the boundary between the internal mliieu of the patient and the external milieu involving our own reactions is often a very porous thing. your reaction can often be an indicator as to what the patient may be experiencing internally for her/himself. your gut reaction is often a reflective mirror of the internal state of the patient....part of your assessment tools.
the belief the only thing they have control over is their food intake
yes, some of that is very true.
however, the crux is what fuels it in the first place....giving it energy.
when you are out of control (an eating disorder is a false sense of control), it often engenders --> fear...folks often attempt to control what they are afraid of. or when control is taken from you by another, it often engenders--->anger.
two strong emotions that are often kissing cousins...in fact, adrenaline and noradrenaline, which are chemically similar, are highly involved in these states of arousal...often present in this illness.
the issue of control, compulsive thinking/behavior, the focus of caloric intake, perceptual distortions, and high states of arousal are all but pieces and parts of the whole animal. if it was easy to understand, solve and cure, the illness would not be as fatal as it is...and folks would recover and live and not die from it. we haven't totally seen the whole animal yet. i described a tail (energy). another member described a leg (the issue of control). another member will come and describe an arm of this beast, which is a particularly complex animal to begin with.
regardless of behavior demonstrated or cognitions/perceptions expressed, one thing often stands out...folks do not do things for no reason.
what are that person's reasons?...because things like behavior do not occur in a vacuum.
behavioral change, if it is to last, often entails a couple steps, often in order and/or revisited.
1) from a cognitive/perceptual standpoint: what is the problem in the first place?...awareness...first step...you can't
change what you are not aware of ....in eating disorders, it is not the food really...food is symbolic of something else...what does it symbolize for that person? how does it distort this person's current perception?
this is the step in seeing/perceiving the origins
of one's energy.
2) from an emotional standpoint: how does this knowledge sit with you after becoming aware? ...developing acceptance through the emotional angst...second step...you won't
change what you are not ready for ...often the hardest step but quite often the most necessary for if not worked through, self sabotage results despite anyone's best efforts. it is the step of shifting
of one's energy.
3) from a behavioral standpoint: what new behaviors can be practiced after
embracing it head and heart (faking it till you make it doesn't work here)?...the development of a new
drive and/or the will
ingness to risk new behavior is key (energy is redirected to a new object/behavior now)....third step...for without the new investment
of energy, fatigue occurs, and the person is unable to persevere. without a new and/or sustaining drive, she/he gives up more easily, and resorts back to the old behavior. it is in this step that energy is refocused
...hopefully, in more healthier ways. this is when role modeling is of its most importance. essentially, what
new behaviors that are practiced are sort of secondary...as long as they are healthier in meeting the unmet need. when a genuine change occurs here..a true shift...behavior changes, and it is more apt to sustain itself. and healthier behavioral change is gradual.
this is not so esoteric as it sounds. it really isn't. but, it is one way to think "outside of the box" when confronted with this illness. again, a description of the tail of the animal. a lot of folks only see eating disorders as a "behavioral" entity or problem. often, it can be much more. and how deep the problem is depends upon the person. just like depression, not all eating disorders are alike. and just like any psychiatric illness, there are often other comorbid psychiatric illnesses ...which just makes it even more complex.
i personally have found that helping the client to develop a sense of control in things outside of food has been the most effective in letting them release that caste iron control over calorific intake. this is by no measn a quick fix, in the clients i worked with it took between 12-18months of intensive work to get the client to the point where they could maintain a weight.
an excellent example, stuper...as to what i discussed already. eating is a symbolic behavior. this is quite often why there are cultural customs surrounding it and set in place, giving it meaning. going outside of the food and what it means is the crux. the treatment of eating disorders is a life long commitment of change, often body and soul. it can truly be a terrible illness for those who have it and for those who care for them.
i know, we as nurses, most often, do not have the luxury of time and/or we may not have the expertise to address it while the patient is inpatient with us...especially in our managed care environment. often, when we see it, we are trying to put out the fires and the damage the body has been subject to as a result of the illness. we deal with the open wound inpatient, but are quite often not equipted to address the infection festering underneath. we do what we can with the time we have with this person. we are not psychotherapists at the bedside. that is handled outpatient when the person leaves to resume/begin therapy...dealing with the infection, sort of speak, and often it is long term.
thunderwolf will be silent now for awhile on this thread so it can be discussed by others. his old days of being a licensed clinical counselor are beginning to become a nuisance...for he gave up that profession.