268 Treating Eating Disorders
- Lowered blood sugars
- Cardiac irregularities
- Muscle weakness
- Impaired blood clotting
- Risk of suicide
- Intolerable family situation
- Social isolation
- Failure of outpatient treatment
Fewer patients are currently admitted to a hospital than 10 years ago,
but inpatient treatment is still regarded as necessary if weight restoration
is essential.
Central to the inpatient treatment of anorexia is nursing care which focuses
on two factors: the development of a therapeutic alliance between nurse
and patient, and weight restoration. Inpatient treatment draws on aspects
of the therapeutic perspectives described in the previous sections.
The therapeutic alliancePatients with anorexia have an overwhelming desire to lose weight and to
avoid eating even though their bodies are telling them to eat. Given that
the main goal of inpatient treatment is weight restoration, developing a
therapeutic relationship between patient and nurse can be difficult. Central
to this relationship is the establishment of trust, a belief by the patient that
the nurse is on their side, and a sense that the relationship is about col-
laboration. This is developed by the nurse asking respectful questions of
the patient, keeping the patient informed about the aims and structure of
the ward, and by the nurse interpreting any deceit and aggression as part
of the illness, not as a personal assault. The nurse also needs to be firm
and consistent in the insistence that the patient’s behavior must change.
Once a trusting relationship has been developed, this alliance can be used
as the forum for some of the therapeutic interventions described in the
previous sections. For example, the nurse may use cognitive restructuring
skills such as searching for evidence and asking Socratic questions of the
patients. It is also becoming common for nurses to use motivational inter-
viewing, which is derived from Stages of Change theory (Prochaska and
DiClemente, 1984). This theory describes individuals as being in a particular
stage in their determination to change their behavior, and is a dynamic model
as it illustrates how people move from stage to stage both away and towards