Eating disorders psychiatry
Background to eating disorders psychiatry
As eating disorders
typically start in adolescence, eating disorder
psychiatry can involve working with children and adolescents or
with adults with anorexia nervosa, bulimia nervosa or binge
eating disorder. Many eating disorder
patients have other psychological difficulties or disorders such as
anxiety, depression, obsessive compulsive disorder or personality
disorders. Physical complications and disabilities are common.
The opportunities and challenges of
working with eating disorder patients include:
- To be able to build a good
therapeutic relationship with young people who, at the point of
referral, may have little understanding of the serious nature of
their condition and no desire to change. To help young people with
eating disorders build motivation for change.
- To safely assess and manage
medical risk and physical complications. This requires sound skills
in physical medicine and expertise in nutritional health and
medical aspects of starvation and refeeding.
- To work with different
psychological models and therapies (individual and family)
appropriate to the development and needs of the person, given the
nature of their eating disorder and any presenting
comorbid disorders.
- To teach families skills for
supporting loved ones with eating
disorders.
- To work with people with long-term
impairments and disabilities to keep them safe, prevent decline,
and support their quality of life.
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Personal perspective one
Imagine having a major argument
with your skeletally thin child at every meal of every day over
whether she will eat a minute portion of food. Imagine lying awake
every night, wondering whether she will die, as she is so painfully
thin, so pale and visibly cold with blue fingers, and getting
weaker, with increasing difficulties in getting up the stairs.
Imagine feeling so bad about
yourself that you simply want to disappear. You don’t deserve to
eat, as you are weak, defective, inferior, worthless… and only when
you starve you feel that you are doing something that is
worthwhile, that gives you a sense of being in control, worthy or
safe. You cannot understand at all why your parents are so
worried.
If you can hold these diametrically
opposed positions in your mind, you have a good idea of the
challenge of working with eating disorders - helping young people
and their families to turn round from a situation that seems to be
progressing inexorably in the direction of death and destruction.
This involves working with the young person towards overcoming
anorexia and aiming for a bigger life and teaching the parents the
skills to support their daughter’s recovery.
I went into eating disorders
psychiatry by accident, having worked in general and liaison
psychiatry for some years, but I immediately knew that I had
finally found my niche. What I enjoy about working in eating
disorders is that it requires knowledge and skills in many
different areas (e.g. knowledge in child and adolescent
development, nutritional medicine and the neurobiology of hunger,
satiety and emotion, expertise in different psychological treatment
modalities, and sound diagnostic skills.) Thus, you will never get
bored and you are always on a steep learning curve. You have got to
be very flexible and be able to switch between the different
mindsets required for dealing energetically with acute medical or
psychiatric emergencies, being reflective and conducting or
supervising psychological therapy with individuals and families to
enable recovery, and working at a slower pace with people with
long-term impairments and disabilities to keep them safe, prevent
decline and support their quality of life.
Early intervention is critical for
good long-term outcome of eating disorders. So in this field, if
you catch the problem early, you can make a real difference to
patients’ lives, helping young people to overcome a devastating
illness and fulfil their potential.
There is also a lot of advocacy,
anti-stigma, educational work to be done in eating disorders.
Sadly, even health professionals are not free from prejudice
against eating disorders as ‘self-inflicted’ disorders, whereas the
reality is that these are severe biologically driven disorders.
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Personal perspective two
I trained in Cape Town, South
Africa, and worked as a house officer at Groote Schuur Hospital
(the world’s very first heart transplant was undertaken there by
Professor Christian Barnard in December 1967). I can still recall
the look of horror on the face of my then consultant, Professor of
Haematology, when he asked what I was planning to do with my career
and I boldly informed him, standing within such an esteemed medical
and surgical establishment, that I planned to study Psychiatry in
England. That was 12 years ago and I certainly do not for one
moment regret my decision.
Psychiatry has allowed me to find
fulfilment far beyond being able to correctly recite the exact
anatomical position of the Flexor Digiti Minimi muscle. I feel
privileged to be able to be of assistance to people in times of
psychological distress and to be trusted by them to know their most
intimate and private thoughts. It is immensely fulfilling to
be able to empower people to overcome their difficulties and often
this is achieved without any intervention other than truly
listening to them, being empathic and providing support and
guidance. I do not deny that at times it is an extremely
challenging field in which to work. I was not-so-gently reminded of
this as an inexperienced senior house officer when I was hit over
the head by a walking stick-yielding little old lady with dementia
who objected to taking the medication I had prescribed for
her.
Indeed, I do feel fulfilled
currently working as a staff grade doctor at the Yorkshire Centre
for Eating Disorders in Leeds. In addition to readily assuming
increasing clinical responsibility, I am also passionate about
medical education and teaching. I enjoy having weekly teaching
sessions with the Leeds medical students during their psychiatric
placements. Following obtaining my Masters in Clinical Psychiatry
(Leeds), I find myself once again possessing a student card (the
shop discounts are just so appealing!); this time though I am
studying for a degree in Medical Education. Simultaneously, I am
pursuing accreditation in a specific form of psychotherapy relevant
to the field in which I work, and will soon be functioning as a
therapist within the multidisciplinary team in addition to my
current role,.
I truly believe that, despite being
a doctor, it is possible to have a fulfilling career and having a
good quality of life. It is after all one of the most important
factors in maintaining one’s own mental health! I congratulate my
consultant colleagues on their hard work and the burden of
responsibility that they bear all day, every day. I, however, enjoy
supporting the work undertaken by a multidisciplinary team,
assuming appropriate clinical responsibility but also being able to
go shopping without a care in the world in addition to my current
role.
Monique Schelhase, staff grade in eating disorders,
Leeds Partnerships NHS Foundation Trust.
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Page updated on 8
December 2010