Importance of Family Therapy in Treating Eating Disorders

How Family Support and Understanding Aids in E.D. Recovery

No problem exists in a vacuum, a fact that applies to eating disorders as well as any other type of mental health condition. Because as human beings we live within a family structure, it comes as no surprise that, when one member of the family develops disordered eating habits, dysfunction in the family is a likely result.

Why is that? How is it that one family member’s disordered eating causes such disruption in the family dynamic? Because just as it causes deep anguish to witness a loved one suffer from any physical illness, it is just as upsetting to watch a family member battle a serious eating disorder. It is painful for parents and siblings to watch their loved one in the throes of anorexia, bulimia, or binge-eating disorder.

Family members often feel helpless while they watch their loved one waste away, with no sense of power to stop the process. The fear of losing them can unleash powerful emotions, such as frustration, anxiety, and anger. Without a basic understanding of how and why an eating disorder has made its way into the family unit, confusion, blame, guilt, and shame begin to color familial relationships, causing disharmony.

How Family Therapy Can Help

Once it is understood that a complex mix of factors cause an eating disorder, the family learns it is not in their best interest to lay blame on each other for having “caused” the illness. A therapist in a family group environment helps much more by focusing on educating the family members about how an eating disorder evolves and how it affects the brain of their loved one, rather than by assigning blame. Effective family therapy is centered on improving communication skills between family members, and equipping them with problem-solving skills to use throughout recovery.

Family group therapy can also help families cope with the stress of the eating disorder. Often, the eating disorder has changed their loved one’s personality, making them irritable and angry as they grapple with the powerful illness, and this causes strain and tension in the home. Group therapy gives family members an opportunity to openly communicate how stressful it is to walk on eggshells in the presence of the sufferer. In the case of anorexia, the starvation has a significant impact on their cognitive processes, so they can’t think or reason correctly. Once weight is restored, the moodiness and irritability usually subside, allowing for a more peaceful home environment and healthier interactions between family members.

Teaching the family about what they can expect in the recovery process is a valuable component of family therapy. Knowledge is a powerful tool in establishing an atmosphere that is conducive to loving support and understanding. Gaining specific skills for family members to employ during their loved one’s recovery phase is important, as it empowers the family. Meaningful participation with their loved one on the path of recovery gives families a sense of helpfulness versus the helplessness they felt before.

Casa Serena’s Multi-Family Group

At Casa Serena, our Family Education and Support Group involves a group of multiple families who gather together with our clients, their loved ones. In this large group setting, family members can learn from other families and gain new perspectives. The depth of knowledge and experience provided by our expert clinical therapists gives family members a new frame of reference and helpful tools. Compassion is emphasized, as family members are encouraged to support their loved one while issues around food, weight, or size are resolved in recovery. Contact Casa Serena today at (925) 682-8252.


The Dangers of Body Dysmorphic Disorder

How a Distorted Body Image Fuels Disordered Eating

Preoccupation with body image usually kicks in during adolescence. In the early teen years, kids suddenly become obsessed with what society has determined as “good looks.” Many will pore over fashion or celebrity magazines, identifying the physical traits of seeming perfection, and then begin comparing these “perfect” body parts to their own. The mirror may become a young person’s worst enemy if this interest in what our culture dictates as physical beauty becomes an unhealthy obsession.

Although most of us can quickly point out the body part we wish we could fix or change, this desire doesn’t usually occupy more than a passing glance in the mirror on a given day. However, when an individual becomes so preoccupied with their perceived flaws that they can no longer control their negative thoughts about themselves, often resorting to drastic measures to fix the imagined defect, they may suffer from body dysmorphic disorder (BDD).

About BDD

BDD is a mental health disorder characterized by extreme and persistent obsessive thoughts regarding some aspect of their appearance. Someone suffering from BDD may spend several hours a day performing rituals coping with or hiding their distorted body image.

Surprisingly, BDD affects males and females nearly equally, with the disorder typically developing during the adolescent and teen years. About 1-2% of the U.S. population grapples with BDD, with the majority zeroing in on their hair, skin, nose, chest, or stomach, although people with BDD can find fault with any part of their anatomy.

BDD is tightly associated with other anxiety disorders, such as obsessive-compulsive disorder (OCD), eating disorders (ED), and social anxiety disorder. Symptoms of BDD, however, are specific and include:

• Preoccupation with appearance. The individual is preoccupied with one or more nonexistent or slight defects in their appearance, thinking about the imagined defects for at least an hour a day. They may spend a great deal of time trying to camouflage the imagined flaw.

• Repetitive behaviors. The individual performs repetitive, compulsive acts in response to the perceived defect. The repetitive acts can be behavioral, as in mirror-checking, excessive grooming, changing clothes often, seeking reassurance from others, or skin picking. If weight is the primary issue, disordered eating, over-exercising, or unnecessary cosmetic surgery may result. Repetitive behaviors can also be mental, such as constantly comparing one’s appearance with others; tormenting themselves by feeling they come up short.

• Impairment. When the preoccupation causes significant distress or impairs areas of functioning such as social, academic, or occupational, then BDD is indicated. Their constant negative self-talk hinders their ability to function, causing them to miss work, skip school, avoid social events, and isolate themselves.

Treatment for BDD

Because the sufferer of BDD is often embarrassed and ashamed of their condition, they might not seek medical help. However, effective treatment is available for treating BDD, often with great success. A typical treatment regimen includes both psychotherapy, specifically cognitive behavioral therapy (CBT), and medication such as selective serotonin reuptake inhibitors (SSRIs).

Cognitive behavioral therapy
Cognitive behavior therapy has been shown to help someone with BDD identify the thoughts that trigger the disordered behaviors, and then to replace the response with a new, healthy thought and behavior pattern. By teaching the BDD patient how to manage their triggers without resorting to avoidance or compulsive behaviors, CBT can help them see the bigger picture and to respond in a more rational way. CBT has been shown to improve such symptoms as depression, low self-esteem, and social anxiety.

SSRIs are considered the first-line medication of choice for treating BDD. SSRIs are antidepressants that can help reduce obsessive thoughts and compulsive behaviors. The medication helps to control the distress that BDD can cause, including anger and suicidal thinking, as well as improve daily functioning.

Casa Serena Can Help

If you or your loved one struggles with irrational perceptions of their physical appearance that have culminated in disordered behaviors, we are here to help! At Casa Serena our caring, expert clinical staff understands that BDD is not just vanity gone wild, but is a serious and dangerous mental health condition that needs to be treated with understanding and compassion. Our treatment plans are individualized to the specific needs of each patient and to how their BDD has manifested itself. Contact us today and speak to our knowledgeable staff today at (925) 682-8252.

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Treating Eating Disorders with Psych Meds

Treatment for an eating disorder commonly includes a multi-disciplinary approach with the psychotherapist and psychiatrist as the primary treatment providers. In addition, a licensed dietician and a primary care physician make up the rest of the team involved in the care of the patient.   Depending on the type of eating disorder diagnosed, use of specific pharmacotherapy can also be effective.

To date, there has not been much success in treating anorexia nervosa with psychotropic drugs to cure the physical aspects of the disease. Indeed, food is still the best medicine for regaining physical wellbeing for anorectics. However, some SSRIs have shown promise in treating the underlying mental health conditions that accompany the eating disorder, once a healthy weight has been attained.

There has been much more success treating patients with psych meds who present with bulimia nervosa or a binge eating disorder. It has been found that bulimics respond well to antidepressants, even if they are not suffering from depression.

 Drug Treatment for Anorexia Nervosa

The most challenging eating disorder to treat is anorexia. Psychotherapy remains the primary tool used to stabilize and treat this eating disorder, as there are typically serious mental health issues that accompany the disordered eating. To date, there has been little evidence that medication is effective in treating anorexia, but when mood disorders such as depression or obsessive-compulsive disorder accompany the disorder, Fluoxetine (Prozac) has helped the anorectic patient manage these.

Side effects of these selective serotonin uptake inhibitors (SSRIs) are generally mild and tolerated well for most patients. Side effects can include:

  • Drowsiness
  • Decreased interest in sex
  • Nausea
  • Diarrhea
  • Weight gain
  • Agitation

If the patient does not tolerate the SSRI, then their psychiatrist may prescribe olanzapine (Zyprexa), a psychotropic drug used primarily to treat schizophrenia. In a patient who has anorexia nervosa, olanzapine can help them gain weight and modify their obsessive thinking. Side effects of olanzapine include:

  • Dizziness
  • Weakness
  • Drowsiness
  • Lightheadedness
  • Dyskinesia (movement disorder)

In addition, anti-anxiety medications can be effective in reducing the anxiety the patient may experience before eating.

Drug Treatment for Bulimia Nervosa

 Patients diagnosed with bulimia nervosa tend to respond well to fluoxetine in reducing the binge eating and purging. This is the only antidepressant that is approved by the U.S. Food and Drug Administration to treat bulimia nervosa.

In addition to fluoxetine, another group of antidepressant drugs called tricyclics (Norpramin, Tofranil, and Elavil) have been prescribed with some success. They have similar side effects as the antidepressants, but also have more risk of overdose and drug interactions.

Several placebo-controlled trials have shown topiramate (Topamax) to be effective in controlling binge and purge behaviors. Side effects include taste perversion, difficulty concentrating, and a sensation of pins and needles or skin crawling.

Studies with lithium demonstrated it is ineffective in treating bulimia.

Drug Treatment for Binge Eating Disorder

In treating binge eating disorders, the most effective drug has been topiramate , a medication usually associated with treating epileptic seizures and migraine headaches, as well as bipolar disorder. Side effects are listed above.

SSRIs (Prozac and Zoloft) and appetite suppressants (such as Meridia) have also been effective in treating the binge-eating behaviors. Appetite suppressants can help suppress hunger, which helps in weight loss, but they can have serious side effects. Common side effects of Meridia include dangerous changes in blood pressure, headache, dry mouth, and sleep disturbance.

Get Help Now

Casa Serena offers a safe and supportive environment to treat Anorexia Nervosa, Bulimia Nervosa, and Binge Eating Disorders. Casa Serena incorporates yoga and mindfulness, expressive arts therapy, family education, body image support group, and many more effective program components. Our caring, professional staff can help you reclaim your power and gently guide your or your loved one to a full, healthy recovery. Call (925) 682-8252