Joshua Cole.

A person with an eating disorder can be helped much more easily if the problem is identified and treated early. However, for treatment to be successful, he or she must be ready to get better. Admitting that they have a problem is the first, yet hardest, step for sufferers of an eating disorder. If they take that step, they can find the support and treatment they need to stop the disorder taking over their lives.

For most people the first step will be to talk to your General Practitioner (GP), or if you feel uncomfortable talking to your GP perhaps you could talk to a practice nurse.

The GP offers the easiest route to diagnosis and further treatment options through the NHS. Depending on the severity of your disorder, you may be offered a course of counselling; dietary counselling or advice; or referral to a specialist for further assessment. This may in turn lead to an offer of day-patient or outpatient treatment or, where the disorder is more serious, inpatient treatment. You may also need treatment for any medical condition that has resulted from your eating disorder, or is associated with it. You may be so concerned about discussing your eating disorder with your GP that the words just won't come out when you are sitting in the surgery. If you are worried about being able to discuss things with the doctor, consider writing down the things that are worrying you and any questions you would like to ask or, perhaps you could take a friend or family member with you.

There are a variety of ways in which you can be treated. You may be offered a combination of different forms of intervention. If you are at a very low weight it may be essential to gain some weight before you begin therapy. You will probably be offered some form of 'talking therapy'; of which there are many varieties, including counselling, psychotherapy, cognitive analytic therapy, cognitive behaviour therapy, group therapy or family therapy. The therapy you are offered should be based on discussions between you and the healthcare professionals.

If you are an in-patient or a day patient you might also be offered drama or art therapy as well as relaxation and body acceptance therapy including massage, aromatherapy or reflexology.

In some instances medication can help in the treatment of bulimia, or to deal with associated depression or other problems.

The most effective and long-lasting treatment for an eating disorder is some form of psychotherapy or counselling, coupled with careful attention to medical and nutritional needs. Ideally, this treatment should be tailored to the individual and will vary according to both the severity of the disorder and the patient's individual problems, needs, and strengths.

Nutritional counselling

• The initial aim of treatment is to re-establish a healthy attitude towards food and a consistent pattern of eating, with three meals a day at regular times.
• It is a necessary stage of treatment and should incorporate education about nutritional needs and planning for and monitoring rational choices of the individual patient.
• Nutritional counselling and advice can help you to identify your fears about food and the physical consequences of not eating well. Education about the nutritional value of food can be beneficial, particularly if you have lost track of what 'normal eating' is.
• Keeping a diary of eating habits to discuss with a GP and learning about healthy eating and sensible weight control may be helpful.

Psychotherapy

• Addresses both the eating disordered symptoms and the underlying psychological, interpersonal, and cultural forces that contribute to, or maintain, the eating disorder.
• Forming a trusting relationship with a therapist allows complex issues to be addressed such as anxiety, depression, low self-esteem, low self-confidence, difficulties with interpersonal relationships, body image concerns, and identity formation. Practitioners may use a particular type of therapy, or a combination of several different approaches such as those outlined below:

• • Psychotherapy: This encompasses a set of techniques intended to improve mental health, emotional or behavioural issues of individuals, group, or family interactions. Mental health problems can include psychological, social and somatic dimensions, which often make it hard for people to manage their lives and achieve their goals. Psychotherapy is aimed at these problems, and attempts to help people to solve them via a number of different approaches and techniques.
  • CBT: A type of talking treatment, or psychotherapy, called cognitive behavioural therapy (CBT) is frequently used with patients who have an eating disorder. It is based on the assumption that eating disorders develop in response to life stresses. Treatment is aimed at identifying and confronting the individual's fears and avoidance behaviours and cultivating new problem-solving skills. It also aims to increase awareness of negative thought processes and to change them. Cognitive techniques are used to encourage patients to evaluate and challenge their automatic thoughts, examine their underlying assumptions, and replace them with realistic beliefs and actions based on reasonable self-expectations.
  • CAT: Cognitive Analytic Therapy (CAT) emphasises collaborative work between the client and therapist, and focuses on the understanding of the patterns of maladaptive behaviours. The aim of the therapy is to understand origins and recognition of these patterns, and subsequently to learn alternative ways in order to cope better.
  • IPT: Interpersonal psychotherapy (IPT) helps people look at their relationships with friends and family and make changes in problem areas.
    IPT is based on the belief that psychological problems are due to communication problems, which are formed due to attachment styles. This therapy is thought to be particularly relevant to the treatment of Bulimia Nervosa.
  • RET: Rational Emotive Therapy (RET) suggests that psychological disorders are due to faulty or incorrect beliefs and, as such, focuses on the sufferers' unhelpful beliefs.
  • Psychoanalytic psychotherapy: In this therapy the focus is on the sufferer's past experiences. Most psychoanalytic therapists believe that psychotherapy is most effective when it leads to increased self-knowledge on the part of the patient. Current psychodynamic approaches prefer techniques designed to change the patient's habitual patterns of living by building an especially authentic or supportive relationship with the analyst that is believed to help the patient learn new ways of relating to others and to life in general.
  • Group Therapy: Group therapy is a form of psychotherapy during which one or several therapists treat a small group of clients together as a group. It provides a supportive network of people who have similar eating disorders.
    The interactions between the members of the group and the therapists become the material with which the therapy is conducted, alongside past experiences and experiences outside the therapeutic group. Groups can address many issues ranging from alternative coping strategies, exploration of underlying issues, ways to change behaviours, and long-term goals. Groups for people with eating disorders are generally for a specific period of time, such as eight weeks.
  • Family therapy: A branch of counselling that works with couples in intimate relationships and families. It tends to view these in terms of the systems of interaction between family members and emphasises family relationships as an important factor in psychological health. As such, family problems are seen to arise as an emergent property of systemic interactions, rather than to be blamed on individual members. The goal is to improve the quality of familial relationships, to address problems of intimate relationships and interpersonal relationships, of family dysfunction, to support the enhancement of the mental health of individuals in family systems and mediate disputes. The family therapist encourages the family, as a unit, to develop ways to cope with issues that may be causing concern, including the eating disorder. The success of this treatment is dependent on the family being willing to participate and make changes in their behaviours.
  • Self Help Groups: Sufferer led groups may also be helpful. It is often comforting to talk to other people who have been through the same thing, and who can offer understanding and acceptance without blame or guilt. Members typically provide each other with various types of non-professional, non-material help based around their particular shared eating concerns. The help may take the form of providing relevant information, relating personal experiences, listening to others' experiences, providing sympathetic understanding and establishing social networks.

Inpatient Care

• Most people who have anorexia can be successfully treated without being admitted to hospital.
• Hospital treatment may be deemed necessary when an eating disorder has led to physical problems that may be life threatening, or when an eating disorder has reached a level of severe psychological or behavioural problems. Inpatient stays typically require a period of outpatient follow-up and aftercare to address the underlying issues in the individual's eating disorder.
• Compulsory treatment is always a last resort, because it is distressing for people with eating disorders to lose control over what they eat and drink. However when someone loses a great deal of weight the effects of starvation on their brain can affect their ability to think. This can make any rational decisions about their own treatment or circumstances very difficult. In extreme circumstances, when all other alternatives have failed and the sufferer's life or health are 'at risk', they may be fed or treated against their will under a 'section' of the Mental Health Act.

In a survey of people who had been fed or treated against their wishes, half said that, looking back, they thought it had been "a positive thing".

Drug treatments

There are no drugs that can cure anorexia. Some people need medicines to treat other health problems caused by anorexia, such as oestrogen hormone supplements in adults if their bones are weak because of anorexia. People who have anorexia often have a low level of zinc in their body. Some doctors think that taking zinc supplements could help people with anorexia put on weight.

In addition the sufferer may be prescribed antidepressants in the short term to relieve symptoms of depression that are often co morbid with eating disorders. Antidepressants have also been shown to reduce bingeing and purging. Examples of these include a class of medications called selective serotonin reuptake inhibitors (SSRIs), in particular fluoxetine (brand name Prozac) and citalopram (Cipramil). However, there is no clear evidence that they can treat eating disorders long-term.

Recovery

Recovery is not easy but it is certainly achievable.

Eating disorders are not attempts to seek attention and are not the fault of the sufferer. It is essential that they are recognised as serious health problems that need specialist care to help deal with both the underlying psychological difficulties and the physical consequences.

Eating disorders are complex illnesses where both the disturbed eating patterns as well as the psychological aspects have to be considered together. Restoring a regular eating pattern and a balanced diet will allow the body to return to health and give you the strength you will need to fight the disorder. Addressing the underlying emotional issues will enable the sufferer to cope with difficulties in a way that is not harmful to their health.

Before any change for the better the sufferer has to recognise their problem and commit to making a change in their lives. No one else can do it on his or her behalf. Family, friends and professional health workers can only help by supporting, caring and providing the necessary guidance to lead them down the road to recovery. People with eating disorders often have mixed feelings about 'giving up' their illness. This is because their eating habits have become established as a way of coping with their emotional difficulties.

The exact treatment needs of each individual will vary. It is important for individuals struggling with an eating disorder to find a health professional they trust to help coordinate and oversee their care.

Treatment is available. Recovery is possible