“I have yet to see any problem, however complicated, which, when you looked at it the right way, didn’t become more complicated.” –Paul Anderson
To say eating disorders are multi-faceted illnesses would be a serious understatement, as any professional in the field would tell you. Not only do treatment teams have to find a balance between their different disciplines when addressing complicated medical and psychiatric issues, but they also face the added challenges of working with patients who are often unhappy about being in treatment, tend to have difficulty trusting treatment providers, may feel in denial of their condition or resistant to treatment, and on top of everything else may face legal or financial barriers to seeking proper treatment. All of these obstacles don’t even begin to cover the myriad of psychiatric and medical comorbidities that typically present in a patient with an eating disorder.
When unraveling an eating disorder medically, we are first encountered with the challenge of discerning whether or not symptoms such as dizziness, tremors, and heart palpitations are the result of malnutrition, dehydration, altered metabolism or from psychiatric manifestations such as anxiety. Additionally, we also come across co-morbid medical conditions such as hypothyroidism, anemia, and atypical chest pain (just to name a few) that can in turn cause psychiatric symptoms. When psychotropic medications are introduced into the equation, it is important for the team to be vigilant as they themselves can have side effects that can manifest as medical or psychiatric complications. This constant presentation of symptoms that compete for both medical and psychiatric care calls for effective and cohesive clinical integration when treating clients with eating disorders. The underlying illness, whether psychiatric or medical may be challenging to diagnose and one should not immediately rule out the other when complications arise. People with mental health issues often get physically ill; they are not mutually exclusive.
It is clear that there are a multitude of considerations to make when first meeting a client and as promised, the problem is only more complicated when we hone in on any one aspect of the illness. When it comes to evaluation and treatment planning, once again, clinical integration is key. There are several general considerations that we recommend taking into account when first meeting a patient:
Be suspicious: patients may make evaluation more difficult, either by being unwilling to give a full history, unable to give an accurate description of symptoms or too frightened to allow a full physical exam.
Remember that patients with mental illness develop medical problems too.
Be alert for presentations, which make medical illness more likely, but don’t stop considering a medical illness just because they don’t initially fit.
Look for symptoms that make medical illness more likely.
Do not assume a certain symptom “must” be of psychological origin.
Be holistic: note the patient’s feelings and functioning within the current context as well as what happened in the past.
Above all, it is important to be aware of the limitations placed on a patient’s capacity for recovery when looking at a complex illness through a narrow lens. It is crucial that clinicians are acutely aware of the urgency of the patient’s needs, whether medical or psychiatric, and appropriately empathize with the individual to reassure them that you understand their concerns. They need to know that you will you will work to help them feel better whatever the cause. Integration of the various disciplines involved in the care and treatment of eating disorders takes collaboration. With balance, careful consideration of contributing factors and regular communication, eating disorder providers can successfully help treat their patients in a holistic and effective way.
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