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  • The Most Important Treatment Step is….

    Posted on October 27, 2015 by

    Symptom Interruption! When a child, teenager, or adult presents for treatment, there needs to be a careful assessment of eating disorder symptoms and a plan for symptom interruption. Symptoms including restrictive eating, binge eating, purging through the use of vomiting, laxatives, diet pills, or excessive exercise all need to be minimized and eventually eliminated for true recovery to take place. Perhaps, easier said then done, but prompt symptom interruption lessens the duration of illness and is all possible with the proper treatment and level-of-care.

    The basic neuroscience premise of symptom interruption is that neural pathways form which make eating disorder behaviors compulsive, impulsive, and destructive. The more severe the eating disorder and the longer the duration, the stronger these neural pathways become and the more difficult they can be to interrupt. The goal is to shut-down these neural pathways from firing- off so that new pathways for coping with food, eating and body image can agin be found freeing the individual from the grip of the eating disorder. Unfortunately, “willpower” is often not an effective solution once these pathways have solidified their place in the brain.

    So what does one do? The most effective form of symptom interruption remains residential treatment where patients are in a safe, secure, and monitored environment where there is little chance that eating disorder behaviors can be allowed to take place. Currently, this abstinence approach is probably the most effective way to limit the neuronal firing of eating disorder pathways, decreasing the likelihood of repeated firings in the future and replacing pathways with better ones for rehabilitation back to a healthier wellbeing. However, many seek to avoid residential treatment, outright refuse that level-of-care, or may not have access to a treatment facility due to insurance or financial constraints.

    When residential treatment is not an option, symptom interruption becomes the responsibility of an outpatient program or private clinicians. With a symptomatic eating disorder, it can be extremely difficult for any expeditious recovery goals to be met. Simple outpatient psychotherapy and nutritional guidance may help patients better understand their condition and what needs to be done, but little progress can be made for shutting-down those behavioral neural pathways without close monitoring. Intensive outpatient programs (IOPs) and day treatment programs can offer some additional monitoring for symptom interruption during morning and day hours, but patients who present with evening, nighttime, or early morning behaviors may still engage in behaviors which keep neural networks in place. Some programs like the Maudsley Method have proven effective with some children and young adults, however, many families cannot become the “food police” for their loved one. Finally, medications can also be somewhat effective for symptom interruption and may be considered with your doctor to expedite recovery.

    The primary point to this article, is that while many people are well aware of the psychotherapy sessions, nutritional consultations, doctor visits and other clinical care necessities, it remains of the utmost importance that symptom interruption take place, leading to a reduction, minimization, and eventual abstinence of eating disorder symptoms in order for recovery to take place. Without a full remission of symptoms, an individual will always live with a level of discontent caused by the remnant eating disorder pathways. – Dr. Jeffrey DeSarbo

     

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