Psychiatrists: How to Approach a Client with a Suspected Eating Disorder

Contributor: Courtney Howard, BA, writer for Eating Disorder Hope

Once an individual’s medication plan has been established, he or she likely only sees a psychiatrist for monthly check-ins to assess how the prescriptions are working and to address any concerns. This can make it difficult for psychiatrists to know what is truly going on in an individual’s recovery, particularly if the client is trying to hide disordered food behaviors.

If a psychiatrist believes his or her client is struggling with an eating disorder, it is important to address it immediately. While therapists might be better off waiting until rapport is established, psychiatrists prescribing drugs to an individual who might be actively bingeing and purging do not have that luxury.

Common Co-occurring Conditions

Certain mental health conditions more commonly co-occur with eating disorders than others. Psychiatrists should be aware of these comorbidities and be able to identify individuals who are at high risk for the development of an eating disorder.

The Anxiety and Depression Association of America (ADAA) reports that as many as two-thirds of individuals with eating disorders have had anxiety at some point in their lives, most commonly beginning in childhood before the development of disordered food behaviors. Obsessive-compulsive disorder (OCD) is an anxiety disorder that commonly co-occurs with eating disorders.

In these cases, an individual’s obsessive thoughts and compulsive behaviors typically center around food and eating. Counting calories obsessively, body checking, and engaging in food rituals are common examples.

Trauma can be a common trigger for eating disorders, so it follows that eating disorders have a high comorbidity with post-traumatic stress disorder (PTSD). In fact, the National Eating Disorders Association (NEDA) reports that as many as 30 percent of individuals with eating disorders have survived sexual abuse.

If an individual is being treated for any of these disorders, his or her psychiatrist would be encouraged to screen for disordered thoughts and behaviors surrounding food, body image, and self-harm.

Medications to Avoid

Certain prescription drugs are particularly harmful for individuals struggling with disordered food behaviors.

Any prescribing psychiatrists should be aware of medications that can have serious physical complications for those who are actively purging. In these cases, tricyclic antidepressants have been known to cause arrhythmias and other cardiac problems that can result in death. Bupropion, also an atypical antidepressant, can cause seizures in those engaging in self-induced vomiting or abusing laxatives.

For any eating disorder, prescription drugs with weight gain as a possible side effect are to be avoided, if possible. Weight gain or changes in appetite can be extremely triggering to those with eating disorders, resulting in an increase in disordered behaviors.

However, if an individual is best suited for a particular medication with weight gain as a potential side effect, the ultimate decision of whether the benefits outweigh the harm lies in the hands of the psychiatrist.

Coordinating With the Treatment Team

Since a psychiatrist might only see a client once per month, sometimes less, it can be beneficial to communicate openly with each client’s therapist and/or other mental health professionals. Of course, this is dependent on the individual and whether he or she has given authorization for this communication.

Touching base with the rest of the individual’s treatment team prior to each meeting can make the difference between a simple check-in and a breakthrough session.

Anyone, but particularly those trying to hide certain thoughts or behaviors, can be selective about what they tell a mental health professional. Depending on where they are in their journey, they might feel scared to come forward and admit they have an eating disorder for the first time or be ashamed if they have relapsed after a long period of recovery.

If an individual is still receiving treatment for a past eating disorder, he or she is likely seeing a registered dietician (R.D.) who can provide further insight into current behaviors. Regardless of the circumstances, gaining insight from the rest of the client’s treatment team prior to a session can help you understand what is truly going on, at least to the extent the rest of the team is aware.

While it is important to address eating disorder suspicions when they first arise since a related diagnosis might impact an individual’s medication regimen, it is always important to approach clients with sensitivity and empathy while guiding them toward recovery and mental health.

Community Discussion – Share your thoughts here!

Who has been a part of your treatment team in your journey to eating disorder recovery?

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About the Author: Courtney Howard is the Executive Assistant for Eating Disorder Hope and Addiction Hope. She graduated summa cum laude with a B.A. from San Diego State University, holds a paralegal certificate in Family Law, and is a Certified Domestic Violence Advocate. After obtaining her certification as a life coach, Courtney launched Lionheart Eating Disorder Recovery Coaching in 2015 and continues to be a passionate advocate for awareness and recovery.

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The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer discussion of various issues by different concerned individuals.

We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.

Last Updated & Reviewed By: Jacquelyn Ekern, MS, LPC on March 27, 2016
Published on EatingDisorderHope.com