Psychodynamic theory asserts that symptoms do not occur by chance; symptoms are determined by contributing factors, including early childhood experiences are suppressed sex and aggressive stimuli, social, religious and cultural dictates, and biological factors. Determine the appropriate eating disorder Treatment requires careful assessment of each individual’s needs, history, and problems in order to select the most effective method.
Adapting to evolving research and expanding theoretical approaches does not obviate the need to recognize the underlying problem: there is no single cause or solution. As health care trends have changed over time, so have approaches to eating disorders, driven by evolving knowledge and persistent misconceptions. This emphasizes the need for treatment to embrace complexity rather than rely on a single theory.
To understand these trends, consider the history of eating disorders. In the 14th and 15th centuries, restriction of eating among young women in Catholic churches is a form spirituality loyalty and control. On the contrary, at the beginning of the 20th century, Freudian Theories view anorexia as an unresolved symptom sexual fantasies– relationship between food, sex and purity.
Despite Freud’s influence, his theories about anorexia received mixed reactions – they were vague to some and incomprehensible to others. For example, he called anorexia a fear from pregnancy through the mouth, it is explained that unresolved sexual conflicts and impulses are displaced from the oral pleasure of food. Freud argued that the fear of growing up keeps the realities of bodily change at bay by suppressing menstruation, sexual desire, and change. Freud paved the way for the idea that eating disorders partly involve a search for control when life feels unmanageable, but for Freud, this only applies to sex.
The reluctance of many who were knee-deep in treating patients to accept Freud’s concepts led to developments that led physicians to reexamine Freud’s conclusions. Freud’s essays on hysteria reflect fantasy desires about sex, not real events. He argued and sometimes denied that some patients were victims of abuse; their stories weren’t really fantasy. Salvatore Frenzchi, a contemporary who disagreed with Freud, wrote extensively about reality and fantasy related to sex. injury.
After Freud, theories of relational and family systems influenced the development of understanding. By the 1990s and 2000s, attention was focused on the experience of loss, psychological trauma, and adversity of the patient’s parents, such as narcissist injury and sympathy failures. During this period, quality treatment and research improved, and increasingly the field revealed that more than half of patients with eating disorders had experienced sexual or physical abuse prior to the onset. It is clear that new treatments can be adapted to it sexual violencetrauma and their impact on the development of eating disorders.
Treatments were improving, but doctors faced their own problems and biases.
Despite advances in treatment, layers of challenges remain among clinicians. Everyone has their own point of view and something useful to add. Comparing regions, the key difference between my 20 years in New York and my 10 years in North Carolina is the hierarchy of providers. I support a collaborative team approach decision making among providers, organized by the primary mental health provider who interacts with the patient and family. Where hierarchy exists, patient resistance increases because it reinforces the patient’s preconceived sense of control. Because eating disorders serve as both a coping and coping mechanism, adopting a dogmatic approach often leads to artificial adherence and, therefore, recidivism or evasion.
Treatment trends in the 1990s and 2000s included some of the “gen theory” for eating disorders, especially among major research hospitals that have received significant NIH and NIMH funding. To date, no specific gene has been found. A global genomic study of 17,000 anorexia nervosa patients has shown genetic factors such as metabolism, brain development and in utero.
Many candidate gene studies have been published, but none are conclusive (Gibson).
This uncertainty is reflected in real-life decisions around caregiving. For example, a family whose daughter had anorexia sent her to a large medical research rehabilitation center for treatment. The recommendation was for a more residential, psychodynamic, and communication program with intensive home health care. Despite any evidence, the family was convinced that their child’s anorexia was a genetically determined biological condition. The child returned to the same institution three times over the next two years.
Eating disorders are essential reading
This begs the question: Would she have had a better response in a differently oriented residential facility? There is no way to know for sure. But the family refused to consider any alternative facilities. The reason for this persistent preference remains unknown; however, the issue of the family’s resistance to looking beyond genetic explanations was raised. For many, the consideration of psychological understanding versus purely biological understanding is daunting; Self-assertion is complicated. Family systems relationships teach us that the person with an eating disorder in the family is “just” the spokesperson for the illness that affects the entire family system.
Clinicians have learned that simply replacing one theoretical approach with another does not guarantee better outcomes because eating disorders are a complex system, not a linear one. Although evidence-based protocols can help, they are usually effective for less than half of patients. Therefore, this highlights the need for an individualized and flexible approach that is open to the integration of different models (Scheel).
If Freud offers an enduring lesson, it is the value of multideterminism: Eating disorders, like most human struggles, have multiple causes and cannot be explained or resolved by a single theory or protocol. Therefore, an effective treatment approach recognizes this complexity and prioritizes integration and flexibility to meet the needs of each patient.
