WEIGHT LOSS: TREATMENT IN THE AGE OF BIOPSYCHIATRY
Eating disorders can arise from biological imbalances, emotional turmoil, and cognitive distortions. The best treatment is one that takes all of these components into account. Let me illustrate. Imagine a car with bad brakes careening out of control down a steep hill during the middle of a rainstorm. Behind the wheel is someone who never learned how to drive a car. A formula for disaster! Given unrestricted powers, how might someone intervene to restore control of the car?
Well, if we could somehow level out the hill so it was no longer as steep, the car would eventually roll to a stop. Perhaps, too, a mechanic could leap aboard and fix the brakes. At the same time we could broadcast a quick course in driver education over the car radio, teaching the driver how to relax and ease up on the gas. And by setting up a giant canopy, we could keep off the rain and reduce the slipperiness of the road surface.
As a biopsychiatrist, I see parallels between this scenario and the treatment of eating disorders.
The slope of the hill represents the physical, or biological, component. If I can “level off” the peaks and valleys (reducing the chemical imbalances, or decreasing the starvation or the bingeing and purging), I can return the patient to a more even course of eating. Medical therapy-the use of everything from controlled nutrition to certain medications-comes into play here.
Behavioral and cognitive therapies work to fix the way a patient behaves and thinks by showing her how to apply the brakes and bring her disordered habits under control.
Individual and group therapies that address her feelings help her to ease up on the gas and stop supplying the emotional fuel that propels her erratic behavior.
Last, by improving her relationships with significant people in her life, for example, through family therapy, we might provide her with a dry surface, a road through life on which she can maneuver with greater confidence and stability.
Lisa’s story shows this principle in action. Medications helped her deal with the biological issues, including her depression. Behavioral therapy showed her how to change bad habits. Cognitive therapy helped her learn new ways to handle stress. Through individual and group therapy she explored her feelings and improved her relationships, and the “twelve-step” approach of Alcoholics Anonymous and Overeaters Anonymous reduced her dependencies on alcohol and food. Though family therapy wasn’t an option in her case, many patients do benefit from this approach.
Treatment that focuses on one element and ignores others may be ineffective. For example, “talking” therapy in which disordered eating behavior is not addressed may lack a crucial ingredient for success. The twelve-step approach of Overeaters Anonymous may be doomed to fail if the patient has a biologically caused depression. For an anorexic, restoring weight without altering distorted attitudes may merely be a “quick fix” whose results won’t last over time. Similarly, fad diets or the megavitamin and food-allergy approaches may seem to work, at least temporarily, but their results are only a placebo effect that provides the passing illusion of a successful cure.
*49/35/5*
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