Do you know of someone who doesn’t eat much, is afraid of becoming fat or appears to have an extreme amount of weight loss? It could be that they are suffering from an eating disorder called Anorexia Nervosa. To help understand Anorexia Nervosa I have interviewed Licensed Marriage and Family Therapist Deborah Klinger.
Tell me a little bit about yourself?
“I have been working in the field of eating disorders since 1990, when I began working at inpatient treatment programs in Los Angeles. I’m currently in private practice in Chapel Hill, NC. I’ve been a Certified Eating Disorders Specialist through the International Association of Eating Disorders Professionals (IAEDP) since 1994, and I am an IAEDP Approved Supervisor for other therapists seeking certification. I am the GoodTherapy.org Eating and Food Issues Topic Expert, and as such, I write articles on that topic each month. I’ve given talks and presentations on eating disorders at numerous conferences and venues. I’m also a certified Phoenix Rising Yoga Therapy practitioner, as I believe in the healing power of therapies that focus on the body. I am myself recovered from Binge Eating Disorder, so I understand eating disorders from a personal as well as professional perspective.”
What is anorexia nervosa?
“Anorexia Nervosa is a complicated, medically dangerous condition in which the person suffering from it develops tremendous concerns about becoming fat or gaining weight, so much so that she decreases her food intake to far below what she needs to maintain a healthy weight and size, and persists in eating inadequate amounts of food (or exercising so much that the amount of calories taken in are insufficient) even when she is experiencing negative or even life-threatening consequences.”
What are the signs and symptoms of someone who has anorexia nervosa?
“A person with Anorexia Nervosa will demonstrate rigidity around eating behaviors, often beginning as a diet and morphing into extreme rules and beliefs about what, when and how much she will allow herself to eat. She will weigh herself often, sometimes several times per day. She might perceive herself to be normal weight, or believe her stomach or thighs are too big, while actually dangerously underweight. She usually feels guilty when she eats more than she believes is reasonable. She may exercise excessively, or engage in constant movement (e.g., standing rather than sitting, fidgeting while sitting). A person with Anorexia Nervosa often is very concerned with being productive and not being lazy, and doing things perfectly. She usually believes that her worth as a person depends on the grades she gets, how well she does at work, the size of her clothing, the number on the scale, and being well-regarded by others. In order to be thought well of by others, a person with Anorexia Nervosa will avoid conflict, and avoid display of emotions that might be thought of as negative, such as anger, or emotions that might cause her to be perceived of as needy, such as sadness or despair. She will focus on the needs of others rather than on her own. Females with Anorexia Nervosa often have ceased to menstruate because of their low body weight and low percentage of body fat.”
What type of impact does anorexia nervosa have on a person’s life?
In the beginning stages, someone suffering from Anorexia Nervosa tends to feel upbeat because she equates controlling food intake and losing weight with being in control, virtuous and worthwhile. As time goes on, people close to her often become concerned. She will often deny that there is a problem, and conflicts around her weight, eating behaviors and medical condition ensue. A malnourished brain generates obsessive thoughts and inaccurate perceptions, so the more deeply entrenched a person’s Anorexia Nervosa becomes, the greater her denial becomes, as the sufferer attributes the effects of starvation to other factors. People who suffer from Anorexia Nervosa sometimes become less social, declining to participate in situations that involve food, and sometimes come to view Anorexia Nervosa as a friend who is there for them when no one else is. Eventually, her daily schedule can revolve around eating and exercise, giving her a sense of consistency and predictability that offsets fears and insecurities, but is frustrating to those around her.
What type of help is available for someone who has anorexia nervosa?
“There are several level of care for people with Anorexia Nervosa (and for all types of eating disorders). They range from the lowest level, outpatient treatment, to the highest, inpatient. The appropriate level of care is determined in part by specific criteria, and in part simply by figuring out what the lowest level of care is that will enable the person to recover. If outpatient treatment is insufficient, a higher level of care must be considered.”
“Outpatient treatment consists of working with a treatment team that includes a psychotherapist and often a dietician and a physician to follow the eating-disordered person medically, and sometimes a psychiatrist for medication. The person meets with the psychotherapist generally a minimum of once per week, and with the other members of the team as determined by each treatment professional. Research shows that there is no one type of psychotherapeutic approach that is most effective for Anorexia Nervosa, but that Cognitive-Behavioral Therapy (CBT), interpersonal psychotherapy, psychodynamic psychotherapy, Dialectical Behavioral Therapy (DBT), Acceptance and Commitment Therapy (ACT) are each helpful to some degree. Treatment appears to be most effective when administered by a therapist who is knowledgeable about eating disorders, skilled in utilizing these approaches as needed, and able to form a positive connection with the client.”
“The next level of care in intensive outpatient, in which the person attends a program several times per week, often in the evenings, while continuing to work or attend school during the day. Such programs usually incorporate group and individual therapy, nutritional guidance and medical oversight.”
“Day treatment (or partial hospitalization, if hospital-based) programs are helpful for Anorexia Nervosa sufferers who need more comprehensive treatment. They involve living at home while attending a treatment program all day Monday through Friday. All meals and most snacks are eaten at the program.”
“Residential treatment requires the patient to live on site, usually for a period of at least 30 days and sometimes much longer. Patients for whom residential treatment is indicated are unable to increase their nutritional intake and/or decrease their activity to restore them to a physically stable weight with a lower level of care. They are highly supervised, prohibiting excessive movement as well as ensuring adequate nutritional intake. Some residential treatment programs offer supplemental feeding, e.g. via a naso-gastirc tube, for patients whose nutritional status indicates it. Residential treatment programs often include a variety of treatment modalities, combining traditional psychotherapy and nutritional counseling with alternative and complementary practices such as equine therapy, yoga, meditation and body-oriented therapies.”
“Inpatient treatment, the highest level of care, is appropriate for patients whose Anorexia Nervosa has compromised their health to such an extent that they require greater medical oversight. It takes place in a hospital setting. It includes the same types of offerings a residential program does, but with increased attention to the patient’s medical status.”
What last advice would you like to leave for someone who is dealing with anorexia nervosa?
“Dare to believe that you are worth far more than your appearance or your grades or your athletic abilities. Let go of the idea that you must be strong and disciplined to be good enough. Be gentle with yourself, and yet firm in your commitment to nourishing your body and your spirit. If you’re not in treatment, get help. If you are, trust your treatment team. Listen to what they tell you and lean on them and others who care about you for support. You can’t do this alone.”
Thank you Deborah for the interview. If you would like more information on Deborah Klinger check out her website at www.pizzadreams.com/dk.