eating disorder treatment facilities

eating disorder treatment facilities Since students may not identify eating problems when they initially present at
the counseling service, all intake interviews should include a question or two
about possible eating issues: “Our society today is so diet conscious. Do you
ever go on diets, or worry about your weight?” Most women in our culture
would answer yes. Watch how they respond. If they seem vague or evasive, ask
for a sample of a typical day’s intake, from the time of getting up to going to
bed. Are all food groups included? Do they eat junk food? If not, continue to
question about foods not eaten and reasons why. Reasons like food allergies,
lactose intolerance, or vegetarianism can oft en mask eating disorder issues.
If the student identifi es concerns about eating or food as part of the presenting
problem, assessment should become more straightforward. Inquiry should
include weight history; medical concerns; restricting, bingeing, or purging
behaviors and their precipitants; and preoccupation with food and body image.
Some key questions concern highest and lowest weights (as adults); menstrual
frequency; exercise patterns; physical problems like dizziness, constipation,and diarrhea; nature and frequency of thoughts about food; and degree of
distress about body size and shape. A sample of a typical day’s food intake will
give you an idea of what foods are avoided (usually fats and/or carbs). Th is can
also elicit food rules like eating nothing aft er 6 p.m., vomiting foods with fat,
etc. Reviewing many purging options may uncover behaviors not mentioned
(vomiting; use of laxatives, diuretics, diet pills; frequency/type of exercise).

Denial and insight are crucial variables in setting treatment goals. Follow-up
is critical to ensure medical safety. Once you have fi rst established that clients
are medically stable, it is safe to ignore the food issues. You can sometimes
engage clients in considering underlying emotional aspects of the problem—
improving their relationships to provide better emotional nourishment, or
learning new strategies for managing anger and hurt. With this group, setting
goals to address food issues is pointless.
When students acknowledge a problem but don’t want to change (they feel
their eating problem works for them), you can highlight the costs of the eating
disordered behaviors—noting how many foods they used to enjoy are now
forbidden, how food restriction limits their social life, how the amount of time
obsessing about food or weight takes away from other pursuits, and how they
risk their physical health. Students may be open to nutritional counseling, to
fi nd “safe” foods that they can add to ensure adequate nutrition.
When students reach the point of recognizing the problem and its costs,
they are ready to address the symptoms. Cognitive-behavioral therapy
(CBT) can be used for weight restoration and return to normal eating. Stress
inoculation is important—warning clients that they’ll probably feel worse
before feeling better. Clinicians can use a surgical analogy: “Immediately
aft er surgery, you feel worse than before you went in, but in time you feel
better. Similarly, changing your eating behaviors will increase your anxiety—
but it will diminish with time.”