The image of beauty in women has been constantly evolving over the ages. In the middle ages, corpulence was considered a sign of fertility, and full figured women were considered the epitome of beauty. Today, a different ideal is advocated, putting forward thinness and valorising performance and control. There are numerous temptations in our consumer society: heavy advertising for ultra processed foods and high calorie products, home delivery, high prices for healthy food, etc.. This is said to be the cause of cognitive dissonance and a loss of reference points for adolescents.
Prevention and early identification are essential steps in detecting eating disorders as early as possible, and will help avoid the development of a chronic form of the disease, usually associated with somatic and psychiatric complications. Many tools are available for the early detection of disorders, in particular the EDE (Eating Disorder Examination) or the SCOFF-F (Sick, Control, One, Fat, Food), which is widely used by general practitioners. The latter has been recommended by the French National Authority for Health (HAS) for the diagnosis of OCDs and is even offered as an online self-diagnosis tool to guide patients towards treatment as soon as possible.
Full-time hospitalisation for emergency situations?
Depending on the severity of the disorder or the somatic or psychiatric emergency, hospitalisation may be the best solution. Unlike anorexics, bulimics are rarely hospitalised except for severe depression or in order to break the binge cycle. Neither are binge eaters, except in the case of serious somatic complications due to weight gain or depression.
The principle of hospitalisation is to cut the adolescent off from his or her environment in order to open him or her up to other types of relationships. In cases of anorexia, a slow and progressive weight increase is essential to overcome anxiety and avoid an inappropriate renutrition syndrome.
During hospitalisation, the aim is to create and maintain a therapeutic alliance between the patient, the family and the doctors (paediatrician, psychiatrist, dietician), in other words, a relationship of trust in which the adolescent can feel supported and listened to. Hospitalisation can be a complex process and be perceived as a new abandonment with potentially negative consequences such as school dropout and social withdrawal. Moreover, a study has shown that hospitalisation of adolescent girls suffering from anorexia was less beneficial than outpatient treatment (Gowers et al. 2000). Out of 75 patients, only 14% of hospitalised patients had a satisfactory outcome compared to 62% of non-hospitalised patients.
So what about outpatient treatment ?
Today, the HAS (2019) recommends outpatient treatment as a first line of defence for people suffering from eating disorders following hospitalisation, since patients do not emerge totally cured and the risks of relapses are high.
The aim is to establish a new multidisciplinary follow-up to maintain the adolescent’s growth, spontaneous eating, the ability to eat socially, reeducation and the rediscovery of sensations related to food.
At the psychotherapeutic level, there are many treatment methods. For bulimia, those that have shown a greater success rate are cognitive-behavioural therapies (CBT), which give better short-term results than interpersonal therapies (FAIRBURN et al. 1995), but this effectiveness is not found in anorexia (MCINTOSH et al. 2005). Body approaches, art therapy and music therapy can be complemented by other CBT-type therapies. The use of several methods or the use of several therapists can be beneficial because it allows the diffraction of the transference by avoiding dual relationships to avoid the fusionism characteristic of adolescents.
In the management of anorexia nervosa, the family approach with the Maudsley model seeks to prevent hospitalisation. The focus is on what causes the maintenance of the anorexia and not on what caused it. This is done by making the parents actors in the treatment.
In 3 phases over about 15 to 20 sessions lasting about 12 months the first aim is to restore the weight by restructuring the family around a new diet and cultivating a non-judgmental attitude. The aim is also to open up the teenager’s relationships with family and friends again and to avoid isolation and taboos about food. Secondly, if the weight regain is satisfactory, the teenager will be given back control of his or her diet, always with a positive attitude towards food. Finally, the last step is to let the teenager build his or her own identity by separating himself from their illness. A fresh start for a new life…
Nutritionist at Nutrimis