Anorexia Nervosa Treatment Influenced By Therapeutic Alliance

• Therapeutic alliance is a predictor in severe and enduring anorexia nervosa.
• Providing hope improves therapeutic alliance and anorexia nervosa

Therapeutic alliance could be a key factor in the progress of anorexia nervosa, an eating disorder that is characterized by I) Distorted Self-image- People with anorexia tend to believe that their body is out of shape and that certain parts of the body are too flabby, even though it might not always be true.

II) Obsession with Weight Loss- Though the patients may be lean, they have an excessive obsession with weight loss and keep a check on every calorie they consume.

III) Maintenance of an Unhealthy Low Weight- They refuse to put on additional weight even when they are advised to do so by family and friends. Intake of smaller amounts of food to avoid gaining weight is a common practice.

IV) Compulsive Need to Exercise- Fearing weight gain, people with anorexia exercise hard, even though they might not need to.

Facts about Anorexia Nervosa

• This eating disorder is growing at an alarming rate among early teens and adolescents.
• The affected individual could weigh 85% below ideal body weight (IBW).
• Highest mortality rates among mental disorders.
• One of the most common psychiatric disorders seen among women, though men too suffer from this disorder.

Symptoms of Anorexia Nervosa

A person with anorexia may exhibit these symptoms:

• Moody or sad behavior
• Inability to eat comfortably, constantly nagged by the fear of gaining weight
• Poor decision-making ability
• Memory lapses
• Thinning of hair or brittle hair that easily break
• Muscle weakness with a sense of lethargy that prevents the individual from being active
• Anemia
• Dull or flaky skin, with eruptions
• Increased risk of miscarriage or delivering a baby with low birth weight.

Therapeutic Alliance

Therapeutic alliance is the bond created between a clinician and the patient, as both of them work together to reach a common goal. This relationship is essential as it drives therapy and treatment of the client.

In a psychological counseling session, the bond that is forged between the patient and the doctor forms the crux of the healing process. Enthusiasm and active participation of the patient are seen as signs of acceptance by the doctor who in turn infuses self-confidence and helps the patient stay motivated.

The main aspects of this intricate relationship are:

• Emotional connect shared between the patient and the doctor
• A consensus on the final goal
• Patient history

Various researches into psychotherapy have shown that different methods of psychotherapy may yield the same result for a particular condition. This could be due to the therapeutic alliance being a non-specific variable. Bordin (1979) described how therapeutic alliance can be used to "fight against patient’s suffering and self- destructive behavior."

Advertisement

A new study by Colleen Shields and colleagues titled “Predictors of therapeutic alliance in two treatments for adults with severe and enduring anorexia nervosa” and published in the Journal of Eating Disorders, reveals the factors important in forging a therapeutic alliance.

Study Participants

Sixty three adult women with severe enduring Anorexia nervosa were included in the study and information regarding the expectations of the patient, the symptoms associated with the condition and the demographics of the patient were collected using a series of questionnaires and interviews.

Some of the parameters that were tested as probable predictors of therapeutic alliance included the duration of illness, severity of the disease condition and lowered motivation levels. The results of the study, however, showed that none of these factors affected therapeutic alliance except the patient expectation about the outcome of treatment.

Advertisement

A patient undergoing psychotherapeutic treatment undergoes two phases during the treatment period. In the first phase, the doctor is seen as being supportive while in the second phase, it is more of collaboration, where the doctor and the patient work together to reach common goals.

When the delicate balance of therapeutic alliance is disturbed, it leads to patients dropping out of treatment or loss of motivation. For a patient suffering from anorexia nervosa, therapeutic alliance aids in:

• Encouraging a healthy weight gain during the stay at the hospital.
• Undertaking a healthy lifestyle that promotes health and well-being.

Anorexia nervosa is a condition in which the patient believes that eating less and exercising more will provide a thinner body, which is the only perceived goal, regardless of the poor health associated with it.

The strong beliefs and the even stronger urge to impress peers can make it difficult for treatment and care at home, requiring professional help. Since the severity of the illness and the duration of the illness are not predictors of therapeutic alliance, a good understanding of the expectations of the patient will aid in forging better doctor-patient relationships.

References:

1. Anorexia Nervosa
2. https://www.nationaleatingdisorders.org/anorexia-nervosa
3. What is anorexia nervosa?
   http://www.helpguide.org/articles/eating-disorders/anorexia-nervosa.htm
4. Anorexia Nervosa - Overview
   http://www.mayoclinic.org/diseases-conditions/anorexia/home/ovc-20179508
5. Perceived coercion in inpatients with Anorexia nervosa: Associations with illness severity and hospital course
   https://www.ncbi.nlm.nih.gov/pubmed/26578421
6. The Therapeutic Alliance
   http://www.supportingsafetherapy.org/therapists/therapeutic-relationship/the-therapeutic-alliance
7. https://www.nlm.nih.gov/medlineplus/ency/article/000362.htm

Source-Medindia