Explain the Psychological Management of eating disorders?
All anorexia nervosa or bulimia nervosa patients are resistant to any kind of therapy and hospitalization may be a life saving measure, especially with anorexia nervosa patients. The intense fear of becoming fat and the disturbed perception of their weight status is what make treatment difficult. The supportive care by an understanding. physician/ psychiatrist is most important. The patient needs to be repeatedly assured by the doctors that the treatment will not make her fat. The patient may be given some reward, may be in terms of freedom/ home-visit as she shows some gain in weight or even when she consumes extra food. The patient needs to be told in a calm but realistic manner about the risks that accompany starvation including sudden death. You will recall reading earlier that sudden death is a real danger if the patient is below 35% of the ideal weight and if the weight loss has been rapid. For bulimic patients hospitalization may be required only for treatment of medical complications like aspiration or electrolyte imbalance. The short- term goal for treatment of bulimics may be stoppage of gorging-regurgitation cycles so that the load of food ingested may be limited. This also minimizes the chance of aspiration or gastric rupture. Psychiatric treatment is required because depression and anti social behaviour are common in bulimia. The use of drugs remains controversial. The use of antidepressant therapy in both the disorders needs to be considered on individual merits of the case.