Eating Disorder Is Characterized by Abnormal Eating

Eating disorder is characterized by abnormal eating habits involving excessive or insufficient intake of food which is detrimental to the individual's physical and mental well-being. There are two common types of eating disorders although there are other types of eating disorders. The first is bulimia nervosa which is excessive eating coupled with frequent vomiting. The second type is anorexia nervosa which is immoderate restriction of food which leads to irrational weight gaining. The other types of eating disorders include eating disorders not otherwise specified which are essentially where a person has anorexic and bulimic behaviors, binge eating disorder which is compulsive overeating without any kind of compensatory behavior, and pica which is craving for certain non-food items such as glue, plaster, paper. It is estimated that roughly 10-15% of cases of eating disorders occur in males and statistics show that women are at a higher risk of developing eating disorders than men Walsh & Devlin, 1998.

This high risk is associated with the high degree of westernization which promotes binge eating. It is estimated that eating disorders occur in roughly a quarter of Americans the American population with interactions that occur between homeostatic, motivation, and self-regulatory control processes primarily leading to eating disorders Doll, Petersen, & Stewart-Brown, 2005()

The exact cause of eating disorders is not known but evidence suggests that it is linked with other medical and psychological conditions. In one study it was shown that girls with attention deficit hyperactivity disorder (ADHD) are more likely to get an eating disorder than the comparator group without ADHD. In a separate study, it was shown that the incidence of anorexia nervosa in women suffering from post-traumatic stress disorder (PTSD) was quite high. Bulimia nervosa was more likely to develop in foster girls. Other studies have shown that there is higher incidence of eating disorders in those who face teenage pressure or idealize certain body types that are portrayed as 'cool' in the media Padierna, Quintana, Arostegui, Gonzalez, & Horcajo, 2000.

These findings from these studies suggest that eating disorders are associated with other medical conditions and disorders. However, other studies also show that eating disorders occur for genetic reasons Rayworth, Wise, & Harlow, 2004()

Intervention strategy

The intervention strategy chosen to help treat eating disorder is cognitive behavioral therapy. The major advantage of cognitive behavioral therapy is that it postulates the individual's feelings and behaviors which come about as a result of their thoughts and not as a result of external stimuli. This helps to change the way the person thinks and reacts to the situations that lead them to have the disorder and thus by changing how they think, it is possible to treat the disorder Rie, Noordenbos, & Furth, 2005()

Cognitive behavioral therapy or CBT as it is commonly known as is involves dealing with both the cognitive and behavioral aspects of the patient in order to arrive at the best treatment option for the patient. In this way, the treatment focuses on changing the thoughts and ideas of the patient which then change their actions towards treating the disorder. This strategy places emphasis on minimizing the number of negative thoughts that the patient has regarding their body or themselves which them helps to reduce their eating acts and attempts to alter the negative and harmful eating behaviors that they are involved in Patton, Selzer, Coffey, Carlin, & Wolfe, 1999()

CBT encourages the person to be able to tolerate negative thoughts and feelings which helps them to change how they think about food and stop looking at food or their bodies as comfort for their negative thoughts and feelings. It emphasizes on the cognition of the person which needs to be changed n order to change the action that the person undertakes. It also involves rewarding the person for any achievements that they make during the treatment process since CBT is a focused approach Padierna, Quintana, Arostegui, Gonzalez, & Horcajo, 2002.

One downside of CBT is that the patient needs to have a particular issue that needs to be addressed in order to treat their eating disorder. In the absence of such issues, it becomes impossible to treat the patient. CBT has, however, been proven to be quite effective in treating eating disorders. Another downside of CBT is that it does not encourage weight loss thus for overweight or obese binge-eaters it may cause an issue since treatment of the disorder is not associated with maintaining a healthy weight while the two should essentially be coupled together.

Phases of the intervention

CBT can be carried out in four phases. The first is the assessment stage where the social worker gets know the patient. This is the foundation of the intervention strategy since it helps the social worker to understand the issues facing the patient and thus conduct a thorough assessment of the client and why they are seeking treatment. This assessment is typically conducted in two to three sessions where the social worker asks a series of questions to the patient some of which the patient may be uncomfortable with but are essential to the treatment process. However, the patient is free to decline to answer any questions. The social worker may also choose to use a standardized questionnaire with follow-up questions in order to find the underlying issues presenting.

The assessment may reveal anorexia or bulimia in the patient resulting in other symptoms of comorbid psychiatric disorders. A diagnostic workup may be conducted using MRI, fMRI, SPECT and PET scans in order to detect any tumors or lesions that may cause the eating disorder. Psychological diagnosis may be done using psychometric tests such as eating attitude test, body attitude test, SCOFF questionnaire, or eating disorder examination interview. Eating disorders should be differentially diagnosed from other conditions such as Lyme or Addison's disease that cause anorexia, Hypo- or hyperthyroidism which may mimic symptoms of eating disorders, or other diseases Munoz et al., 2009()

The second phase is treatment planning. After the initial assessment has been conducted, the social worker then discusses their impressions and observations with the patient and how they intend to deal with the patient's issue. The social worker also discusses with the patient on the areas of their life that they need to change in order to succeed in the treatment. In eating disorders, the treatment goal will be to resume normal eating behavior. The treatment plan will focus on this goal by ensuring that the patient resolves any self-esteem issues or other issues that are facing them which give rise to the eating disorder Mond, Hay, Rodgers, Owen, & Beumont, 2005()

The third phase is the therapy phase which in the case of CBT is divided into two sub-phases. The first is the cognitive stage where the social worker works with the patient to understand how the patient thinks. In this stage, the social worker and patient discuss events that have taken place in the past and how they patient has reacted to them. Here, the social worker seeks to find ideas and thoughts that lead to the patient's eating disorder and shows these to the patient. The second stage is the behavior stage where the social worker works with the patient to find new ways of thinking of the patient. In this stage, the social worker is basically seeking to change the ideas, thoughts and behavior of the patient in order to institute new patterns of thinking. Cultural competence is important in this phase since it is only through cultural competence that the social worker will be able to understand and resolve the issues facing the patient Martin et al., 1999.

Cultural competence allows the patient to treat the patient with respect and to prevent discrimination or stating anything that may harm the therapeutic relationship created between them.

The last phase is the ending or termination phase where the social worker and patient work together to ensure that the changes that have begun in the third phase are sustained and that there is no relapse. This involves the social worker highlighting the changes that the patient has made so far and the gains from these changes. The patient also learns how to apply the CBT principles on their own and that the principles are not independent rather they need to be done together. If the patient has not recovered by this phase, the social worker may choose to refer the patient or to continue with the third phase of treatment until the goals of treatment are achieved. Time for termination of the treatment will be known when the patient is able to sustain the changes achieved. This will be known through the patient being able to eat normally and to avoid binge eating at all costs.

In the application of CBT as the intervention, referral is a probable option for patients with eating disorders. This is majorly because they are mostly chronic and come as co-infections with other disorders. The client thus has to come clean about the underlying issues that in the view of the social worker may lead to the eating disorders. The client comes into the counseling system either by voluntarily enrolling themselves in counseling, through a friend or family referral or expert advice at a health facility. For typical patients, there may be a history of visiting other systems of care since it is likely that the patient will seek other forms of medical treatment before visiting a counselor.

Role of social worker

As a social worker, the role played will be in the long-term care segment of continuum of care since treatment of the eating disorder falls under rehabilitative care. This is because CBT aims at reforming the individual's cognitive and behavioral issues in order to achieve the goals of treatment.

The social worker is quite different from other practitioners since the social worker has a role to play in social education. In that the social worker has the role to educate the patient about the options available and other overlapping aspects that are relevant to the case at hand. The social worker needs to be more apt in giving holistic treatment such as family therapy, counseling, and community development, to the patient as compared to a doctor who only works on the physical aspect. The social worker thus has a greater leadership and advocacy role to play since in giving holistic treatment, they would be required to understand the patient from a wider perspective.

Factors influencing client use of mental care

Utilization of mental health services has been a problematic issue as a result of many individuals facing challenges in receiving mental care. One major factor is the social stigma that is attached to mental illness. The society believes that mental illness make a person 'crazy' or unfit as per society standards which should not be the case. Therefore this stigma prevents many people from seeking mental care. Another factor is the cultural believes that relate to the causes of mental illness. It is believed that mental illnesses are as a result of curses or other similar harms which causes people to feel shy to disclose their mental status.

In addition to these major factors, other factors contribute to people not procuring mental health services. One is the negative attitude that people have towards mental illnesses and providers of mental health services, others feel that mental health care is a waste of money since they feel that providers are unable to solve their problems, inaccessibility of metal health care services locally and lack of mental care services that are culturally compatible is also a huge issue. Other reasons include the use of alternative services which are informal and ineffective and the unfamiliarity of individuals to the existence of formal mental care services. These factors are part of the external factors that have been the focus of researchers in mental care including accessibility, affordability and availability of mental care services.

An individual's attitude towards seeking and using formal mental health care services is the single most important factor that affects their decision to seek professional mental health services. The link that exists between the attitude that an individual has and their subsequent behavior has been the subject of research and greatly affects their health-seeking behavior.

Building rapport and empathy

As a result of maladaptive behaviors that come with anorexia and bulimia, there may be challenges in creating rapport and empathy with patients. However, the importance of building rapport and empathy for patients cannot be overemphasized Krauth, Buser, & Vogel, 2002.

Without this, the treatment is bound to fail. To establish a rapport and empathy with the patient, the first and most important step will be to ensure the patient understands their need for mental care and the anticipated outcome of mental care. This involves explaining to the patient why they are where they are, what mental care will do for them and how they need to change. The second thing would be to form a therapeutic relationship with the patient that creates a supportive environment for the patient to disclose as much information as possible. Trust, reliability and compassion should be the foundation of this relationship.

The importance of the therapeutic relationship has been emphasized by several researchers who state that it has a potential to guard the patient against discrimination and helps them to change their attitude and behavior thus making treatment effective.

Cultural issues in eating disorders

Eating disorders, though evidence is limited, have been found by researchers to vary with their ethnicity. Amongst Caucasians, African-Americans, Pacific Islanders, Native Americans, and Asians, there are certain values and norms that lead to higher incidences of eating disorders Kime, 2008.

The primary reason for this is that women from these ethnicities develop eating disorders as a result of their rejection of their culture and adoption of more typical European or American cultures. At the same instance, there are values and norms that inhibit their ability to seek mental health care services which creates a vicious cycle for eating disorders.

In dealing with diverse groups of patients, it will be important to understand the influence that culture may have on the incidence of eating disorders resulting in anorexia and bulimia. It is important to understand that environmental cues for self-esteem may create negative attitudes leading to eating disorders. Thus though treating eating disorders in a diverse population will be a challenge, by understanding and incorporating these cultural influences as well as understanding the interdependence of cultural values, it will be much easier to disentangle these challenges.