Eating disorders can be widely misunderstood and those affected by the problem can suffer great shame and isolation. Families often struggle coping with a family member who has the problem. If you suffer from eating disorders it is important to raise it with your GP, who will be able to determine if there are any organic causes to the problem. If you are seeking therapy for the problem then you may find it helpful to read my article on the effectiveness of therapy for eating disorders.
My course is going well. So far this term we have had lectures on a transpersonal view of adolescence, sexual development and eating disorders. In addition we have had two weekends on sexual development. For the next two weeks we have lectures on addictions so presumably we will cover the whole gambit of addictions.
I have enjoyed discussing Freud’s Three Essays on the Theory on Sexuality (1905). Freud was writing at a time when women were chaperoned to the doctor by their husbands. It is also important to remember that Freud was writing in a time that pre-dated gay liberation. So, perhaps writing about sexuality would be akin to writing a history of England purely from the lenses of Victorian books.Indeed, it is interesting to note that the BACP has modified its Ethical Framework that only now informs its members that gay conversion therapy is unethical.
The statement, drawn up by the board of governors, ends: “BACP believes that socially inclusive, non-judgmental attitudes to people who identify across the diverse range of human sexualities will have positive consequences for those individuals, as well as for the wider society in which they live. There is no scientific, rational or ethical reason to treat people who identify within a range of human sexualities any differently from those who identify solely as heterosexual.”
Rosemary Cowan, in a previous edition of Therapy Today, has pointed out that the developmental model that CCPE has suggested is that trainees in the first year are likened to wide-eyed, enthusiastic primary school children; in the second year, like pre-teens, they gain confidence and independence but may also be ‘know-alls’ who overstretch themselves; in the third year they reach the rebellious, argumentative, difficult teenager stage; in the fourth year, with increased maturity and stability, they become more rounded, finished characters. I am not sure where I fit with that model but remaining open minded and receptive is probably the best option and lectures on addictions are probably best placed in the teen period.
I have been continuing with my NHS clinical placement and have been fortunate to shadow the work of one of the largest and oldest established Eating Disorders Services in the world. The service is for anyone from the age of 11 years (with no upper age limit) who are requiring assessment, care and treatment. The course of treatment is offered on an outpatient, day-care or inpatient basis dependent upon the severity and the individual needs of the patient. The Service also accepts patients detained under the Mental Health Act and provides specialist opinions.
The patients present with very severe symptoms and can remind you that psychiatry has its own unique challenges. It has been interesting to note the wider health-care team working with eating disorders, and areas of expertise include occupational therapy (OT), psychotherapy, social work, dietetics, psychology, family therapy, psychodrama and exercise therapy. However, treatment has the very obvious input from nursing and medicine as this is after all a psychiatric setting.
The extent of the severity of the symptoms can be gauged from the in ward unit which offers re-feeding including naso-gastric feeding and medical monitoring of people with severe anorexia nervosa in crisis. The service also takes male patients, though I haven’t seen one yet. There is a full programme of groups and individual psychological therapies.
The outcome measures and audit include patient experience, quality of life, and change in eating behaviours. Results show that the majority of patients leave having increased their BMI, reduced use of behaviours and having learned new skills.
I have been intrigued about the approaches taken with such a vulnerable client base. In the outpatient services the multidisciplinary team offers a wide range of evidence based therapies including Cognitive Behavioural Therapy for Eating Disorders, Cognitive Analytical Therapy, Mentalisation Based Therapy, Dialectic Behavioural Therapy, OT, psychodynamic behavioural psychotherapy, psycho-education, psychotherapy groups, and non-specific supportive clinical management or person centred treatment and the nurse led intervention.
Click on the links below if you are effected by any of these issues.