Eating disorders comprise Anorexia Nervosa and Bulimia. Patients with Anorexia Nervosa and Bulimia have had a long reputation as facing treatment challenges. A deeper understanding of these difficulties is required to treat treatment-resistant patients. It will lead to a decrease in the death rates of patients with these disorders.
Clinical characteristics in patients with eating disorders:
Patients with these disorders seek treatment only after being sick for around three years. The patients with anorexia nervosa are in denial about them being ill, whereas patients with bulimia nervosa are secretive and ashamed of the symptoms. They have difficulty giving up their perspective of being thin to have a perfect body even after being in the treatment. It leads to considerable weight loss. Their self-fulfilling behaviors of struggling to lead them to prevent nourishing medicines lead to symptoms being more and more chronic.
1.Trust issues
They are required to seek mental help as well, along with help for physiological symptoms. However, trust is a very significant component for the therapy to work. As their past relationships might have been abusive, intrusive, and controlling, they have a hard time trusting their therapists. They are unable to leave the control and be vulnerable to open up about themselves, thereby making any therapeutic progress. Several doctors are not experienced in treating patients with eating disorders, which leads to an increase in the issue. It makes them more untrusting professionals and leads them to terminate the therapy or treatment.
2.Ineffectiveness of inpatient services
Most of the patients are required to stay in the hospital, but clinicians are hesitant to treat them. It is because of the unavailability of the services or the frustrating and time-consuming process of bargaining with resistant patients, accepting the available care. It further leads to the overall perception among the hospital workers and clinicians that such patients are difficult to deal with.
3.Comorbid disorders
The presence of other disorders with eating disorders increases the difficulty in treatment. Disorders such as anxiety, depression, substance abuse, obesity, and other medical complications are considered comorbid.
4.Depression
Patients with depression have less motivation and psychological inaccessibility to behavioral and cognitive therapeutic interventions for eating disorders symptoms.
It becomes complex to differentiate the mood changes as a symptom of depression and mood changes as a result of not eating properly. Antidepressants don’t work on them as they lack nutrition and have an empty stomach most of the time. Again, clinicians who are unaware of such effects of starvation might perceive their unresponsiveness to the treatment as difficult patients.
6.Anxiety
Patients with anorexia nervosa and anxiety are unable to socialize, leading to no support system and self-esteem issues, which could have been helpful for their treatment effectiveness. Patients with Bulimia are more sociable before their treatment, but then the reduced symptoms lead to a considerable rise in anxiety.
Hence, clinicians face this paradox of successful treatment of Bulimia but leading them to feel out of control. It makes it significant for the professionals to understand and know the leads for those who can help such patients cope with anxiety. If they don’t know of it, they are more likely to look at them again as treatment-resistant patients.
7.Substance abuse
Alcohol intake affects their appetite, mood, and weight. Therefore, it becomes important to treat substance abuse first and then focus on the treatment of eating disorders.
8.Personality disorders
Patients with eating disorders and comorbid personality disorders such as narcissistic and borderline disorders lack a sense of self, issues with impulse control, regulation of effect, self-esteem, and feeling healthily autonomous.
They also face difficulties in psychotherapeutic relationships such as producing false self, intense rejection sensitivity, fear of attachment and dependency, need to please others, and a fear of being overwhelmed by emotions. These difficulties further make it difficult to establish trust in the therapeutic relationship. It calls for the professionals’ open, firm, active, and active therapeutic approach.
9.Medical complications
Patients suffering from eating disorders are often medically unstable, which includes life-threat too. Medical complications affect every organ system. Awareness and knowledge amongst clinicians are important for required treatment and assessment. Such instability and uncertainty lead to anxiety amongst caregivers, decreasing patients’ therapeutic effectiveness.
10.Obesity
Societal lack of awareness of eating disorders and negative perspectives of obesity affect patients. Clinicians should take it into account. They should be able to establish acceptance of the patient being obese and that it is not wrong. Obesity should not be treated differently through other methods used usually to treat it as it can affect the patient’s recovery from an eating disorder.
Effect on the therapists
Patients with eating disorders tend to elicit very negative emotions in therapists, which may affect the therapy. It is majorly because of their perception of them being difficult. Patients’ high expectations of human warmth, attention demand more time and energy from the therapists. Caregivers’ anxiety and demands add to the difficulty. Therapists need to understand why they are difficult clients and other treatment challenges which may reduce these negative emotions. It is how they can make the therapy sessions more effective. Having more experience working with patients with eating disorders and having less workload of patients with eating disorders can also decrease negative emotions.
Female therapists can experience a sense of competitiveness while dealing with patients who are attractive yet tend to scrutinize their weight. It can interfere with the establishment of an empathic relationship. If a female patient with a past abusive relationship has a male therapist, it can lead to trust issues. The patient might attempt to be controlling and powerful and distance herself from being emotionally vulnerable. Discussions of sexuality and body image without leading the therapeutic relationship to be sexualized are great challenges for therapists.
Hence, these are the treatment challenges for eating disorders. Increased awareness among professionals will help overcome these challenges.