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+++++++++++++++++++++++++++++++++++++++++ + + +++++++++++++++++++++++++++++++++++++++++ SPECIAL SECTION: WOMEN'S HEALTH +++ +++ Eating Disorders T Early Recognition Is Key for Treatment of By Kelly Bhatnagar, PhD ODAY, BODY IMAGE issues seem synonymous with children and adolescents due, in part, to ideal- ized images of celebrity bodies and media messages promoting the belief that being thin leads to happiness and success. As the severity of these body image issues increases, so does the prevalence of life-threatening eating disorders such as anorexia nervosa, bulimia nervosa, binge-eating disorder and a grouping of other unspecified eating disorders. The good news is that the medical com- munity is making significant progress to identify presenting symptoms of these illnesses and is conducting research to find efficacious treatments. Currently, research-supported treat- ments are available for patients diagnosed with bulimia nervosa and binge-eating disorder. Anorexia nervosa, however, continues to demonstrate a number of unknowns, making treatment more chal- lenging. Neuroimaging studies are being conducted to obtain a better understanding of brain functioning in relation to eating disorders, such as anorexia nervosa. Because eating disorders can lead to mortality and cause significant damage and complications, early detection and referral to a specialist are key. The window of opportunity to help is often short, and results are most promising when the problem is diagnosed and addressed early, so treatment is advised at the first detection of a possible issue. Early symptoms include significant weight loss or gain, failure to make expected weight gains or substantial weight fluctuations. The patient may also exhibit other underlying symptoms that signal a problem including electrolyte imbalances, cold intolerance, amenorrhea, constipation or abdominal pains, low blood pressure and fainting, a history of compensatory behav- iors (e.g., fasting, use of laxatives/diuretics), etc. All possible warning signs should be taken seriously, even if minimized or rationalized by the patient who may not recognize they have an illness. Because treatment goes beyond encour- aging patients to eat, specialists often employ a multidisciplinary, evidence-based approach to assess the problem. This includes a psychological, nutritional and medical evaluation, in addition to a family- centric session for discussing diagnosis and treatment recommendations. For children and adolescents, family- based treatment (FBT) of anorexia nervosa, bulimia nervosa and unspecified eating disorders has the most empirical support. Historically, young patients with eating disorders were treated with little family involvement or support. They often relapsed on reentry in their daily lives, leaving family members feeling disempowered. FBT encourages parents and family members 20 | Cleveland-Akron-Canton MD NEWS ■ MDNEWS.COM ■ JULY-AUGUST 2012 to play an active role in the rehabilitation and management of the patient's illness, just as they would for chronic diseases such as diabetes, cancer, etc. This method empow- ers parents to be a valuable and responsible resource for their child as they monitor and help give their child the skills and control needed to function independently and avoid relapses, while acknowledging that the eating disorder was not caused by something they did. Other therapies like cognitive-behavioral therapy (CBT) and dialectical behavioral therapy (DBT) are therapeutic approaches that have historically been used to treat depression, anxiety and personality dis- orders. Now, these methods are being applied to patients experiencing body image disturbances, with CBT targeting maladaptive thinking patterns in relation to life-threatening behaviors, and DBT stress- ing the importance of balance between change and acceptance, while providing skills to help manage life's difficulties. Regardless of which therapy is deemed best for individual patients, once detected, all eating disorders should be treated by a team of qualified specialists to help restore the patient's physical and emotional health through balanced nutrition, medical monitoring, counseling and support. Kelly Bhatnagar, PhD, is the clinical director of the Eating Disorders Program at Akron Children's Hospital. ■