One woman’s battle to overcome an eating disorder amid a groundswell of emotions.
Amanda walks off the plane and sees a person holding a sign with her first name and last initial. Driving to the inpatient treatment center, she reflects on how she got to this place in her life. Amanda had years of unsuccessful outpatient treatment to address her anorexia and depression. A month ago, she was admitted to the emergency room as a result of fainting from extensive calorie restriction. As a result, she agreed with reluctance to inpatient treatment.
Upon arrival at the center, Amanda undergoes a physical and psychiatric assessment by a licensed nurse. Amanda panics when she sees the scale, not having weighed herself since falling below 85 pounds two months ago.The nurse reads the weight — 75 pounds — but does not disclose this information. At lunchtime, she is told her food is considered a “grace meal,” and is told she may choose whether or not to eat. Nursing staff tells her that following the grace meal she will be expected to comply with the individualized meal plan that will be developed by her registered dietician.
Next, she meets with her primary care provider who obtains her medical history and conducts a physical assessment.The provider explains that due to Amanda’s low weight, a nasogastric (NG) tube is recommended to aid in refeeding. Although Amanda refuses, the doctor explains the rationale: NG tube feeding is a gentler method of introducing nutrition to the body than oral refeeding alone. Since caloric requirements are great for weight restoration, an NG tube feeding provides the needed calories without excessive food volume and without replicating a binge-eating experience.Nocturnal tube feedings are more comfortable than oral refeeding and less stressful. Abdominal discomfort is lessened, and there is less pressure to consume a large volume of food. NG tube administration delivers weight gain calories needed while the meals and snacks provide maintenance calories. Her laboratory work revealed symptoms of malnutrition — hypoglycemia, low white blood cell count, low platelets and disturbed liver function.
Throughout the next three days, Amanda meets with her treatment team members for many assessments.A psychologist interviews her and orders a battery of psychological testing that will be used in her treatment planning.A psychiatric assessment is conducted by her psychiatric provider and she meets with her registered dietician who completes a nutritional assessment. Her therapist conducts thorough psychosocial and family assessments. In addition, she completes a body image assessment and an assessment for animal-assisted psychotherapy with horses. Amanda’s diagnoses include anorexia nervosa, restricting type; major depression, moderate; obsessive-compulsive disorder; post-traumatic stress disorder; amenorrhea; bradycardia; dehydration; and malnourishment. Decreased cognitive functioning is indicated across her assessments. Amanda’s psychiatric provider prescribes medication for depression and anxiety.
Amanda entered treatment in the “precontemplation stage” of recovery, which indicates that she is in denial about the severity of her disorder and the need for treatment.The team sets initial goals for Amanda: orientation to the program, medical and nutritional stability, full assessment of her individualized needs, denial reduction, and commitment to treatment.
After a week, Amanda’s team concurs that she has progressed to the “contemplation stage” of recovery. Although she struggles with the prescribed caloric intake, she is improving daily. Through intense process groups, didactics, and individual therapy, Amanda finally begins to deal with the origins of her eating disorder, which stemmed from childhood abuse. In outpatient therapy, she was able to continue her eating disorder behaviors to control her emotions and distract herself from her memories. Now, since she cannot practice her eating disorder behaviors, her emotions come to the surface and memories start to flood her. She begins to face the dysfunction that has ruled her life for 15 years.
Amanda experiences a setback when the emotional pain seems too great. She attempts to control her emotions again by restriction and self-injury.The team uses multiple interventions throughout this difficult period.The staff points out to Amanda the ineffective behaviors she chose in reaction to her emotions, and redirects her to use the skills she has learned. As she begins to identify the triggers and patterns of her eating disorder behavior, she practices alternative solutions and commits to using them.
Amanda realizes her treatment team truly has something to offer her and begins to process the underlying issues of her eating disorder.
Amanda’s team agrees that she has now entered the “preparation stage” of recovery. She is openly sharing, taking ownership of her behaviors, and she now understands what purpose the eating disorder has had in her life. She is cooperating with nutritional recommendations and her weight is increasing at the medically appropriate target rate of two to three pounds per week. Amanda prepares for family week. She feels extreme anxiety over the truths she will share with her husband and mother.Through roleplaying with her therapist, she has learned to forgive her deceased father for issues in the past.
On Monday and Tuesday of family week, Amanda and her family participate in didactics and therapy sessions with other families. On Wednesday, Amanda and her family participate in their own intensive “truth in love” session. Amanda shares the origins of her eating disorder, takes ownership of her behaviors, and makes amends for the damage her behaviors have caused her family. Her mother and husband open up with newfound honesty.This highly emotional session is facilitated by a family therapist who has expertise in family system therapy.
Amanda has advanced to the “action stage” of recovery. She goes on community passes to experience restaurant and shopping challenges. Amanda is now very committed to change. She has learned to deal effectively with the present and not relive the past.
Amanda moves into the “separation stage” of recovery as she prepares for discharge and finalizes her aftercare appointments. She now has the necessary tools to appropriately handle everyday life and crises.