OUR ADVICES – When eating disorders become invasive, randomly knocking on the door of a therapist or looking for a solution on the internet are not good ideas. Who to contact in the event of a characterized pathology?
The pathologies of poor eating – anorexia, bulimia, binge eating disorder – are essentially multifactorial, calling for comprehensive care. « A multidisciplinary care pathway must be considered, comments psychiatrist Xavier Pommereau, author of The Mystery of Anorexia (Albin Michel), coordinator of the TCA sector at the day hospital of the Béthanie clinic (Talence). This support, both physiological and psychological, but also behavioral and emotional, is provided by several health professionals. » General practitioner, psychiatrist, psychologist, dietician, psychomotrician, occupational therapist… All must be trained in the specificities of pathologies such as anorexia – which proves to be fatal in certain cases. However, the psychiatrist wants to be reassuring: “The combination of these methods, which are different but complementary, and therefore synergistic, is bearing fruit: two-thirds of patients see their problems diminish within two years. »
The treating or family doctor
“He is the first point of contact, recalls Florian Saffer, dietitian-nutritionist and behavioral psychology therapist. The general practitioner performs an initial somatic assessment (weighing, blood pressure, biological analyses) to assess the general state of health of the patient, and the physiological consequences that the TCA may have caused (amenorrhea, for example). » Attentive to the difficulties encountered on a daily basis, he distinguishes transient and fleeting cravings for a “diet” from truly “troubled” behavior that risks settling in over time or worsening. “At the slightest doubt or if he suspects a TCA, he directs the patient to a psychiatrist, continues the therapist. He can also refer to the national directory of healthcare centres, published on the FFAB website. » Throughout the care, the attending physician remains an important support and sometimes the family mediator, who monitors the evolution of the situation through regular examinations and interviews.
The psychiatrist
Whether he works in town or in a health centre, the psychiatrist makes the diagnosis of the disease. “For this, it refers to several criteria that are now clearly defined, in particular by the DSM-V guide, says Xavier Pommereau. It also assesses the psychological repercussions of the TCA: alteration of self-image or self-esteem, inability to identify and express emotions, mastery or loss of control, denial mechanism…” When the symptoms disrupt the daily life of the person, who is truly overwhelmed by his reactions, a single therapeutic relationship is not enough. “At the end of the diagnosis, multidisciplinary care is put in place, on an outpatient basis, in town or in a day hospital, in a specialized unit, to allow the patient, when possible, to continue its activities and stay in its environment. » In the event of a life-threatening emergency, hospitalization is decided; this can also occur during treatment.
psychologist or psychotherapist
Therapeutic work is considered since, like any symptom, an ED “says” that something is wrong with the patient. “However, in the field of addictive behaviors, this disorder is not considered as the means of expression of a problem, explains Rébecca Shankland, professor and researcher in developmental psychology at the University of Lyon II, author of Eating Disorders (Dunod). It is an attempt to solve the problem: the person “uses” food to relieve suffering. It is an attempt to adapt to a difficult psychological situation or state. » That needs to be deciphered. Several methods have been proven in TCA, including:
● Behavioral and cognitive therapies (TCC). “They allow you to learn to think and react differently, with more perspective and critical thinking, she explains. For example, the patient often believes that by thinking about a food, he already risks gaining weight. Confronting these beliefs with a more realistic point of view reduces anxiety and calms the relationship to food. » Gradually, the person softens his behavior, thanks to short-term objectives that allow him to see himself progress.
● Body-mind approaches. The idea is to consider the individual as a whole by relying on the body-mind link. “Many methods offer better consideration of one’s body, such as meditation, sophrology or yoga, précise Rébecca Shankland. Often stressed, tense, prey to incessant ruminations, the patient is a lot “in his head” and little in the present moment. Thanks to techniques of attention, breathing, relaxation, movements in full consciousness, he manages to enter into a relationship with his body and its needs, without judgment, by simply observing its reactions. »
When a child or adolescent is in a situation of ill-being, it leads to family reorganization and communication centered on the problem which tends to reinforce the disorder.
– acceptance and commitment therapy (ACT).
Instead of seeking to modify the emotions, this approach proposes to learn to live with them. “Food can be used to avoid feeling difficult inner experiences such as sadness, fear, frustration, observes the psychologist. In the session, the patient experiences these feelings and becomes aware of the impasses in which he puts himself when he struggles against what he feels. » Working on values and the meaning of life also helps to direct one’s attention and efforts towards actions that are not related to food.
– Family therapy.
“When a child or adolescent is in a situation of ill-being, it leads to family reorganization and communication centered on the problem which tends to reinforce the disorder. Often, the young person feels trapped in a relationship, a role, a function. Not knowing how to move forward in this situation, which is a source of tension, he identifies with his eating disorder, she continues. Thanks to interviews in the presence of the whole family, the systemic approach proposes to work on the interactions that have become problematic in order to promote social support within the family while allowing the young person to develop his autonomy. »
The dietitian and other stakeholders
The dietician intervenes on the nutritional level so that the patient relearns to eat. “It participates in the process of renutrition, explains Florian Saffer, respecting and accompanying the therapeutic work on beliefs, fears, resistances. The objective is to define concretely with the person and often the family what they are able to do or not, when and how. It is also a question of prioritizing the types of food to be gradually reintroduced, proteins for example, and of being by your side in a relationship of trust and motivation. » When the patient is followed in a specialized day hospital, he has access to other ED professionals and, above all, benefits from collective work: discussion groups, non-verbal mediation workshops (body expression, motor skills, music , design…) “Anything that secures the patient, opens him up to others and remains consistent with the system, is good to take, concludes Xavier Pommereau. In the case of a follow-up in town, these activities can also complete the course of care. But they will have a cost and may present a risk of scattering. »