Eating disorders are most successfully treated when diagnosed early. Unfortunately, even when family members confront the ill person about his or her behavior, or physicians make a diagnosis, individuals with eating disorders may deny that they have a problem. Thus, people with anorexia may not receive medical or psychological attention until they have already become dangerously thin and malnourished. People with bulimia are often normal weight and are able to hide their illness from others for years. Eating disorders in males may be overlooked because anorexia and bulimia are relatively rare in boys and men. Consequently, diagnosing people with these disorders and convincing them they need treatment can be extremely difficult.

In any case, it cannot be overemphasized how important treatment is - the sooner, the better. The longer abnormal eating behaviors persist, the more difficult it is to overcome the disorder's psychological and physical effects on the body. In some cases, longer term treatment may be required. Families and friends offering support and encouragement can play an important role in the success of the treatment program.

If an eating disorder is suspected, particularly if it involves weight loss, the first step is a complete physical examination to rule out any other illnesses. Once an eating disorder is diagnosed, the clinician must determine whether the patient is in immediate medical danger which requires inpatient care.

We believe a variety of factors contribute to the development of an eating disorder. This multiple causation requires a multi-dimensional assessment and treatment planning approach and the delivery of treatment services by a skilled, multi-disciplinary treatment team. Hence, our treatment team is lead by our staff psychiatrist. Our multi-dimensional assessment process consists of a nursing assessment, dietary evaluation by our registered dietitian and physical examination and history by our medical director, including an analysis of lab findings, psychological testing and evaluation by our clinical psychologist and a psychiatric evaluation. A social history is gathered and focuses upon the early childhood history, family history, current inter-personal history, and relevant stressors which may have contributed to or be sustaining the distorted thinking and eating behaviors.

While our addiction model is used as a framework for the patient to begin assuming responsibility for his/her destructive behaviors, food is not viewed as an addictive substance. Rather, the destructive behaviors and irrational thoughts that serve to maintain the eating disorder and the resulting pathological relationship to food are the focus of our Advanced Integrated Model of Addiction.

The Goals of the Eating Disorder Program include:

• To initially stabilize the emotional and nutritional status of the patient.
• To bring about an immediate cessation of the destructive behaviors that are compromising the physical and/or emotional health of the patient.
• To normalize eating patterns and assist the patient in achieving healthy weight goals.
• To assist the patient in identifying and correcting the irrational thoughts toward food and body image.
• To provide a safe, supportive, environment in which the patient can discover and work through the psychological issues underlying the eating disorder behaviors.

Phase I. Stabilization and Engagement

This phase is generally a short?term focused placement in the sub?acute medical unit of the Foundation with the objective of stabilizing the destructive manifestations of the eating disorder. Additionally, interventions are designed to establish a primary clinical relationship and to facilitate engagement of the patient into the therapy program. A patient is deemed appropriate for transfer when the following conditions are met:

1. Weight has been stabilized and the patient is compliant with the preliminary food plan.
2. Medical stability: Patient is stable on medications and lab findings are stable.
3. Destructive compensatory behaviors are sufficiently under control to permit less intensive supervision.
4. Patient is compliant with prescribed food supplements.
5. Patient is compliant with prescribed medications and not experiencing adverse reactions.

Phase II. Active Psychosocial Treatment
to Maintain Stabilization

This phase of treatment takes place in the longer-term Inpatient unit of the Foundation. Interventions during this phase are designed to continue to stabilize the symptoms of the disorder, and achieve personal growth once stabilization has been consistently established. In addition, therapy modalities are focused on assisting the patients in exploring the issues/stressors underlying the eating disorder behaviors, and developing new and healthy coping skills.

Personal responsibility is stressed during this phase of treatment and the patient gradually assumes more responsibility for food choices and portions. Healthy weight goals are achieved during this phase as well under the supervision of the Registered Dietitian and Eating Disorder Case Manager. Family Therapy is initiated during this phase of treatment and is regarded as essential to the achievement of recovery for the patient.

Treatment Modalities Utilized in Phase II

• Cognitive Behavioral Therapy
• Nutrition Education
• School/Tutoring Education Program (patients 18 years or younger)
• Dietary Supplements
• Medication Therapy
• Family Therapy
• Group Therapy
• Individual Therapy
• Body Imagery Therapy
• Leisure and Physical Activity Education

Use of individual psychotherapy, group therapy, family therapy, and cognitive-behavioral therapy teaches our patients how to change abnormal thoughts and behavior--is often the most productive. Our cognitive-behavior therapists focus on changing eating behaviors usually by rewarding or modeling wanted behavior. These therapists also help patients work to change the distorted and rigid thinking patterns associated with eating disorders.

Phase III: Discharge Planning

The patient is deemed appropriate for discharge and transfer when the following conditions are met:

1. Weight goals have been consistently maintained and the patient is complying with the prescribed food plan.

2. The patient's mood is stable and he/she demonstrates compliance with medication regime.

3. Behavioral symptoms have been substantially controlled and sufficient work with psychological and family factors has been accomplished to assure the patient does not relapse in a less intensive level of care.

4. The patient evidences insight regarding relapse triggers and demonstrates initial coping skills with which to avoid relapse.

5. Any co-existing psychiatric conditions are stable and the patient demonstrates the knowledge and the skills with which to manage such conditions.

DUAL DIAGNOSIS

"Dual Diagnosis" is a term that refers to the presence of one or more addiction problems complicated by a coexisting mental health problem, such as major depression. In National Institute of Mental Health supported research, scientists have found that many patients with anorexia and bulimia also suffer from other psychiatric illnesses. While the majority have co-occurring clinical depression, others suffer from anxiety, personality or substance abuse disorders, and many are at risk for suicide. Obsessive-compulsive disorder (OCD), an illness characterized by repetitive thoughts and behaviors, can also accompany anorexia. Individuals with anorexia are typically compliant in personality but may have sudden outbursts of hostility and anger or become socially withdrawn.

Some individuals with bulimia struggle with addictions, including abuse of drugs and alcohol, and compulsive stealing. Like individuals with anorexia, many people with bulimia suffer from clinical depression, anxiety, obsessive compulsive disorder, and other psychiatric illnesses. These problems, combined with their impulsive tendencies, place them at increased risk for suicidal behavior.

Research at the National Institute of Mental Health and elsewhere has shown that individuals with binge eating disorder have high rates of co-occurring psychiatric illnesses-especially depression.

USE OF MEDICATIONS

National Institute of Mental Health-supported scientists have examined the effectiveness of combining psychotherapy and medications. In recent studies of bulimia, researchers found that both intensive group therapy and antidepressant medications, combined or alone, benefited patients. In another study, the combined use of cognitive-behavioral therapy and antidepressant medications was most beneficial. This combination treatment was particularly effective in preventing relapse once medications were discontinued. For patients with binge eating disorder, cognitive-behavioral therapy and antidepressant medications may also prove to be useful.

Antidepressant medications commonly used to treat bulimia include desipramine, imipramine, and fluoxetine. For anorexia, preliminary evidence shows that some antidepressant medications may be effective when combined with other forms of treatment. Fluoxetine has also been useful in treating some patients with binge eating disorder. These antidepressants may also treat any co-occurring depression.

The efforts of mental health professionals need to be combined with those of other medical professionals to obtain the best treatment. Our physicians treat any medical complications, and nutritionists advise on diet and eating regimens. The challenge of treating eating disorders is made more difficult by the metabolic changes associated with them. Just to maintain a stable weight, individuals with anorexia may actually have to consume more calories than someone of similar weight and age without an eating disorder.

HELPING THE PERSON WITH AN EATING DISORDER

Treatment can save the life of someone with an eating disorder. Friends, relatives, teachers, and physicians all play an important role in helping the ill person start and stay with a treatment program. Encouragement, caring, and persistence, as well as information about eating disorders and their dangers, may be needed to convince the ill person to get help, stick with treatment, or try again.

Current research has shown that people with eating disorders who get early treatment have a better chance of full recovery than those who wait years before getting help. So please read this information, but don't stop there. Professional, caring help for you or your loved one is only a phone call away. And recovery can begin with that phone call. Family members and friends can help recognize the problem and encourage the person to seek treatment.

For further information on our Advanced Integrated Model for the treatment of eating disorders, call Althea Bartlett, Admissions Supervisor, at 1-800-227-3953 or 1-406-248-3175, or visit our website at www.rimrock.org

Family members and friends should read as much as possible about eating disorders, so they can help the person with the illness understand his or her problem. Once the person gets help, he or she will continue to need lots of understanding and encouragement to stay in the treatment process.

For more educational information on eating disorders, contact the Library at 1-800-227-3953 or 1-406-248-3175.

RECOMMENDED READING

• Afraid to Eat
• Father Hunger
• Anatomy Of A Food Addition
• The Monster Within
• Anorexia Nervosa: A Guide To Recovery
• Overcoming Overeating
• Anorexia Nervosa: Finding The Life Line
• Body Wars
• Surviving an Eating Disorder
• Bulimia: A Guide To Recovery
• When Food is Love
• Fat and Furious
• Women Afraid to Eat
• Fat is a Family Affair