The clinical term for a mental illness is a psychiatric disorder. Depression, generalized anxiety, schizophrenia, personality disorders and eating disorders are all considered psychiatric disorders by the healthcare community. Clementine’s day treatment programs for teens and women with eating disorders provide psychiatric evaluations for all patients entering our facility to help clarify the kind of personalized treatment program they will need to address their eating disorder and mental health issues.
What Is a Day Treatment Center for Teens and Women with an Eating Disorder?
Psychiatric day treatment programs often work best for patients who have never entered an eating disorder program and who do not require a higher level of medical, psychiatric or nutritional care. Additionally, this can be an appropriate level of treatment for an individual stepping down from a residential to a day treatment program.
Day treatment involves intensive psychotherapy, counseling and group therapy that begins in the morning and continues into the afternoon. Unlike residential treatment programs for eating disorders, day treatment programs for teens and women allows clients to return home every day instead of consistently remaining at the center.
Seven Common Psychiatric Disorders Affecting Teens and Women with Eating Disorders
The overlap between symptoms of an eating disorder and a psychiatric illness is difficult to separate. In some cases, psychologists may delay officially diagnosing an eating disorder patient with a mental health problem until symptoms of the eating disorder have diminished enough to differentiate the two disorders.
The DSM-V (Diagnostic and Statistical Manual for Mental Disorders-V) supports a diagnosis of clinical depression if five or more of the following symptoms are reported by an eating disorder patient:
- Insomnia or hypersomnia (sleeping more than 12 hours every day)
- Disinterest in doing things that were once enjoyable (anhedonia)
- Self-isolation/avoiding social situations
- Cognitive problems (inability to concentrate, remember or make decisions with feeling anxious about making a decision)
- Neglecting to seek treatment for health problems (teens and women with eating disorders won’t acknowledge signs of malnutrition, heart palpitations, tooth decay or other physical side effects of an eating disorder because this would mean admitting they have an eating disorder)
- Suicidal ideation (thinking of suicide but not telling anyone they think about it)
- Constantly feeling empty, sad and tearful
Depression in Teens
Adolescence is a time of complex changes involving biological, social and psychological aspects of a teenager’s life. It can be difficult for parents to recognize early signs of depression in teens because of their moodiness, unwillingness to communicate and unpredictability. Depression often precedes the development of an eating disorder in adolescents as they try to find behaviors that alleviate the sadness and anger they feel.
Possible signs an adolescent has clinical depression include:
- Consistent angry or hostile attitude, especially when alternating between tearful, sad moods
- Uncharacteristic withdrawal from family and friends; socially isolating oneself
- Feeling worthless, guilty, useless; saying things like “I’m the reason for everyone’s problems” or “I don’t blame anybody for not liking me. I’m stupid, dumb, ugly, etc”.
- Disinterest in activities that were once enjoyed
- Sleeping all the time
- Suicide ideation
Characterized by irrational worries, a constant sense of apprehension and persistent pessimism over the outcome of any situation, generalized anxiety disorder (GAD) is commonly co-diagnosed with teens and women with eating disorders. One of the primary reasons someone rigidly controls their food intake is the anxiety relief they feel after gaining a sense of control over something in their lives. Like depression, GAD reinforces abnormal eating disorder habits. Day treatment programs addressing eating and psychiatric disorders will include psychotherapies and counseling to treat anxiety in teens and women with eating disorders.
Phobias and Panic Disorder
Also on the spectrum of anxiety disorders are phobias and recurring panic attacks. Patients with binge-eating disorder may be phobic about certain foods because they fear the food may gag them, make them choke or cause them to gain weight expeditiously. Patients with anorexia nervosa may suffer panic attacks if they are forced by their parent or loved one to eat a spoonful of “real” food. Treating psychiatric disorders such as phobias and panic is an essential precursor to successfully addressing a patient’s eating disorder.
Eating disorder patients participating in programs at a day treatment center are rarely diagnosed with schizophrenia. A serious, difficult to treat psychiatric disorder, schizophrenia can be managed to an extent with medications and professional counseling and life skills support. If a patient is diagnosed with schizophrenia and an eating disorder, the eating disorder is typically a selective eating disorder, pica or overeating disorder not otherwise specified.
Symptoms of schizophrenia include delusions, audio/visual hallucinations, incoherent speech and inability to understand reality.
Posttraumatic Stress Disorder (PTSD)
Experiencing traumatic events such as war, violence, sexual assaults and abandonment can severely impact a person’s psychological health. Symptoms of PTSD such as extreme anxiety, nightmares, flashbacks (memories of the traumatic event), difficulty coping with normal life stressors and emotional instability could lead to someone developing an eating disorder as a way to control their PTSD.
Personality disorders are often more difficult to treat than other, non-psychotic mental illnesses because they are so ingrained in a person’s sense of self-awareness and self-identity. Borderline, obsessive-compulsive and avoidant personality disorders are some of the most common types of personality disorders diagnosed in people with anorexia nervosa, bulimia nervosa or binge-eating disorder. After patients complete day treatment programs for teens and women with eating disorders, ongoing counseling is often necessary to help them deal with symptoms of their personality disorder to avoid relapsing.
What Is Psychiatric Evaluation?
A comprehensive psychiatric evaluation provides information about a patient’s mental and emotional state to eating disorder psychologists. This information is critical to developing an individualized recovery program that fully addresses the patient’s needs.
Completing questionnaires that help identify cognitive issues may also be part of a patient’s psychiatric evaluation. Since eating disorders combined with mental illness will affect brain function to varying degrees (especially in terms of memory and attention), verbal cognitive questionnaires give information to psychiatrists vital to accurately diagnosing a patient’s mental status. For example, tests containing questions that measure a patient’s complex attention processes can determine how well patients can maintain focus and observe multiple stimuli without becoming easily distracted. This gives psychiatrists more insight into the possibility of organic brain damage impacting seriously ill patients.
Teens and women undergoing a psychiatric evaluation at an eating disorder day treatment center may be asked about symptoms and illnesses they experienced at any point in their lives. Does the patient have a history of seizures? Migraine headaches? Recurring infections? Heart disease? Dental issues? Patients will also be asked to indicate all substances they have abused in the past or are currently abusing in addition to naming any prescription medications they are presently taking. During intake, patients are told it is essential they give psychiatrists accurate information to optimize the success of specific therapeutic interventions.
Psychosocial and Developmental History
Another component of psychiatric evaluations involves the patient’s developmental and psychosocial history. Developmental history involves information that sheds light on the normal or abnormal progression of a patient’s infancy, childhood and adolescence. Some things of particular concern to psychiatrists include a history of chronic diseases, physical abuse or sexual abuse that may have had a profound effect on the patient’s psychological maturation.
A patient’s psychosocial history embraces their ability to maintain satisfying and stable relationships with family members and friends and their ability to experience intimacy and trust with significant others. Sexual history, sexual orientation and cultural beliefs concerning sex are further examined as part of a complete psychiatric evaluation. Additionally, if the patient belongs to a specific ethnic group, the degree that social roles, issues with acculturation and discrimination and ongoing economic difficulties have affected a patient’s emotional and mental health condition may be discussed with the psychiatrist performing the evaluation.
Treatments for Dual Diagnosis of Eating and Psychiatric Disorders
Following an intake examination by doctors at an eating disorder day treatment center, patients begin receiving one or more psychotherapies that carefully probe the core causes of their eating disorders and mental health issues:
Teens and women with eating disorders develop a deep understanding of themselves through psychotherapy, a type of “talk” therapy that reinforces a patient’s ability to perceive reality as it is instead of how they think it is. Psychotherapists attempt to persuade the patient to talk about their thoughts and feelings even if they experience anxiety and fear over acknowledging them. Therapy sessions also center around repressed emotions and the powerful influence the subconscious has on their perceptions, attitudes and behaviors.
Through psychotherapy teens and women at eating disorder treatment centers learn that focusing on being aware of the self in the present (mindfulness) instead of the self in the past or future facilitates coping with anxieties that fuel compulsions to engage in eating disorder behaviors.
Cognitive Behavioral Therapy
A highly successful offshoot of psychotherapy utilized by eating disorder therapists and psychologists is cognitive behavioral therapy (CBT). CBT helps patients recognize and correct distortions in thinking and perception that may be responsible for misinterpreting beliefs about themselves and others. Especially helpful for teens and women diagnosed with borderline personality disorder, depression, eating disorders and anxiety/phobias, CBT challenges false assumptions and rigid thought patterns, such as magnification of negative events, overgeneralizing and catastrophizing (expecting the worst to happen regardless of the situation).
CBT is also a kind of “talk” therapy emphasizing the power that subjective thoughts have on how we perceive the world. Eating disorder patients with personality and/or mental disorders are taught by CBT counselors to deeply examine how thoughts affect mood and behavior. For example, a patient who reports they are unable to focus on anything because they feel something bad is going to happen to them will be guided by a CBT therapist to systematically and objectively examine these thoughts to find any merit to their validity. Eventually, patients conclude their fears are not based on solid evidence supporting their beliefs and that these false beliefs should be considered more as hypotheses rather than truths.
Staying Motivated in Day Treatment Programs
The freedom and self-regulation associated with outpatient programs make it difficult for some teens and women with eating disorders to remain in the program. Family members and support groups can be of great help to patients who may need extra motivation and support when the urge to start engaging in eating disorder behaviors is persistent and overwhelming.
While externally supplied motivation is a necessity to complete an eating disorder recovery program, patients participating in outpatient therapy must realize the incentive to enjoying a successful recovery lies primarily within themselves and their desire to live a healthy, productive life. Although day treatment counseling sessions involve cognitive behavioral therapy, psychotherapy or other psychologically-oriented treatment methods that seeks to explore and resolve the origins of an eating disorder, counselors will also include and emphasize the importance of attending therapy sessions as scheduled.