Eating disorders such as anorexia nervosa and bulimia nervosa do not exist in a vacuum; cases where they exist almost always co-occur with a psychological disorder or one which requires psychiatric treatment. These can range from the relatively mild to severe disorders such as schizophrenia that necessitate intensive psychiatric care. Because of the high incidence of disorders such as depression, anxiety, obsessive-compulsive disorder (OCD) and others that require medication, eating disorder professionals ranging from therapists to support staff at eating disorder treatment centers must be prepared to provide treatment options ranging from talk therapy to inpatient psychiatric care.
Recovery from an eating disorder is as much a spiritual and emotional path as a physical one. In addition to the distorted relationship with food, eating, body image and movement that make these disorders so dangerous, there are various psychological and psychiatric factors that contribute to their development. A prime example is the similarity between the repetitive behaviors associated with bulimia nervosa (in which recurring binge eating episodes are followed by purging behaviors designed to get rid of those calories) and the compulsive actions associated with OCD (debilitating anxiety that strikes when a certain repetitive behavior such as cleaning has not taken place).
Teenage Years Carry the Highest Risk
Inpatient psychiatric care is frequently needed in conjunction with medical care and therapy, even in adolescents. The teenage years and young adulthood are the most common ages of onset for both eating disorders and most conditions requiring psychiatric treatment. This is due in part to the neurological changes associated with adolescence and partially due to the social and environmental factors which come into play around that time.
Neurology and Eating Disorders
During adolescence and young adulthood, the neural circuits begin to set. These neural circuits relate to the brain’s reward mechanisms, particularly dopamine. Over time, repeated behaviors can “train” the brain to release dopamine as a reward response, becoming addictive just like a repeated dose of a drug. The leads to a reinforcement of these behaviors, which leads to an ongoing repeating cycle of disordered behavior.
An interesting twist is that neurological experts providing psychiatric care for people with anorexia nervosa have noted that, when playing a win / lose game, dopamine is released at a higher rate when the individuals lost. This suggests that the brain’s dopamine release is associated with punishment rather than pleasure in these individuals. The upshot is that self-punishing behaviors like extreme fasting in people with anorexia nervosa or self-induced vomiting in people with bulimia nervosa actually begin to trigger a pleasurable response.
While not every residential eating disorder patient will require inpatient psychiatric care, it is important to consult the individual’s psychiatric history as well as performing a psychiatric assessment. Comorbid eating disorder and psychiatric illnesses are both likely to develop during the later years of adolescence and both can prevent people from living their healthiest, happiest lives.
At Clementine, we ensure each young woman that comes into our care receives a complete psychiatric evaluation on admission to the program. Our psychiatric staff also, in cooperation with the medical, nutritional, and therapeutic teams, review the plan for psychiatric treatment at least weekly, allowing for flexibility and constant updates in the treatment program.
The Role of Medication
In compliance with the recommendations of the APA, psychiatric medication solely for the treatment of eating disorders like binge eating disorder or anorexia nervosa is generally avoided at the best eating disorder treatment centers. In certain extreme cases, for a person with anorexia nervosa facing extreme anxiety before a meal, anxiolytic medications (anti-anxiety meds) may be used. Appetite stimulants are generally not considered to be effective in long-term solutions for anorexia nervosa.
There have been some studies that show antidepressants may help in the reduction of binge-eating episodes among people with bulimia nervosa and binge eating disorder. However, in the very sensitive, developmental period that is adolescence, these kinds of medications are not usually used for the sole treatment of an eating disorder. A comprehensive multi-level psychiatric treatment plan consisting of evidence-based therapy such as Cognitive Behavioral Therapy is proven to be more effective in the long and short-term than a strictly pharmaceutical approach. It is important to remember that at this young age, young adults need psychologically gentle care.
Of course, if the client is taking any psychiatric medication, such as aripiprazole, Clementine or any other quality eating disorder treatment center will work with the psychiatric team to design an appropriate continuation of existing psychiatric medication. Experience in treating multiple disorders simultaneously is key in the concurrent resolution.
Types of Psychiatric Disorders Often Appearing Alongside Eating Disorders
As with eating disorders, dissociative disorders are more likely to appear in women than in men, putting adolescent girls and young women at a greater risk of developing a co-occurring eating disorder and dissociative disorder. These mental health illnesses consist of an involuntary separation from reality, normally occurring in episodes. The three main types of dissociative disorder are:
- Dissociative amnesia
The individual will have difficulty remembering events or memories in their lives, with no explanations. Like with disordered eating behaviors, this is often triggered by a traumatic event and the resultant PTSD.
- Depersonalization disorder
This disorder, which normally has an onset around age 16 to 18, causes the individual to feel they or their surroundings are not real. It has been described as a feeling that the person is not living a real life but instead watching a movie of their life, or alternatively, that the individual themselves is not real. These kinds of distorted perceptions are also common in body image disorders, which are central to eating disorders.
- Dissociative identity disorder
This type of dissociative disorder occurs when an individual has more than one manifested personality. These disorders often also exhibit amnesia symptoms, when one personality cannot remember the actions or experiences of another. As with all dissociative disorders, it normally results as a coping mechanism for a past traumatic event or series of events.
One of the more severe disorders requiring inpatient psychiatric care, schizophrenia is a disease which skews people’s perceptions of reality in a variety of ways. Hallucinations, both visual and auditory (i.e. hearing voices) are common. In a similar fashion, delusions are common, where the individual imagines things or events that aren’t there. These delusions are often connected with strong paranoia. People with schizophrenia are often unable to make an accurate assessment of themselves or the world around them, symptoms common with body dysmorphia (body image disorder), which is a frequent contributing factor for eating disorders such as anorexia nervosa and bulimia nervosa.
Schizophrenia medications can carry with them severe side effects which can exacerbate eating disorders. Individuals with co-occurring eating disorders and schizophrenia must carefully and comprehensively plan the continuation of their medicinal regimen with both their doctors and the staff at an eating disorder-focused inpatient psychiatric care facility.
Borderline Personality Disorder (BPD)
Bulimia nervosa, in particular, is found to be co-occurring with BPD. BPD consists of difficulty regulating emotion, experiencing intense feelings and struggling to return to a neutral baseline after a triggering event. People with BPD may experience:
- Intense, uncontrollable feelings
- Poor self-esteem
- Flawed or distorted body image
- Intense fear of abandonment
- Increased risk of self-harm such as cutting or suicide
- Impulsive behaviors such as substance abuse and risky sexual activity
- Inward or outward anger, followed by feelings of guilt and shame
Many of these symptoms are similar to those found in anorexia nervosa and bulimia nervosa. For example, the neurological dispensing of dopamine based on punishment or pain is one of the root causes not only of anorexia’s starving behavior or bulimia nervosa’s purging behavior but the practice of cutting or burning which is common to sufferers of BPD. Likewise, a negative distorted self-image is a central part of virtually every eating disorder. Additionally, the feelings of guilt and shame that follow impulsive behaviors caused by BPD are similar to the guilty feelings following a binge eating episode and the following purge associated with bulimia nervosa.
In contrast to schizophrenia or even general anxiety disorder, BPD does not have any one type of medication normally prescribed for treatment. Instead, a combination of talk therapy and cognitive training like CBT or Dialectical Behavior Therapy is normally applied to correct the intense and disordered thoughts and feelings. This is nearly identical to the methodology applied to treatments for eating disorders.
The Developmental Aspect of Psychiatric Care for Adolescents with Eating Disorders
Psychiatric conditions that present in teenagers and adolescents must receive a sensitive approach to treatment. The ages 13 to 21 are fundamental periods for individual’s neurological development, as well as the solidifying of the personality they carry into their adult years. A one-size-fits-all treatment plan at this critical stage of development won’t serve the healthiest development of an individual’s future, recovered self. For this reason, when treating psychiatric disorders concurrent with eating disorders, specialists in adolescent medicine, psychiatry, and psychology should lead the planning of every course of treatment.
Why an Adolescent-Centric Program Is Essential
At Clementine, adolescent-focused psychiatric care is at the center of each individualized recovery plan we design. We begin with a full psychiatric assessment with the cooperation of our client’s doctor and psychiatric providers, and base the medication (when necessary) and therapeutic implementation on this assessment. By working with specialists in adolescent psychiatric treatment, our staff (also experts in behavioral health treatment) can create a program which is sensitive to developmental issues. We also incorporate genetic testing for psychotropic medication responsiveness, which allows us to stay abreast of the latest clinically-approved psychiatric treatments available to medical science.
Our programs are always individualized, with weekly updates as the treatment progresses. If you suspect your adolescent child needs eating disorder treatment combined with psychiatric care, or if you have received a co-occurring diagnosis yourself, call our admissions team today at 855.900.2221 to get started on the path to recovery.
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