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Write a report on Eating Disorders with the topic of your choice.

Suggestions for topics include:

  1. Eating disorders and diversity.
  2. Eating disorders and families.
  3. Eating disorders and sexual abuse.
  4. Eating disorders and athletes.
  5. Describe different treatment models e.g. cognitive behavioural treatment of bulimia, family therapy, intensive programs.
  6. How do eating disorders affect a woman's ability to parent?
  7. The ethical issues associated with compulsory treatment.
  8. Prevention of eating disorders or weight related issues.

Discussion

Eating disorders are the serious illness which occur specifically in the adolescent and it impacts adolescence both medically and psychologically. Eating disorders are characterised by low body weight, fear of weight gain and disturbance in the shape and weight of the body. It impairs quality of life adversely and it is evident that mortality rate is higher in patients with eating disorders. Hence, in this essay different aspects of eating disorders like causes, symptoms, diagnosis and available management options are discussed.

Families with eating disorder: Eating disorders are mainly classified into three types like anorexia, bulimia and binge eating disorder. Anorexia nervosa is serious mental illness in which people lose weight due to very less energy intake. People with bulimia nervosa eat large quantities of food during each cycle. After consumption of large quantities of food, they try to compensate it by vomiting, consuming laxatives or diuretics, fasting and purging. People with binge lose control over eating and consume large quality of food on the regular basis. Epidemiological studies indicated that prevalence of anorexia nervosa, bulimia nervosa and binge eating disorder is 0.3 %, 0.9 % and 1.6 % respectively. Eating disorders occur in 5.7 % and 1.2 % girls and boys respectively (Erzegovesi and Bellodi, 2016).

Family treatments for eating disorders should be given to both patient and other family members. It is necessary to consider family members for the treatment of eating disorders because genetic predispositions are potential factors for changing eating behaviours and preferences. Family members influence types of foods, style of eating and availability of foods. From the studies, it is evident that few family’s food choices lead to disordered eating. Studies demonstrated that family’s associated with psychiatric disorders are more vulnerable to development of eating disorders (Mairs and Nicholls, 2016). These psychiatric disorders include borderline personality disorders, avoidant personality disorders and depression. It is evident from the  studies that specifically mothers are responsible for the eating disorders in the daughters because they force them to lose weight. Family functioning is also responsible for the eating disorders because conflicted, disorganised, critical and less cohesive families are susceptible for development of eating disorder. Family pathology mainly occur due to offering disorder instead of cause.  Different psychological aspects like significant body dissatisfaction, the beauty ideal, maturity fears, interpersonal safety, perfectionism, and self-awareness are responsible for eating disorder (Darrow, Accurso, Nauman, Goldschmidt, Le Grange, 2017).

Children of families from the modelling background are more vulnerable for the development of eating disorder because the same attitude and behaviour of the parents can be transferred to their children. It is evident that family’s thinness in directly proportional to the symptoms of bulimic symptoms and attitudes. Eating disorder studies established that poorer outcomes are evident from the prevention and management studies. In most of the family-based studies it is evident that correlational results rather than experimental results are established for Eating disorders (Kanbur and Harrison, 2016). Eating disorders usually starts in early adolescence and puberty (11–14 years of life). It indicates eating disorders usually starts in transitional phase of life which it is characterised by physical, psychological and social modifications. Eating disorder mostly occur in this stage because adolescent age is associated with major and fast body alterations and they are more concerned about their body size and shape. Moreover, there is increased brain and cognitive functioning which lead to societal pressure to become thin and to increase peer acceptance. It is evident that all the ages are prone to the development of eating disorders; however, onset of its prevalence is more in the adolescence (Cook-Darzens, 2016).

Causes

Causes: Multiple factors like genetic, environmental, psychological and sociological factors are responsible for occurrence of eating disorders. Eating disorder is highly heritable. It is evident that polymorphisms of agouti-related peptide, brain derived neurotrophic factor, catechol-o-methyl transferase, SK3 and opioid receptor delta-1 are responsible for occurrence of eating disorder. Recent research indicated that DNA methylation is also responsible eating disorder. All these factors can contribute significantly for the family related eating disorder. Obstetric complications like prenatal and perinatal complications are also responsible for the occurrence of family related to eating disorder. Prenatal and perinatal complications include maternal anemia, diabetes mellitus, preeclampsia, placental infarction, and neonatal cardiac abnormalities. Social effect like family influence is also responsible for family related eating disorder (Hilbert et al., 2014).

Signs and symptoms: Eating disorder is characterised by malnutrition, complication in the major organ in the systems, hypokalaemia, abnormal heart rhythms, constipation, fatigue, muscle damage and paralysis. Symptoms of eating disorders also include low body index, amenorrhea, brittle hair, yellow skin, depression, anxiety disorders, insomnia, chronic fatigue and rapid mood swings (Gaetani et al., 2016)

Diagnosis: Certain established criteria are helpful in identifying potential eating disorder. According to Diagnostic and Statistical Manual of Mental Disorders (DSM-5), eating disorder is characterised by significant weight loss or inability to achieve desired weight, deficiency of nutrients, or interference with psychological functioning. However, accurate diagnosis is not possible in eating disorder. In cases of eating disorders, clinical variability is significantly evident (Mairs and Nicholls, 2016).

Treatment and management : Family based therapies for eating disorders include structural family therapy, strategic family therapy, narrative family therapy and family-based treatment. Minuchin and colleagues initiated structural therapy at Philadelphia Child Guidance Centre. Family process is mainly responsible for the development and maintenance of psychological and behavioural symptoms responsible for eating disorder. This therapy proved useful in the treatment and management of psychosomatic illness in children and adolescents. Psychosomatic families are mainly associated with problems like enmeshment, conflict avoidance, overprotectiveness and rigidity. Enmeshment characterised by failure to maintain adequate personal boundaries, conflict avoidance led to suppression of anger and other emotions, overprotectiveness in the families is evident due to limited range of problem-solving strategies and rigidity occurs due to changes in the developmental needs which are difficult to manage. Adolescents with family enmeshment are associated with more emotional dysregulation, negative global appraisals of distress tolerance and subjective negative mood are responsible for anorexia nervosa (Jewell, Blessitt, Stewart, Simic, Eisler, 2016). In strategic family therapy, symptoms are considered as influencing factors for the family functioning and families are not blamed for the occurrence of eating disorder in their children. According to narrative family therapy, families are considered as nonpathological and specific techniques like externalization are developed and implemented to bring the change. Externalization and co-generation are useful in the fighting against eating disorder (Rienecke, 2017).

Family based treatment: Treatment of eating disorder is a complex process because it is necessary to improve eating habits and restore normal weight of the patient. Moreover, intervention related to eating habits and exercise need to be provided to the patients. It is difficult to establish and implement set protocol for the eating disorder because in the same family patients can be of different age like child, preadolescent and adolescent. Family based therapy creates safe and predictable environment which is useful in minimising anxiety due to eating disorder. It is also helpful in promoting specific early change in eating disorder associated behaviour. It is also helpful in the mobilisation of hope and expectancy necessary for promoting improvement in eating behaviour (Murray and Le Grange, 2014).

Signs and Symptoms

It is the responsibility of parents to increase the types and variety of foods for their child and adolescent. Education to the parents is necessary to improve mechanisms for new types of foods and to increase frequency of foods in child and adolescent. In family-based therapy, it is very important not to blame neither parents nor adolescent for development of eating disorder or cause of the eating disorder. Parents should not criticise child for the disorder and they should make sure that disorder should not take control over children. Therapist or healthcare professional working with the family for eating disorder should take authorisation from the parents for implementation of the care protocol. Therapist need to explain complete recovery process of the child to the parents and probable outcome of the care protocol. Exact care plan needs to be submitted to the parents (Kosmerly, Waller, Lafrance Robinson, 2015).

Family based treatment is directed towards rapid restoration of physical health of adolescent. Due to diseased condition, it would be difficult for the patient for making healthy decisions. Hence, family members need to be incorporated in the care of eating disorder patient. Family based treatment is more prolific approach because day-to-day environment for patient would be improved rather than sending patient to the residential or inpatient care homes. Family meal strategy proved useful in improving eating habits of the adolescent. In family-based eating child and adolescent need start regular eating without the parent’s involvement. It is necessary to achieve stage where child or adolescent serve themselves instead of parents and parents would oversee the consumption of food by the children (Cook-Darzens, 2016). It is necessary to resolve developmental challenges associated with child and adolescent due to eating disorders. Parents need to be very confident while providing care for the children with eating disorder. They should establish effective communication with their children. Therapist need to put extra effort to empower parents to follow accurate process to manage eating disorder in their children. Therapist need to remind the parents that they know how to feed their children; however, due to eating disorder there might be doubt and disturbance in their feeding to their children. It is necessary for the parents to be dependent on themselves for selecting care plan rather than therapist because it would be helpful in augmenting their confidence (Robinson, Dolhanty, Greenberg, 2015).

In family-based therapy for eating disorder, initial focus should be on symptoms reduction. Major control on the eating disorder need to be achieved in the initial phase because long term malnutrition would lead to physical and psychological disturbance in the patient. It would be difficult to manage long-term damage of physical health of the patient. Eating disorder is associated with psychological disorders like depressed mood, anxiety, irritability, difficulty concentrating, or social withdrawal. However, in the initial phase of the treatment, emphasis is not given for management of these psychological problems. In the initial phase of the management of eating disorder, major emphasis is given to the weight restoration because with the restoration of the weight other psychological problems can be effectively managed. Even though, family-based therapy proved effective for both child and adolescent; few of the families would not respond effectively for this treatment. In such scenario, multifamily treatment of child and adolescent is the viable option. Conceptual focus of family-based therapy and multifamily therapy is similar; however, effective families of family-based therapy mobilise themselves to treat another child and adolescent. In multifamily therapy usually 5 to 7 families take part and support each other based on their learning and experience (Swenne, Parling, Salonen Ros, 2017).

Diagnosis

Family-based treatment is usually provided in three phases like parental refeeding, adolescent control of eating and weight processes and addressing of adolescent issues and termination. Aim of parental feeding is promotion of taking charge of eating and weight-loss behaviours. In this phase parents’ anxieties need to be modulated to encourage food consumption, supporting and educating parents in their activities, assisting siblings to support ill siblings and supporting mother to tolerate refeeding. Aim of adolescent control of eating and weight processes is to encourage parents to facilitate transition of eating and weigh control to adolescent. Family need to be supported for identification of patient’s readiness to initiate controlling of eating and weight control behaviours with respect to their age (Couturier, Kimber, Szatmari, 2013). Parents need to be educated for management of anxiety during transition. All the problems related to the food and weight need to solved in adolescent. Aim of the addressing adolescent issues and termination phase is promotion of maturity and understanding of adolescence. Families need to be supported and educated for identifying issues which require more attention. Psychoeducational review of the adolescent development needs to be carried out. Implications of eating disorder on patient and family need to be studied. Emotional and developmental issues of patient and family for which they seek assistance need to be identified and these issues need to be addressed effectively (Forsberg and Lock, 2015; Costa and Melnik, 2016).

Family treatment for Adults with Eating disorder: Family therapy for Eating disorder is also applicable to adults. Broadly process of family therapy is almost similar to the adolescent. However, parents and other relationships need to be negotiated more efficiently in adults. Adult Eating disorder is not much legally dependent on parents and other adults in the family. Adults are self-motivated develop self-starvation; hence, this behaviour in adults is more challenging. Three phases of family centred therapy are almost similar in the adults like adolescent; however, emphasis on third phase need to be given in adolescent. Relationship of adults need to be considered while providing family-centred treatment for eating disorder. Adults need to maintain multiple relationships and different relationships can influence eating behaviour of adults differently (Brauhardt, de Zwaan, Hilbert, 2014).     

It is evident that outcome of family therapy is more in comparison to the standard care and no treatment. However, individualised therapy in adolescents proved more effective in comparison to the family centred therapy. It is evident that most of the adults prefer individualised therapy rather than family-based therapy. Adolescents are more resistant to family-based therapy. It is necessary to establish higher therapeutic relationship between the patient and other family members in family-based therapy. However, no valid data is available to prove superiority of family centred therapy or individualised therapy. Moreover, there is no substantial data available for establishing combined effect of family centred therapy and individualised therapy. It is necessary to establish extent to which and circumstances in which family centred therapy is applicable because eating disorder in a multifactorial disease and different factors affect eating behaviour differently. It is necessary to identify age and other behavioural aspects of the patients, to whom eating disorder intervention is required. Effective evaluation programme needs to implemented for eating disorder (Sadeh-Sharvit, Zubery, Mankovski, Steiner, Lock, 2016).

Treatment and Management

Conclusion:

Eating disorders are the psychological disorders which affect quality of life and associated with significant morbidity and mortality. In the management of the eating disorder, family members like parents and siblings need to be at the central. Therapist need to work in coordination with the parents to improve effectiveness of family-based therapy. Family based intervention proved to be effective for the management of eating disorders. Multifamily therapy is the additional support for the family-based therapy for providing effective intervention to child and adolescent. Development, implementation and its proven usefulness in the eating disorders made family-based therapy as first line therapy for eating disorders. It improved the recovery process in the children and adolescent, and proved significant landscape in the treatment and management of eating disorders. However, further research is necessary to identify reasons for ineffective family-based therapy for specific families. Further improvements and adaptations are necessary in the family-based therapy to improve its effectiveness in the non-respondents. Also, ways need to be identified to improve adherence of children and parents to family-based therapy for eating disorders.

References:

Brauhardt, A., de Zwaan, M., and Hilbert, A. (2014). The therapeutic process in psychological treatments for eating disorders: a systematic review. International Journal of Eating Disorders, 47(6), 565-84.

Cook-Darzens, S. (2016). The role of family meals in the treatment of eating disorders: a scoping review of the literature and implications. Eating and Weight Disorders, 21(3), 383-93.

Costa, M.B., and Melnik, T. (2016). Effectiveness of psychosocial interventions in eating disorders: an overview of Cochrane systematic reviews. Einstein, 14(2), 235-77.

Couturier, J., Kimber, M., and Szatmari, P. (2013). Efficacy of family-based treatment for adolescents with eating disorders: a systematic review and meta-analysis. International Journal of Eating Disorders, 46(1), 3-11.

Darrow, S.M., Accurso, E.C., Nauman, E.R., Goldschmidt, A.B., Le Grange, D. (2017).  Exploring Types of Family Environments in Youth with Eating Disorders. European Eating Disorders Review, 25(5), 389-396.

Erzegovesi, S., and Bellodi, L. (2016). Eating disorders. CNS Spectrums, 21(4):304-9.

Forsberg, S., and Lock, J. (2015). Family-based Treatment of Child and Adolescent Eating Disorders. Child and Adolescent Psychiatric Clinics of North America, 24(3), 617-29.

Gaetani, S., Romano, A., Provensi, G., Ricca, V., Lutz, T., and Passani, M.B. (2016). Eating disorders: from bench to bedside and back. Journal of Neurochemistry. 139(5), 691-699.

Hilbert, A., Pike, K.M., Goldschmidt, A.B., Wilfley, D.E., Fairburn, C.G., Dohm, F.A., Walsh, B.T., and Striegel Weissman, R. (2014). Risk factors across the eating disorders. Psychiatry Research, 220(1-2), 500-6.

Jewell, T., Blessitt, E., Stewart, C., Simic, M., and Eisler, I. (2016). Family Therapy for Child and Adolescent Eating Disorders: A Critical Review. Family Process, 55(3), 577-94.

Kanbur, N., and Harrison, A. (2016).  Co-occurrence of Substance Use and Eating Disorders: An Approach to the Adolescent Patient in the Context of Family Centered Care. A Literature Review. Substance Use & Misuse, 51(7), 853-60.

Kosmerly, S., Waller, G., and Lafrance Robinson, A. (2015). Clinician adherence to guidelines in the delivery of family-based therapy for eating disorders. International Journal of Eating Disorders, 48(2), 223-9.

Mairs, R., and Nicholls, D. (2016). Assessment and treatment of eating disorders in children and adolescents. Archives of Disease in Childhood, 101(12), 1168-1175.

Mairs, R., and Nicholls, D. (2016). Assessment and treatment of eating disorders in children

Murray, S.B., and  Le Grange, D. (2014). Family therapy for adolescent eating disorders: an update. Current Psychiatry Reports, 16(5), 447.

Rienecke, R.D. (2017). Family-based treatment of eating disorders in adolescents: current insights. Adolescent Health, Medicine and Therapeutics, 8, 69-79.

Robinson, A.L., Dolhanty, J., and Greenberg, L. (2015). Emotion-focused family therapy for eating disorders in children and adolescents. Clinical Psychology & Psychotherapy, 22(1), 75-82.

Sadeh-Sharvit, S., Zubery, E., Mankovski, E., Steiner, E., and Lock, J.D. (2016). Parent-based prevention program for the children of mothers with eating disorders: Feasibility and preliminary outcomes. Eating Disorders, 24(4), 312-25.

Swenne, I., Parling, T., and Salonen Ros, H. (2017). Family-based intervention in adolescent restrictive eating disorders: early treatment response and low weight suppression is associated with favourable one-year outcome. BMC Psychiatry,  17(1), 333. doi: 10.1186/s12888-017-1486-9.

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