Understanding the Difficult Eating Disorder Patient

By Vicki Berkus M.D., Ph.D., CEDS, Remuda Ranch Medical Advisor

When they first begin treatment, patients often struggle and insist on “doing treatment their way.” I tell my patients’ families that they can typically expect a phone call after two or three days, during which they are likely to hear, “Get me out of here! They don’t understand me!”

To gain some insight into what a patient’s experience was like I went undercover and entered a treatment program as a patient struggling with laxative abuse. I packed my suitcase, hid laxatives in my hair and in the handle of my suitcase and walked through the front door.

My process as a patient started with the intake interview where I had to tell a complete stranger some of the most private things about me.

Once I was admitted, I was given an exam gown and my luggage was removed to be searched. I had to change into the exam gown in the shower so that the nurse could see whether I was hiding anything. Then, I was again questioned and went through a physical exam. I had blood drawn, an EKG, and weight taken without hearing or seeing the results. I then was allowed to eat and read the orientation packet.

I was exhausted after three hours of being somewhere I didn’t want to be, talking to people I didn’t trust and having no support (or perceiving that I had no support.) Throughout my stay, I was told when to eat and when to sleep, and had most of my personal items taken from me and locked away.

Finding Empathy for Struggling Patients

I knew as a doctor and eating disorder treatment professional that the purpose of all of this wasn’t to make me feel like an infant, but to make sure I was medically stable and safe in that environment.

Many of our patients don’t quite understand that. They are angry, tired, lonely, and scared. It takes courage to go through treatment.

My insight increased over the next few weeks as I ate with peers, attended Family Week, and sat in process groups observing the patients’ progress. Overall, it wasn’t an entirely pleasant experience for me; I can’t imagine having an eating disorder in my head and trying to go through this process. I’m glad I had a chance to experience it first-hand so that I would not longer have to base my assumptions on my limited perception.

Today, I tell my patients that I don’t expect them to like treatment or even want treatment; but, if they know deep down that their way isn’t working to just do it anyway. I think the key when trying to help eating disorder patients is to set boundaries and be firm while including incentives in their treatment that they can earn.

Starvation, biochemical changes in the brain and body while re-feeding, and co-occurring mood disorders all exacerbate the disease and the lack of control over emotions and behaviors. I think back to my residency days when I was on call every other night (at age 43) and remember that without proper sleep and nutrition, I was not fun to be around.

Think about the last time you were trying to function without the right amount of sleep or food, and try to remember how you felt when dealing with your patient or loved one as they enter into eating disorder treatment.

Remuda Ranch Can Help

The experienced staff at Remuda Ranch at The Meadows understands the pain that eating disorders can bring. There is hope. We can help you or your loved one get on the road recovery.

Our beautiful campus in the heart of the Sonoran Desert offers patients large rooms, indoor and outdoor horse arenas, a swimming pool, and a challenge course. Among the lush landscapes, patients are surrounding by peace and tranquility while they work with our team to overcome their eating disorders and dual diagnoses, and find peace within. Call us today 866-390-5100 or reach out online.

Source Link

Rewards Matter for Eating Disorder Patients

By Vicki Berkus M.D., Ph.D., CEDS, Remuda Ranch Medical Advisor

People who are struggling with their eating disorders (ED) and refusing to cooperate in treatment often need rewards they can work toward. Being in treatment would be hard for anyone; but, it’s especially hard for adolescents and for those who don’t yet have coping skills or a mind that’s fed well enough to fully function.

Privileges as Rewards

To encourage patients to follow their treatment plans, most programs use levels of activity as rewards. Anything that patients tend to look forward to–going on outings, going to a movie, more exercise time, eating somewhere other than the treatment group table for a meal—can serve as motivation for patients to adhere to their treatment regimens.

I used to be stopped in the hall by my patients with requests. “Can I _________?” they would say. They couldn’t help themselves. The idea that their entire treatment team would have to make the decision, not just me, was not in their thoughts at the moment of the request.

I decided to come up with a system that would help them know exactly what they needed to do to earn one of the privileges they wanted.

Actions Replace Words

I would have patients fill out a “request sheet” every Monday. On the sheet they were asked to write down what they wanted to do most at the end of the week – exercise more, go on an outing, etc. They also would have to write down what would be required for them to be allowed to do what they asked. (e.g., eating 100 percent for the three days prior to the activity, or not needing to be reminded to limit their movement when sitting.)

Depending on each patient’s need, the clinical team would either set the criteria for them or the patient would sit with the therapist to develop the criteria. Either way, the patient knew and agreed upon exactly what they needed to do on their part to get the added perks.

I was amazed at how quickly their behavior changed. Instead of finding me and putting a lot of energy into “making their case,” they would get excited for the change and for the challenge of meeting their goals. They would then hear from the clinical team by Thursday what the weekend would look like in terms of activities and changes.

It sounds simple but ED patients are adept at holding onto the yardstick that compares their peers’ eating disorder behaviors to their own. The ability to put on “emotional blinders” and focus on their treatment is just not in their skill set in the beginning of treatment. Having structured reward systems help them to achieve that focus.

A Team Approach

It is important for treatment teams to be consistent with patients and for each team member to be fully up to date on the latest information about their behavior and their risks. Patients need to know that the team members have access to their daily behaviors including, meal consumption, fluid consumption or daily weights. They also need our united front on the decisions we make that have such a significant impact on them during their treatment.

At Remuda Ranch at The Meadows, we use a consistent team approach every day and work with each person individually based on their strengths. With the support of our teams, our patients achieve much greater success toward their recovery.
If you would like to find out more about Remuda Ranch, please call 866-390-5100 or contact us.

Source Link

 

A Story about a Cat - Remuda Ranch Eating Disorder Treatment Program

By Vicki Berkus M.D., Ph.D., CEDS, Remuda Ranch Medical Advisor

I have learned that I will not win a “battle of wills” against a patient with an eating disorder.
They have perfected setting rules for themselves and the last thing I want to do is give them more rules. I also don’t expect a new patient to immediately trust me; I know that I need to earn the trust. If a patient refuses to talk about their eating disorder or refuses to tell me what they would be willing eat, I start by finding a way to get them to just talk—about anything.

A Story about a Cat

One of the most difficult patients I’ve met in my career actually said to me, “Dr. B, don’t look at me. I don’t deserve to be looked at.” Where do you start from there?

This patient was extremely shut down. The only thing she was willing to talk about was her cat. So, we visited about her cat for a while. Once she started to relax, I asked her if she would be willing to imagine that her cat had an eating disorder and write a story about it.
She did an amazing job! (I tried to get it published but no luck.) She was able to clearly and beautifully articulate her own fears and feelings as long as she was able to imagine that it was all about the cat.

Finding a Way through Shame

I had another patient who was 16 and had lost her hair and her teeth to her disease. She refused to talk about her eating disorder. So, I asked her what she would like to talk about.

She told me that she would talk about her heroin use but not her eating disorder.
So, we started there. Not long after, she told me she had dropped out of high school because the kids would snatch off her wig and laugh at her baldness. She was filled with shame and guilt. As a result, she had only eaten one piece of hard candy, ½ cup of yogurt, and a half of bagel each day for the last year. It can be hard to imagine someone needing that kind of control.

Eventually, she was able to start talking about her eating disorder, but we had to go at her pace. To push her too far too fast might have ruined any chance I had at developing a rapport with her.

Meeting Patients Where They Are

The hardest part of our work as eating disorder professionals is establishing relationships with our patients that allow trust to develop. I frequently start by asking them what they would be willing to try. It may be a smoothie or a quarter cup of a supplement like Ensure or Boost. It may be talking about a beloved pet, or a co-occurring disorder rather than the eating disorder itself.

I also try to provide patients with the information they need in order feel ready to try. For example, if their fear of eating includes fear of the pain that they feel in their GI tract when they eat, I will talk to them about how together we can address the pain and come up with a plan to make it less painful. I will also often order abdominal films for patients so they can look at it and see why they are not “going to burst” with one more mouthful.

Most importantly, I try to remember that with each suggestion I make, the eating disorder is pushing the patient to make the opposite decision. It will take the entire treatment team to help the patient through this difficult phase of their recovery.

Remuda Ranch Can Help

One of the most important goals to achieve while in treatment is to learn how to live life with your Eating Disorder (ED). Remuda Ranch at the Meadows uses a 45-day curriculum to teach the skills you will need to live with ED and move toward life-long recovery. Call us today for more information: 866-390-5100.

Source Link

Accepting the Past as an Asset in Recovery

By Aleah Johnson, The Meadows Alumni Coordinator
What if I were to tell you that all aspects of your past would be used as an asset? Would you believe it or would you instantly regret and want to change it?
I have a love/hate relationship with the word "acceptance." As a stubborn addict, I am not supposed to agree with everything, right?

What is Acceptance?

Acceptance is defined as "the act of taking or receiving something offered." Sometimes I really have to stop and take inventory of the things in my life, both personally and professionally and ask myself if I am fighting or if I am accepting.
One of the most crucial bits of advice I have learned in recovery is to accept my past as an asset. It is important to accept ourselves where we are on our journey and be able to leverage ourselves for good.

The past is a place or state of being in an earlier period of a one's life, career, etc., that might be thought of as shameful or embarrassing. We have all done things in our past that we may not be proud of— choosing to resist or deny our past only leads to more suffering. Acceptance allows us to live in the present moment and not "future trip" or worry about the past.

Resistance is often about control; the more we try to control our lives, the more out of control they get. Acceptance allows emotional balance and gives us the ability to accept people and things exactly as they are, even when we can't see the WHY or when we're not getting what we want.

Finding Serenity

Acceptance is a key solution to our problems. When we are disturbed, it is because we find some person, place, thing, or situation—some fact of life—unacceptable. We can find no serenity until we accept that person, place, thing or situation as being exactly the way it is supposed to be at that moment.

Until we accept ourselves, our situations and our life, on life's terms, we cannot be happy. We need not concentrate so much on what happens in the world as on what needs to be changed in ourselves and in our attitudes. (Page 417, The Big Book)

Early in my recovery, an old-timer in one of my first meetings told me, "You can make this as easy or as hard as you want, little lady, but ultimately the choice is up to you." I fully accepted this not only as a piece of advice but also as a challenge.

Nobody is perfect and everyone has battles and struggles; this is part of this amazing journey that we call life. Every saint has a past and every sinner has a future. Recovery is a marathon, not a sprint. It is our job to accept all aspects, to start where we are, use what we have, and do what we can to make the best out of the life we have left.

Join The Meadows Alumni Association

If you are a graduate from any of The Meadows inpatient programs, The Meadows Intensive Outpatient program, any weeklong intensive workshop at the Rio Retreat Center at The Meadows, or a family member who attended Family Week, you are welcome to join The Meadows Alumni Association!
Sign up today to receive our monthly email newsletter and to be kept up-to-date on any relevant, recovery-related news and events in your area.

Source Link