We spoke with an expert in the intervention of TCA cases.
Despite the many efforts that have been made in recent decades to prevent these behaviors, cases continue to appear.
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Interview with Marta Juliana Garrido, psychologist specializing in eating behavior disorders
In the work of knowing more in depth how these types of diseases appear and what their evolution is, we have talked with Marta Juliana Garrido de Frutos , a psychologist at Psicode .
Bertrand Regader: Many times it is assumed that suffering from anorexia or bulimia consists simply of wanting to lose weight at all costs, and that’s it. Is there much diversity in the way of experiencing these psychological disorders in the first person?
Marta Juliana Garrido de Frutos: It is true that it is believed that anorexia and bulimia arise from the obsession with wanting to lose weight at all costs, but that explanation is very banal if we take into account that eating behavior disorders are very complex problems time to develop and treat.
Losing weight, or rather thinness, is the superficial sign of much internal discomfort. Phrases like “I am not enough”, “it is as if this body does not belong to me”, “nothing I do is right”… show us that discomfort is not as closely related to eating behavior as it seems at first glance.
Throughout the coexistence with the problem, the way of living it can come to be perceived as similar among all the people who suffer from it, having food and the body as the main axis. However, the origin of these behaviors that can be perceived as self-destructive is as diverse as the person who suffers from it. In a large number of cases, the need to fit in, to be accepted, to be “perfect” for having felt abandoned throughout their lives is usually present and is a breeding ground for developing an eating behavior disorder.
Bulimia and anorexia are the best known eating disorders, but they are not the only ones that exist. What are the rest of psychological alterations of this type that are usually seen in consultation?
Until now these two disorders have been the best known and the most prevalent, but it is true that today the cult of the body or the search for acceptance, approval, and “perfection” through it is creating new disorders. This is the case of psychological disorders such as vigorexia (addiction to physical activity) or orthorexia (obsession with healthy food) that are beginning to present themselves as problems by affecting the person’s daily life.
In consultation, the problem that is most seen if we ignore anorexia and bulimia, is binge eating disorder. Verbalizations of the type “it’s coming home and I can’t stop eating, I’m not aware, it’s as if I lost track of time”, “I can’t buy certain things because they don’t last me a day”, “every night I get up and I destroy what I see”… they are more common every day.
Much is said about the way in which fashions and social pressure influence the appearance of eating disorders. But beyond the influence of the big media, there are also communities of young people with these disorders who are encouraged to lose weight. Do they have a significant impact on the maintenance of the problem?
Nowadays, body image is given a lot of importance in society and this influences the course of these disorders. “I began to see myself better and I felt more confident”, “everyone told me how beautiful I was”, “I felt that I fit in, I was no longer the nice one”…these are examples of reinforcements that people perceive when it comes to have a sense of control over your body and end up hooking.
This weight control is still difficult and that is why there are communities of people with the disorder who create blogs, forums or even Instagram accounts where patients encourage and advise each other to achieve their goal. These communities are very dangerous and it is important to control the use and participation in them if we want to eradicate the harmful behaviors that the disease presents.
Do most people with anorexia or bulimia have a hard time recognizing the problem?
Anorexia and bulimia are not a problem, they are the solution to a problem. This is how patients see both disorders, mainly anorexia, so it is difficult for them to recognize it as a problem. What began as a search for perfectionism, for external validation, for being able to fit in…has become a problem, but even so, it continues to be their shield, their refuge…so putting it on the table to work on it would leave them defenseless and with many fears.
The main demand for which these patients come to the consultation is usually because of the consequences of the problem, but not because of the problem itself, since they are afraid to do without it. Thus, what we find are demands for social isolation, relationship problems, poor conflict management, decreased work or school productivity… that show the consequences that the disease leaves behind.
Once you are aware that something is wrong with your habits and state of health, what usually motivates these people to go to psychologists?
The truth is that these patients rarely ask for help directly because of the eating problem, but because of the consequences that the disorder is having on their lives.
In the case of adolescents, it is the parents who bring them to the consultation and from that moment they are an important part of the treatment. In these cases, it has been the parents who have begun to perceive certain suspicious behaviors, the school or a friend.
The demand they present is usually: “she has been refusing to eat for a while”, “I don’t know what happens if she has everything but I see her very sad and she says she doesn’t want to eat”, “we had seen something but we thought it was an age thing and that they like to be a little better”, “the other day I found the food in the garbage and since then I have been more alert”, “it all started in some exams, I began to notice that she ate eagerly and only talked about food all the time”…
In the case of adults, the reason for consultation is not always so clear and awareness of the disease as a problem is usually not entirely clear. In the case of binge eating disorder and bulimia, yes, they may be motivated to change since at a social level they feel quite anxious because many of the encounters usually revolve around food in the second case and in the first the appearance generates discomfort in the person.
What can mental health professionals do to help these people?
Multidisciplinary work in these disorders is very important in practically all cases as it is a serious psychological problem. Regarding the approach at a psychological level, it is important to combine guidelines that help the person to establish healthy eating habits and not forget the great weight that the emotional part has in these patients.
Identifying the role that the problem is playing in the patient is crucial to help these people get out of it. This work requires a lot of time since, as I have mentioned before, it is not something conscious on the part of the patient. During emotional treatment we help patients to face fears that appear throughout the treatment, such as the fear of losing control of what they eat, fear of trust, fear of gaining weight, fear of feeling, fear of stop wanting, fear of facing life without illness…
The collaboration of relatives is a very important factor in the intervention in these disorders. For this reason, at Psicode we need your help in a large part of the treatment process and we help you manage delicate situations and emotions that living with the disorder provokes.
In which case is hospitalization necessary?
Hospitalization is necessary when the person’s health is at high risk. It should not be forgotten that in the case of anorexia between 7-15% of patients with the disease die, so admission can help a lot in severe cases.
Another option that is also offered to patients when they are not in such an extreme situation is home admission, where they are under the supervision of a family member. This is often beneficial to the person since maintaining a daily life is easier and therefore helps to continue working with the patient on many real-life fears.
Finally… how is the recovery process taking place, access to a healthy lifestyle?
The recovery process is gradual and changes are slow. It is important from the first moment to recover a healthy weight in the patient that does not put her life at risk, together with healthy eating patterns. Although this is usually one of the first goals to work on, it is usually the last to be fully achieved.
The patient in the recovery process goes through different stages that in few cases follow a linear course. Many times they start from a stage in which they do not recognize the problem and therefore the need to change: “I feel much better, everyone tells me so”, “I am fine, I do not stop making plans, that is why they pass me by certain things”, “I have no problem”…
Then they go on to perceive costs to the problem, but even so they are not “enough” to change: “everyone messing where they are not called”, “I am not capable of performing the same”, “I do not want to stay, it is always the same … I stay later”.
When they prepare for action or decide to heal themselves, they begin to go through a forest of fears to let go of the disease and start making changes: “and if I start to say no and it makes them feel bad”, “I don’t think I can leave him, I would be left alone ”, “and if they reject me”. Finally, when they begin to poke their heads out of that forest of fears, they begin to forgive each other, to love each other, to look at each other with kindness and begin to be honest and set goals: “I am proud, it is true that it has cost me, but I have done it”, “I was not to blame, it did not matter what I had done.”
To the classic question “what do you do?” I always answer “basically I am a psychologist”. In fact, my academic training has revolved around the psychology of development, education and community, a field of study influenced my volunteer activities, as well as my first work experiences in personal services.