Eating Disorders and Treatment

Eating disorders, which are very difficult to treat because the patient is not prone to therapeutic cooperation in most cases, can be treated in the hospital as an outpatient or inpatient, with medications and psychotherapy. One of the common scenarios is that the patient does not realize his/her own condition, cannot convey the situation to his/her relatives even if he/she realizes it, and therefore the patient does not ask for treatment. The earlier the treatment process, which requires diligence not only from the patient but also from their relatives, approaches, the more effective it is. In this case, the patient and their relatives should be informed about the eating disorder and explained how the process will go on.

While the definitions of eating disorders involve a desire to be thin, avoiding meals, and continuously engaging in weight loss diets, they also have some differences. To receive a diagnosis of anorexia nervosa, a client must exhibit symptoms such as abnormally decreased portions for at least 3 months, a level of weight loss that would lead to complications, a distorted body image, and an obsession with weighing and getting thinner. Patients diagnosed with bulimia nervosa, like those with anorexia nervosa, are obsessed with being thin and weighing themselves, but they compensate for their consumption of abnormally small portions or eating according to their own criteria by using methods like laxatives, exercise, and vomiting. In binge-eating disorder, patients experience binge-eating attacks at least once a week for 3 months, either due to restrictions caused by an obsession with being thin or emotional reasons, but unlike bulimia, they do not resort to any compensatory methods.

A binge-eating attack involves consuming more than 2000 calories in less than 2 hours or eating excessively by considering what they have eaten as excessive. For example, a patient with anorexia nervosa may consider consuming even 10% of their normal calorie needs as a binge-eating attack.

Common Reasons of Eating Disorders:

-Delusions created by the media on aesthetics,

-Oppressions from the society to be thin,

-More consideration in the perception about the importance of physical appearance,

-Authoritarian parenting,

-Interparental conflicts,

-Having someone in the family with an eating disorder,

-Sexual and physical abuse,

-Perfectionism,

- The desire for social acceptance,

-Fear of being overweight.

Treatment of eating disorders is carried out under the leadership of psychiatry and psychotherapy, in cooperation with other medical branches for the treatment of possible physiological diseases. One of the values examined in diagnosing an eating disorder is the body mass index (BMI), which is determined by the weight-to-height ratio. According to the criteria of the World Health Organization, although BMI <17 is the typical level of anorexia nervosa, it is still possible to be diagnosed with anorexia nervosa even though it is not within this range. Likewise, the typical BMI of binge eating disorder is high, but someone with a BMI in the normal or low range may also have an eating disorder. For this reason, BMI alone is not a sufficient criterion for diagnosing of eating disorder.

The primary goal in the treatment of eating disorders is to establish therapeutic cooperation with the patient, who is generally closed to treatment, and to motivate the patient and his family to receive treatment. Cognitive behavioural therapy (CBT), one of the methods used for treatment, is a form of therapy that argues that our thoughts determine how we feel and behave, and in the treatment of eating disorders, it focuses on the cognitive processes underlying the individual's impaired eating behaviour. CBT is more effective in binge-eating disorder and bulimia nervosa compared to anorexia nervosa and consists of an average of 16-20 sessions. Since eating disorders can also be a sign of other problems, such as low self-esteem, CBT aims to change the distorted thoughts related to eating behaviour and teach the individual to cope with negative emotions.

Key Cognitive Steps in the Implementation of CBT:

1. Identifying automatic thoughts
2. Replacing cognitive distortions with more realistic beliefs

Key Behavioural Steps in the Implementation of CBT:

1. Exposure
2. Desensitization
3. Behavioural exercises
4. Role-playing

While treatment methods may vary according to each client's individual situation, CBT is generally the most widely used method for the treatment of eating disorders.

Another topic to be mentioned in eating disorders is gender difference. This is because eating disorders are much more common in women than in men, and there is not enough research in the literature regarding the complications of eating disorders in men. Due to some differences in sociocultural roles between men and women, men may be affected by situations that do not affect women. For example, in societies where the belief "Real men don't cry." prevails, men may feel pressure to hide their emotions, and individuals who cannot express themselves emotionally may experience some psychiatric disorders, including eating disorders. Since there may be other factors besides sociocultural factors, more research is needed on the dynamics of eating disorders in men.

*The Diagnostic and Statistical Manual of Mental Disorders

REFERENCES

Tahiroğlu AY, Fırat S, Diler RS, Avcı A. Erkek çocuklarda yeme bozuklukları; bir anoreksiya nervosa vakası. Çocuk Sağlığı ve Hastalıkları Dergisi 2005; 48: 151-157.

Kaya B, Yiğittürk D, Yalvaç HD. Anoreksiya nervosa tanılı iki kız kardeş: olgu sunumu. Klinik Psikiyatri 2003;6:56-61.

Sarı SA. Ergenlerde yeme bozuklukları yönetimi. Aile Hekimliğine Güncel Yaklaşımlar 2019;44:315-323.

Özcan Ö, Çelik GG. Bilişsel davranışçı terapi. Turkiye Klinikleri J Child Psychiatry-Special Topics 2017;3(2):115-120.

Şentürk Z. Yeme bozukluğu hastalarında tedavi motivasyonu ve tedavide bilişsel davranışçı terapi. Yüksek Lisans Projesi, Fatih Sultan Mehmet Vakıf Üniversitesi, 2020.