The first step in the treatment of eating disorders is diagnosis, or assessment. Assessment involves careful diagnosis of the specifics of the disorder (if any), as well as physiological tests and perhaps psychiatric evaluations. Initial interviews may include a question or two about possible eating issues, or the interviewer may ask for a sample of a typical day's intake, from the time the patient gets up till going to bed. If any foods or food groups are excluded, the interviewer may ask why.
A thorough evaluation will include a medical exam. If you start by seeing a counselor, for example, the counselor should refer you to a doctor. Expect the doctor to take your vital signs, of course, and your height and weight (this happens during almost any doctor's appointment). You will be checked for appropriate physical growth and development.
The doctor will likely check you for signs of dehydration, since eating disorders often leave the body drained of water. Expect your heart to be checked (especially since heart failure is a frequent cause of death in advanced anorexia). It is common to take a blood sample to get information about whether your body's internal systems are working normally. If you purge, you may be referred to a dentist to have your teeth evaluated for damage from stomach acid.
If you don't start by seeing a counselor or psychiatrist, your doctor will probably refer you to one. This person will gather a history of your disordered eating and any treatment that you have received in the past. It is common to provide a report of what you eat in a day (or several days).
You can expect to hear questions about how you view your body and what your attitudes are toward eating. Your mood and anxiety level will be evaluated, since these can fuel eating disorders, and vice versa. You may also be asked whether you have ever suffered abuse. A good interview will also explore any stressors that trigger disordered eating or magnify the effects of the disorder. You will probably be asked about problems that have come up in past relationships.
Providers will base their treatment choices on the results of these evaluations. Treatment may involve changes to your diet, counseling, medications, and medical checks. It may occur in an outpatient setting or an inpatient treatment center, depending on the severity of your symptoms.
If it's determined to be necessary, a patient may be hospitalized. There may be a fairly brief emergency stay to get a critically ill patient stabilized, or a longer hospitalization in a specialized facility. But each treatment plan is individualized. For example, someone with occasional purging problems but no physical problems might need an initial checkup with a physician, but then see only a therapist. Or, a stable weight restrictionist may also only need a therapist.
Some people need to be encouraged to eat what they're hungry for, and give up food rules. In this case, seeing a nutritionist would be unnecessary. Some may need to see physicians regularly; others rely more on psychiatrists. Depending on the specifics of the patient's condition, treatment can be successful after a fairly brief series of sessions with a therapist, or it can take longer or require more intense multidisciplinary attention. Most patients find longer-term follow-up valuable - perhaps in the form of professional therapy, or through support groups, or simply by employing techniques learned in the treatment process.
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