Treating Eating Disorders 267- At times family therapy requires the patient to challenge existing ways
of relating to and supporting individual family members as a means to
shift the homeostasis within the family system. This can be experienced
as threatening by the family and patient and if not carried out profes-
sionally can result in hostility to the therapist. - For very ill, emaciated patients, there may not be enough time to encour-
age them into family therapy, and hospital admission may be necessary. - Some family boundaries may be so enmeshed and the family so over-
involved with the problem that time away from the family can be helpful.
In summary, family therapy addresses the patient’s symptoms through
information, problem solving, and family dynamics, using the strategies
of family systems theory. These include being challenging, and blocking
and facilitating communication. Getting patients and their families to agree
to family therapy can be problematic, as it is often regarded as a diagnosis
that the family was to blame. Once patients are involved in therapy,
however, evidence indicates that they build strong relationships with their
therapists (Zaitsoff et al., 2008). Further, evidence indicates that it can be a
successful approach for treating both adolescent and adult anorexics.
This chapter has explored the ways in which individual theories of
etiology can be translated into treatment approaches. These approaches are
mostly carried out without the patient being admitted to a hospital. At times,
however, individuals become so emaciated, dehydrated, and ill that
admission to a hospital is necessary. This chapter will now explore the pro-
cesses involved in the inpatient treatment of anorexia nervosa, which often
reflects an integration of several aspects of the treatment approaches
described above.
Inpatient Treatment
The main reason for treating eating-disordered patients as inpatients is weight
restoration. The large majority of inpatients, therefore, are anorexic rather
than bulimic, although many also show bulimic symptoms. Treasure,
Todd, and Szmukler (1995) described the grounds for admission to a
hospital as including the following physical indications:
- BMI below 13.5 or a rapid decrease in weight of more than 20 percent
in 6 months