When Dr. Emmett “Rick” Bishop, MD first became interested in eating disorders, back in the mid-1970’s, there wasn’t even a formal diagnosis for this multi-faceted problem. Nor was there a treatment protocol. He became interested when a graduate student suggested collaborating on a research paper on bulimia. He quickly realized, “we’re not treating these patients very well at all.”
Now Dr. Bishop is part of the treatment team at the Eating Recovery Center in Denver, where he continues to try to improve and refine our understanding and treatment of this very difficult problem. He points out that what we call anorexia has been around for a very long time. In medieval times, it was associated with extreme spirituality, as if self-starvation was a sign of holiness and rejection of earthly things. In the late 20th Century, we blamed the media and dieting. Now, with better understanding of the influence of genes, eating disorders are recognized as the end result of the interaction of genetic predisposition with a triggering environment. According to Dr. Bishop, weight loss from any source can trigger an eating disorder in a vulnerable person, whether deliberate dieting or illness or default weight loss from stress.
New patients at the ERC complete a temperament and character questionnaire. Analysis of the answers gives a picture of behavior patterns likely to have a genetic basis, such as novelty-seeking or harm avoidance. The profile helps the treatment team target each person’s therapy. Eating disordered people use the behaviors to cope with stress, bad feelings and anxiety. It’s terribly easy to get stuck in the behavior, and very difficult to stop. Dr. Bishop says the ERC uses a protocol called Acceptance and Commitment therapy to challenge the person’s reliance on restrictive eating, and help them get un-stuck and develop healthier coping mechanisms.
I asked Dr. Bishop about brain function in eating disorder treatment. “If the body is thin, the brain is thin,” he said. Brain volume shrinks with starvation, and Dr. Bishop notes that a shrunken brain is a lot like dementia. The effects of poor nutrient intake associated with starvation impact the person’s ability to process thoughts and feelings, which impacts the success of therapy. ERC patients take omega-3 supplements as part of treatment, since omega-3 fatty acids, particularly DHA, make up a significant part of brain structure.
When should a person seek treatment? According to Dr. Bishop, weight loss to below 10% of ideal body weight is a clear warning sign, regardless of whether or not the person’s lab values look “normal”. Medical professionals sometimes make the mistake of assuming lab values are the deciding factor. A severely underweight person with normal lab values can go into sudden medical crisis, so weight should be a key deciding factor.
Later this month, I’ll have more on the Eating Recovery Center, and my interview with Dr. Bishop’s colleague Dr. Ken Weiner, MD. Meanwhile you can find information about their treatment programs on the ERC website.
Comments