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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 2 of 2. This is the beginning of the thread.
Posted by Racer on March 14, 2005, at 21:33:46
I've been looking for a new therapist, and having trouble finding anyone who'll agree to see me. (I have found one now, and I think she'll be a good fit, but this question is still bugging me.) Even looking at the ED referral pages, therapists will see adolescents with AN, and any age bulimics, but very, very few are willing to see adults with AN.
I realize that an adult with AN is likely to be chronic, a poor potential outcome, likely has had previous treatment, etc, but can you explain why there's such an incredible dearth of options out there for people like me?
For what it's worth, I'm over 40, have been anorexic since early teens with long periods of "normal" weight due to anti-depressants (including periods of overweight due to ADs, drat them!), but have never had any treatment for it before. (Psychiatrists just order the pills, say, "Oh, your weight is in the normal range now, excellent!" No treatment to stop it coming back once the meds are discontinued.) Yes, I'm chronic, but it's not because prior treatment has failed.
Also, the therapist-candidate whom I have now seen twice who seems like a good fit has no background in AN -- although she has had experience with BN. Can you offer any suggestions on treatment specific to AN that I might pass on to her? I know that my body image is Not Good, and that restricting food is about restricting emotions in response to external pressures, but beyond that I don't know much about what might be helpful. This T is pretty Cognitive, although we've talked about the dangers of that for me, and I wonder if there's anything else you can suggest.
Thank you, and thank you for stopping in again to be our Guest Expert.
Posted by Dr. Beth Steinhauer on March 15, 2005, at 13:45:25
In reply to Steinhauer: question about finding treatment, posted by Racer on March 14, 2005, at 21:33:46
Dear Racer,
I'm sorry it's been so difficult for you to find a therapist willing to treat you. I suspect that you're right; many clinicians probably regard adults with A.N. as more chronic, refractory to treatment, potentially medically unstable, etc. Also, resources vary widely depending on region. I'm glad that you've found someone. For other readers who are looking, try www.aedweb.org for help with local referrals.
The treatment of choice for Anorexia Nervosa is CALORIES; the goal is restoration of normal weight. When people are starving, they are not able to engage in meaningful outpatient therapy. Medications, too, have shown very limited utility in treating A.N. (though some medications, such as antidepressants, may help with coexisting conditions e.g. depression, anxiety, etc.) Generally speaking, someone with A.N. whose BMI (Body Mass Index) is below 16 needs hospital admission for refeeding.
If antidepressants have helped you in the past to sustain a more normal weight, they could be very useful to you now. Once your weight is stable, you can use psychotherapy (cognitive-behavioral or interpersonal therapies) to better address the body image concerns and other issues that have been fuelling your weight loss.
Best of luck with your recovery--ES
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