People with eating disorders are often diagnosed with comorbid psychiatric illnesses including depression, panic disorder, and obsessive-compulsive disorder in addition to many others. Clinicians do not often attempt to differentiate between the diagnoses and clarify the interplay between them, much to the detriment of the patient.
It is rare that another diagnosis is the primary diagnosis; usually the eating disorder is the central issue. People with other primary diagnoses may have eating symptoms as a part of their struggle, but a full-fledged eating disorder inevitably takes over a person's life.
A list of diagnoses, rather than just one, only makes someone feel sicker and untreatable. An explanation of what the diagnoses mean and how they reflect the person's current state and likelihood of successful treatment is a much kinder and more helpful way to approach the path to recovery.
What is rarely discussed with patients is that starvation and binge/purge cycles themselves can cause psychiatric syndromes. In other words, one effect of chronic eating disorder symptoms is to create a new psychiatric diagnosis hat resolves with normalized eating.
Starvation and binging are known to lead to depressed mood. Chronic, severe hunger begins to feel like anxiety much of the time, especially because people who are starved lose the ability to identify hunger. In addition, low blood sugar, a common long-term effect of an eating disorder, creates the feeling of a panic attack. Anyone starved over time develops OCD symptoms no matter how susceptible they are to this illness.
Having a series of psychiatric diagnoses is different from realizing that the eating disorder causes a host of psychiatric symptoms that mimic other diagnoses. This fact also explains why medications tend not to be as helpful in treating psychiatric symptomatology associated with an eating disorder. If starvation or binging causes the symptoms, then medication will be much less effective than food, the only real medication that helps with recovery.
This idea also brings up the idea that food is a mind-altering substance. It can lead to emotional stability, clarity and mental acuity. Starvation can lead to volatility, confused thoughts and dullness. Eating disorders are illnesses that affect our entire bodies, our minds and emotions included.
How do you approach a patient with 12 years of purging disorder? She believes that her disorder originated with the understanding that someone is unlovable if they're not the most physically coveted...no amount of affection or reassurance dents this opinion. At best, she'll just accept that you're an idiot for believing she's lovable, but normally she'll get mad that you dare try to lie to her.
ReplyDeleteShe definitely has these associated conditions. She has extreme anxiety, OCD, depression, anger, irritability, etc. She is an introvert to begin with and spends HOURS "recharging" alone, but from the outside appears to be delving deeper into her anxiety and feelings of unworthiness.
Because she's convinced of the "objective truth" of her worldview, nothing anyone says can sway her otherwise. She's fought with counselors before because they've required that she trust them (she doesn't fully trust me and I'm her husband).