It front of eating disorders, loved ones often feel helpless. However, they are taken care of better, with lesshospitalization. And many recover. It is most often between the ages of 14 and 17 that anorexia nervosa starts, but it can also occur from the age of 8, or later, in adults. In nine out of ten cases, it is young girls or women who suffer from anorexia. But of the 20% of young girls who go on a diet at some point in their lives, only 1% become anorexic.
Signs that should alert: restriction, avoidance of certain foods, weight loss greater than 15%, excessive increase in sports activities, cessation of menstruation, fear of gaining weight… Some personalities are more at risk: an anxious and perfectionist personality, low self-esteem, environmental stresses, genetic predisposition, and possibly biological abnormalities are possible.
Children can also suffer from anorexia. They complain of headaches, nausea, stomach pains, they eat and drink little, young girls are afraid of having breasts and growing… They are often rigid and perfectionist personalities. “For some, the relationship with food has always been complex. For others, the disorders start suddenly, these are the most serious cases. You have to take care of the body, prevent growth retardation and deficiencies, and take charge of their anxiety,” says Dr Catherine Doyen, child psychiatrist at St Anne Hospital in Paris.
Act as soon as possible
The French National Authority for Health (HAS) insists on the importance of early detection. We recommend follow-up by a general practitioner or a pediatrician to deal with physical problems and coordinate care, and by a psychiatrist, a child psychiatrist or a psychotherapist for the psychological side. If possible also by a nutritionist. Care should be continued for at least a year after significant improvement.
“The anorexic phase lasts on average a year and a half to three years, but it can last up to five years and more. At the end of an often difficult course, half of the adolescents treated for anorexia recover and a third is improved,” says Dr Nathalie Godart, psychiatrist in the adolescent and young adult psychiatry department at theInstitut Mutualiste Montsouris, in Paris (IMM).
Restore weight and treat psychological suffering
These care objectives are essential to regain a relational and social life that has often disappeared. It is only in the event of a vital emergency (extreme thinness, suicidal risk) or failure of treatment that hospitalization is considered. “Adolescents stay on average four months in the hospital. At the beginning, contact with the outside world and their parents is limited, which allows everyone to breathe,” explains Dr Nathalie Godart.
Apart from these serious cases, day hospitalization gives just as good results. The adolescent comes one or more times a week for an appointment with a psychiatrist, psychotherapy or other activities. It can also be followed by practitioners in private practice. Medication may be needed temporarily to relieve anxiety, depression, or sleep disturbances. And in some cases, to compensate for dietary deficiencies (vitamins, trace elements, phosphorus…).
“In my department, very severely malnourished adult patients are hospitalized. Most are between 20 and 30 years old, but we sometimes take care of women aged 40 and over who recover after twenty years of anorexia, explains Pr Jean-Claude Melchior, nutritionist and infectiologist at the Raymond Poincaré hospital, in Garches.We even had a 72-year-old patient who managed to climb the slope! It is often very useful to involve parents, siblings and relatives in the care. If we manage to make patients want to seek treatment, there is always a way for them to get out of it.”
Individual psychotherapy is needed
Cornerstone of treatment, psychotherapy can treat anxiety and depression that are often the cause of anorexia. These teenagers have low self-esteem, they may have experienced early stress (difficulties around birth, separations, physical or psychological “abuse”). Anorexia gives them the impression of regaining control over their environment, but they quickly find themselves trapped in it and need help to get out of it.
“Analytical, cognitive-behavioural (CBT) therapies, but also family therapy, psychodrama consisting of acting out what cannot be said… We use what works, treating the person as a whole and not just the symptom, and by calling on its internal resources”, explains Professor Maurice Corcos, head of the adolescent and young adult psychiatry department at IMM.
Family therapy is often a plus
Anorexia causes significant stress and family disruption. Recent studies have shown that family therapy brings a real benefit, which seems to be maintained at 5 years. “The teenager, her parents and the brothers and sisters living at home have one appointment a month for a year with a therapist. The interviews address the food and relational aspects, and aim to strengthen family ties”, explains the Dr Nathalie Godard.
The benefits of bodily and artistic approaches
Young anorexic women have a distorted view of their bodies: they still feel too fat even though they are extremely thin. They are taught to accept and love their bodies, through activities that bring feelings of well-being: dance, massage, relaxation, qi gong…
Creativity is also a good way to express what is difficult to say with words to let out your emotions and regain self-confidence. In day hospital or full-time hospitalization, adolescents practice various activities in small groups and in the presence of a therapist: visual arts, music, theater workshop…
As such, the experience of Camille, 33, is eloquent. “It all started when I had just obtained my literary baccalaureate with honors. The future worried me, I started to lose weight to attract attention and I got into the game, says the young woman. When I finished college, I had fallen from 47 kg to 31 kg. I remained locked in my bubble for several years, dropping to 27 kg, unable to work. I drew, I wrote, I had my little rituals… I never saw a general practitioner, only a psychiatrist for 3 years who prescribed me antidepressants to hold on.”
At 26, Camille met Didier Pleux, a psychotherapist in Caen. But she stops seeing him after three sessions. Four years later, she contacted Didier Pleux to write the preface to her comic strip on anorexia. “When Camille came to see me, I felt that I could use her book project as a “carrot” to motivate her to get out of the spiral of anorexia, explains the psychotherapist. With each blockage, for example to resume one breakfast, I asked her to analyze what she was telling herself in her head (I’m going to get fat, feel bad), to talk about it and write it down, and I confronted her thoughts with reality. sessions spaced 15 days apart, I offered him support by email.”
In this approach which makes the synthesis between classical analysis and CBTs, the therapist is fully committed and does not hesitate to shake up the patient, relying on the spring that will motivate everyone to regain weight: to be able to seduce, to practice the profession that fascinates… After a year and a half, Camille gained 20 kg and they published together. Today, she teaches, has found a social and love life. She is cured.
Positive remediation to learn to be less rigid
Anorexics often have perfectionist and obsessive personalities, which contributes to maintaining their disorders. A study is currently evaluating the contribution of cognitive remediation. “During individual interviews, based on concrete situations related to their studies, for example (we don’t talk about food), we help them to have an overview rather than focusing on the details”, explains Dr Nathalie Godard.
Where to find support?
www.anorexieboulimie-afdas.fr The site of the French Association for the Development of Specialized Approaches to Eating Disorders (AFDAS-TCA) is useful for obtaining the address of a healthcare centre, association or healthcare network. You can consult and download the recommendations of the Haute Autorité de santé and information documents. Anorexia bulimia listening info: 0810 037 037. Doctors and shrinks answer you.
www.fna-tca.com The website of the National Federation of Associations (TCA FNA-TCA). It brings together around twenty associations dealing with eating disorders.
www.reseautca-idf.org The site of the network of professionals in Ile-de-France.
www.imm.fr The website of the Institut Mutualiste Montsouris (IMM), adolescent and young adult psychiatry department.
www.maisondesolenn.fr The House of Solenn, in Paris.
