useful alongside psychological counselling and medical management. The aim is to educate and to enable the person to begin to make the choices necessary to restore healthy eating habits and normal weight. Access to public services generally requires a referral.
Some people may require psychiatric assessment for their eating disorder and related or co-existing problems. This can also sometimes be necessary when diagnosis is not straightforward. A referral is needed.
Both in-patient and out-patient treatment programmes are available. Some hospitals offer eating disorder recovery programmes. In-patient programmes need to be followed up by out-patient care and support. A small number of dedicated clinics and some addiction treatment centres also offer programmes. The more structured environment of treatment programmes can often help those who have repeatedly tried and failed to get better on their own or who have not responded to other forms of treatment.
Hospitalisation may be required where it is felt that a person is in medical danger or when their psychological state puts them at risk. Occasionally, an acutely ill person may need to be admitted to hospital involuntarily.
Medication under careful supervision may be appropriate for some individuals.
Self help and Support Groups
Self help books on eating disorders are now widely available. They can be used on their own or with the guidance and support of a professional. Support groups can also provide invaluable help throughout the recovery process. However, where therapy is required, support groups should not be seen as an alternative but as an additional form of support. With the right support and a high level of commitment, some people will manage to recover from their eating disorder without professional help.
Confidentiality will be crucial no matter what treatment options are chosen. People accessing treatment should ask about confidentiality so that there is clarity from the beginning for all concerned. This will help build trust, and disclosure of important information, whether physical, psychological or behavioural, will be made easier. Carers will also need to be aware of confidentiality agreements so that appropriate boundaries are respected.
The treatment needs of children and adolescents are different to those of adults. When hospitalisation is required, children and adolescents should not be treated on adult wards if this can be avoided.