How to deal with eating disorders
What are eating disorders? The DSM-5, i.e. the most important of the diagnostic manuals to which professionals internationally refer to diagnose psychological and psychiatric disorders, defines eating disorders (EAD) as “characterised by a persistent eating disorder or eating-related behaviour that results in impaired food consumption or intake and significantly impairs physical health or psychosocial functioning”
Furthermore, the manual identifies the following diagnostic categories: Pica, Rumination Disorder, Food Intake Avoidance/Restriction Disorder, Anorexia Nervosa, Bulimia Nervosa, Uncontrolled Eating Disorder, Nutrition or Eating Disorder with Specification and finally Nutrition or Eating Disorder without Specification.
With these categories, we are able to categorise all disorders that can occur from early childhood onwards.
It must be specified, however, that the diagnostic categories tell us nothing about the person suffering from an eating disorder, each person is more than one diagnosis
When we say “the girl suffers from anorexia nervosa” we are not saying anything about the deeper meaning that the disorder acquires for this young patient, indeed sometimes the misuse of the diagnosis can in the sufferer indexicalise the disorder rather than drive it out.
Individual, family and nutritional therapy for the treatment of eating disorders
Obviously the clinical diagnosis is useful to be able to talk among professional colleagues and define what are the common lines of this disorder.
Defining sometimes allows one to know how to orient oneself and control anxiety, but it is not the cure.
The cure is something else.
The Treccani dictionary defines care as “diligent and caring interest in an object, which engages both our soul and our activity”; I believe this definition is complete, so when we care for a patient suffering from an eating disorder we should behave like a mother good enough to nurture him/her, help him/her recognise his/her needs, support him/her in his/her first steps, nurture him/her with love, but not only that, we should behave like “a father” and thus encourage him/her to autonomy and self-confidence in taking his/her first steps in the world outside the family.
Intervention in eating disorders is complex and often requires the conjunction of individual and family therapy, as well as nutrition, for success.
Individual therapy is useful for the individual development of the person; it is important to have a therapist who becomes an inner reference point in the difficult moments that the patient will have to face; while family meetings are useful to elaborate new relational modalities that are more functional for the whole family and useful to guarantee the right emotional support for the suffering person, helping him/her to come out of the evolutionary stasis in which he/she finds him/herself and in which the whole family is suspended.
Eating disorders: what is the relational significance?
An eating disorder in fact signifies a developmental stasis, i.e. the impossibility of growing and evolving; this is almost always true for all variants of the disorders; it is as if the person suffering from the disorder manifested an impossibility of making a developmental leap, for example: the transition from childhood to adolescence, which implies precisely the entry into the adult world, and therefore the need for a confrontation aimed at constructing one’s own values and interests, as well as the sexual drive with the consequent choice of one’s first partners.
The onset of an eating disorder therefore almost always has a relational significance that must be grasped, understood and explored.
For example, what does the symptom want to communicate within his family? To his mother, father, brothers and sisters?
And so on.
In therapy, it will be important to retrace the family’s history by creating and generating a new narrative, a new story shared and constructed by the voice of all the family members.
Often families tell ‘stories’ about themselves that always have the same plot; therapy allows them to change the plot, creating chapters within a pathway that seemed already written but was only the circumscribed reading of a few or a certain historical time.
Another important aspect will be to understand from which event the eating disorder arose and how this relates to the patient’s developmental block.
Beyond the diagnosis, therefore, there is the person and this is unique; we must remember that suffering is not a disgrace but a gift because it is only through fragility that we encounter the true face of being human and of being human and creative ourselves.
It is in extending a hand to the other that we encounter his strength and his need, and it is only through this intimate and trusting contact with the other that we can arrive at the essential, and thus at ourselves with the other.
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