| Exercise: Too much of a good thing |
| Over-activity is common in anorexia and bulimia, and often missed in individuals who binge eat and use excessive exercise as their sole compensatory behavior. The nature of this activity is expressed in both the elaboration of daily routines, like taking items up the stairs one by one when one trip could suffice for several items, and unreasonable amounts of structured exercise, usually solitary pursuits like running or cardiovascular machines. Attempting to control or restrict activity in your patient can result in a battle of wills and erode the relationship. In mild to moderate cases, a good beginning is requesting your patient implement one "exercise free day" each week, perhaps on a day she is scheduled with a medical or mental health provider in order to process feelings about |
| "abstaining". In more severe cases the health practitioner must make strict recommendations on curtailing activity. For anorexia patients, future access to physical activity can be a great reinforcer to weight gain. As your patient restores her weight, favorite activities may also be restored. This strategy can be particularly effective with adolescents. How do you assess if activity has crossed the line from healthful to harmful? When it interferes with interpersonal, social, educational and vocational activity. It can also be deemed excessive when the thought of not exercising induces extreme anxiety in your patient. |
| To keep or not keep a scale at home? |
| sometimes the best we can do is try to negotiate the use of the scale downward. Help patients understand how misleading the scale is by using the "Garden Hose Theory" from Carolyn Costin's book , Your Dieting Daughter. "If you take an empty garden hose and weigh it, it weighs a certain amount. If you fill that hose with water and then weigh it again, it will weigh more, yet the hose didn't get any bigger. When a person who has been starving or purging begins to eat again, she fills up her stomach and intestines with food and her body becomes more hydrated. Like the hose, she now has additional mass but hasn't gotten any bigger". The earlier you dialogue with your patient about their use of the scale, the better protected they will be from their own eating disorder thinking. |
| "The earlier you dialogue with your patient about their use of the scale, the better protected they will be from their own eating disorder thinking." |
| Support for families and friends |
| Have you ever noticed that parents and spouses of your ED patients have a lot to talk about, even after the medical appointment is over? It is helpful for them to have the support of a therapist or group, separate from the patient, where they can focus on life outside of the eating disorder. Also |
| consider Al-Anon, a 12-step group aimed at those in relationship with an alcoholic/addict. Messages found at meetings cover detached helping and tending to one's own self care. Until we have more groups like this in our community specifically geared towards ED's, utilize Al-Anon. |
