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By Dr. Cris Haltom
(Part 1, Part 3)
What are some reasons symptoms sometimes worsen early in treatment?
1. Often, early dysfunctional eating is done privately and secretly by a child. Obsession with weight and body image and attempts to appease internal anxiety about weight gain are usually recognized by your child to be excessive and even bizarre. The need to HIDE SYMPTOMS can be high. Treatment exposes what a child has been invested in hiding. This is frightening. The nature of an eating disorder is often to stay private and hidden, even from the treatment team. Thus symptoms can become exacerbated in response to exposure in treatment.
2. The work of recovery seems simple enough. Reintroduce foods that have been avoided gradually. Build health so thinking and judgment are not impaired by the eating disorder. Treat any accompanying depression or anxiety. The problem is that the nature of disordered eating is to maintain symptoms, not lose them. Thus treatment becomes a COMPLEX PROCESS of emotional and behavioral letting go of old habits. It also includes slow dismantling of a web of false or distorted beliefs about diet and body image.
3. EARLY RE-FEEDING sometimes leads to gastrointestinal discomfort, bloating and/or constipation. Instead of feeling better, those in recovery sometimes feel physically worse, not better, early in treatment. This can challenge and stall recovery.
4. Sometimes young people and/or their families are under the impression that WILLPOWER will bring about recovery once treatment has started. This leads to a false belief that, with enough willpower, treators' suggestions and guidelines can be followed along a straight path to recovery. However, recovery usually comes about with emotional, thinking and behavioral changes that occur gradually, sometimes with one step forward, two steps to the side, and sometimes a few steps backwards prior to moving forward.
5. Confronting co-existing problems that may surface because of treatment for an eating disorder sometimes seems to increase the unhappiness of both the sufferer and her or his family. Confronting problems related to an eating disorder can lead to conflict and controversy in the family, e.g., dysfunctional eating amplified by the stress of parental marital conflicts or discovery of a family history of depression or anxiety. At first this is difficult and may appear counter- productive. However, paying attention to a pre-existing problem can lead to defining, clarifying, and eventually resolving problems.
6. Your CHILD'S GUILT and frustration about not recovering as quickly as you would like may create a setback. Guilt can come from financial and/or time pressures on you related to treatment. Guilt can occur because of early parental misunderstanding about the complexity of recovery unrealistic pressure to recover.
7. Early in recovery the body's hunger and satiation mechanisms are may not be working correctly. Thus attempts to eat may not only be psychologically noxious to the sufferer but may also feel "unnatural" because of CONFUSED OR NON-EXISTENT APPETITE signals. With time and restored nutrition appetite signals return to normal for many.
Cris Haltom has a Ph.D. from Cornell University. She is a licensed psychologist in private practice in Ithaca, N. Y. Cris is an Approved Supervisor (#110) for the International Association of Eating Disorder Professionals. She is available for training, presentations, and workshops. She has published articles, co-edited a text book, appeared on cable television, taught workshops, and taught academic courses as adjunct faculty at Cornell University and other colleges.
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