| Patients suffering from eating disorders binge on | | | | stage, he is unable to differentiate his own feelings |
| food and sometimes are both anorectic and bulimic. | | | | and needs from those of others. His cognitive and |
| This is an impulsive behaviour as defined by the DSM | | | | perceptual distortions (for instance, regarding body |
| (particularly in the case of BPD and to a lesser extent | | | | image - somatoform disorders) only increase his |
| of Cluster B disorders in general). Some patients | | | | feeling of personal ineffectiveness and his need to |
| develop these disorders as a way to self-mutilate. It | | | | exercise even more self-control (on his diet, the only |
| is a convergence of two pathological behaviours: | | | | thing left). |
| self-mutilation and an impulsive (rather, compulsive or | | | | The patient does not trust himself in the slightest. He |
| ritualistic) behaviour. | | | | is his worst enemy, a mortal enemy, and he knows |
| The key to improving the mental state of patients | | | | it. Therefore, any efforts to collaborate with HIM |
| with dual diagnosis (a personality disorder plus an | | | | against his disorder - are perceived as collaboration |
| eating disorder) lies in concentrating upon their eating | | | | with his worst enemy against his only mode of |
| and sleeping disorders. | | | | controlling his life to some extent. |
| By controlling their eating disorders, patients assert | | | | The patient views the world in terms of black and |
| control over their lives. This is bound to reduce their | | | | white, of absolutes. So, he cannot let go even to a |
| depression (even eliminate it altogether as a constant | | | | very small degree. He is HORRIFIED - constantly. This |
| feature of their mental life). This is likely to ameliorate | | | | is why he finds it impossible to form relationships: he |
| other facets of their personality disorders. Here is the | | | | mistrusts (himself and by extension others), he does |
| chain: controlling one's eating disorders controlling | | | | not want to become an adult, he does not enjoy |
| one's life enhanced sense of self-worth, | | | | sex or love (which both entail a modicum of loss of |
| self-confidence, self-esteem a challenge, an interest, | | | | control). All this leads to a chronic absence of |
| an enemy to subjugate a feeling of strength | | | | self-esteem. These patients like their disorder. Their |
| socialising feeling better. | | | | eating disorder is their only achievement. Otherwise |
| When a patient has a personality disorder and an | | | | they are ashamed of themselves and disgusted by |
| eating disorder, the therapist should concentrate on | | | | their shortcomings (expressed through shame and |
| the eating disorder. Personality disorders are intricate | | | | disgust directed at their bodies). |
| and intractable. They are rarely curable (though | | | | There is a chance to cure the patient of his eating |
| certain aspects, like OCD, or depression can be | | | | disorders (though the dual diagnosis of eating disorder |
| ameliorated with medication). Their treatment calls for | | | | and personality disorder has a poor prognosis). This - |
| the enormous, persistent and continuous investment | | | | and ONLY this - must be done at the first stage. The |
| of resources of every kind by everyone involved. | | | | patient's family should consider therapy AND support |
| From the patient's point of view, the treatment of | | | | groups (Overeaters Anonymous). Recovery |
| her personality disorder is not an efficient allocation | | | | prognosis is good after 2 years of treatment and |
| of scarce mental resources. Also personality disorders | | | | support. The family must be heavily involved in the |
| are not the real threat. If a patient with a personality | | | | therapeutic process. Family dynamics usually |
| disorder is cured of it but her eating disorders are | | | | contribute to the development of such disorders. |
| aggravated, she might die (though mentally healthy)... | | | | Medication, cognitive or behavioural therapy, |
| An eating disorder is both a signal of distress ("I wish | | | | psychodynamic therapy and family therapy ought to |
| to die, I feel so bad, somebody help me") and a | | | | do it. |
| message: "I think I lost control. I am very afraid of | | | | The change in the patient IF the treatment of his |
| losing control. I will control my food intake and | | | | eating disorders is successful is VERY MARKED. His |
| discharge. This way I control at least ONE aspect of | | | | major depression disappears together with his |
| my life." | | | | sleeping disorders. He becomes socially active again |
| This is where we can and should begin to help the | | | | and gets a life. His personality disorder might make it |
| patient. Help him to regain control. The family or | | | | difficult for him - but, in isolation, without the |
| other supporting figures must think what they can do | | | | exacerbating circumstances of his other disorders, he |
| to make the patient feel that he is in control, that he | | | | finds it much easier to cope with. |
| manages things his own way, that he is contributing, | | | | Patients with eating disorders may be in mortal |
| has his own schedules, his own agenda, matter. | | | | danger. Their behaviour is ruining their bodies |
| Eating disorders indicate the strong combined activity | | | | relentlessly and inexorably. They might attempt |
| of an underlying sense of lack of personal autonomy | | | | suicide. They might do drugs. It is only a question of |
| and an underlying sense of lack of self-control. The | | | | time. Our goal is to buy them time. The older they |
| patient feels inordinately, paralysingly helpless and | | | | get, the more experienced they become, the more |
| ineffective. His eating disorders are an effort to | | | | their body chemistry changes with age - the better |
| exert and reassert mastery over his own life. At this | | | | their prognosis. |