Thursday, June 28, 2012

So many topics, so little time!

Throughout a week, as I cover so many different topics with patients, I think over and over of what information I would want to share through this blog. There are so many different things about eating disorders that are misunderstood, and so much to the physiology of eating disorders that is not discussed.

When a new patient comes in, the first priority is to assess their physiological state, because if that is not understood, so much can be missed. For instance, if a patient who has not been eating enough comes in and says they have obsessive-compulsive disorder (OCD), there's an important question to ask. Did that OCD exist prior to the onset of starvation? For many, the answer will be "no." If one does not understand that starvation, which is defined quite broadly, causes a variety of issues that appear to be separate diagnoses (ie, OCD, anxiety, depression, even some symptoms of various personality disorders), the therapist or physician may accidentally give the patient these diagnoses and then attempt to treat them. But, if the therapist understands that starvation alone causes these behavior patterns, they understand there is less need to treat all the individual symptoms, and instead focus on supporting the patient in getting enough food. And, then there's that awesome moment where the patient's starvation-related symptom goes away, and 1) you look super-brilliant, and 2) the patient feels such relief that it IS indeed true that food is the best medicine.

So, how is starvation defined? It is not limited to those everyone would likely think of as starved. Yes, some individuals with eating disorders actually appear starved. But many do not. Many can even be overweight, obese, or morbidly obese. This concept usually makes heads spin a little. "How can someone who is overweight be starved?", I am asked. Body weight is irrelevant in defining starvation. Starvation occurs when someone is not eating enough to support normal functioning of their bodies. That can happen at any weight. What is sad is when starvation is not recognized in those who do not "appear" starved, and goes unaddressed, greatly worsening the patient's physical state over time.

I hear many times that patients do not see themselves as starving because "I eat." Well, yes. In fact, everyone with an eating disorder eats! This is a misconception supported by our society, that in order to have an eating disorder, and anorexia in specific, one must not eat. Everyone eats! Every last one of my clients eats. But they, almost without fail, do not eat enough. The pattern of how and when they do not eat enough varies, but they all do not eat enough at some point.

Those who binge eat assume they do not have enough willpower to stop eating. But, no, again almost without fail, a binge will be triggered by some period of not eating enough. How many of you, eating disordered or not, go through your day eating fairly little and then eat a lot at night? This is such a common pattern in our society. How many have gone on a diet, only to end up eating a significant amount of food, "breaking the diet." Anyone who has experience something like these situations can now understand bingeing. Sure, not everyone will binge, but you can understand how the physiology of your body works and how that can create binge eating in some. Bingeing is, I believe, most often caused by undereating. Your body needs a certain amount of food to function, and if you eat less than what it needs, you will experience a drive towards food. There certainly are emotional components also; I am not denying that. I'm just saying treatment has to start with addressing the physiology, and THEN dealing with the emotion. Through changing eating patterns alone, and helping a patient eat enough during the day (which, is information provided by a dietitian working with the patient), many times the bingeing will decrease significantly.

Well, it seems I could go on forever on this topic. I could endlessly address the physiology of eating disorders. I'm kind of a physiology junkie, though I certainly cannot claim to be extensively trained in human physiology. There's so much to learn! But, my challenge is this: If you treat eating disorders, and do not understand the physiological impact of starvation, refeeding, bingeing, then go learn about it! And, if you have an eating disorder and don't understand the physiological impact, then have someone teach you about it. You will come out of it feeling much less like a "failure," or someone with "no willpower" and your treatment process, what your body goes through, will make a lot more sense.

Never fear, fair readers, this is not the last you will hear of this topic from me!

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