Understanding Eating Disorder And Ways To Treat It

Presenter: Katherine
Guest: Sue Paton
Guest Bio: Sue Paton is the Clinical Director of an intensive outpatient treatment centre, EATFED in Sydney.


Health Professional Radio

Katherine: Thanks for listening to Health Professional Radio. My name is Katherine, and today, I’m joined by Sue Paton, the Clinical Director of an intensive outpatient treatment centre, EATFED in Sydney. Welcome to our show, Sue.

Sue Paton:  Hi, Katherine.  Thanks for having me.

Katherine:  Now Sue, can you tell us what are some of the eating disorders that you help treat in your centre, EATFED?

Sue:  We mainly focus on anorexia and bulimia.  At the moment, in two weeks’ time, we’re just about to start another program for binge eating disorder because that’s been actually classified in the new DSM 5 as an eating disorder, and also for emotionalovereaters or what’s sometimes called ‘compulsive overeaters’.  So, we have those two programs running at the moment.

Katherine:  Right.  And as I understand it, you can have more than one, is that correct?  Like you can be a binge eater and a bulimic, is that correct?

Sue:  Yeah, it’s quite interesting how it shifts and changes.  You can have someone who starts off with the restriction of anorexia.  And then they will shift into the binge-purge cycle.  And sometimes, you have both.  So, what is often is seen that the person will restrict all through the day and then binge at night.  And then, sometimes there’s purging and sometimes not, and the purging can be anything through actual purging-vomiting or laxative abuse, or even over-exercising can be a way of purging as well.  So, yeah, they can be all mixed in.

Katherine:  Yeah.  Do you know when do the eating disorders present themselves, at what age?  I just ask because I’ve seen children as young as … they’re fourteen years old.

Sue:  Yeah.

Katherine:  They have a chronic … For example, I know a child who will only eat white food.  I know that sounds silly, but it actually has been going on for quite an extended period of time.  Or, I know other kids who won’t eat outside of the home and it’s become an issue.  Can you tell us a little bit about [inaudible 02:19]?

Sue:  Yeah.  So, typically, what we see is that the real signs of an eating disorder like anorexia or bulimia start at around thirteen or fourteen, and that’s a really important developmental time for a young girl, where she’s moving from being a child into an adolescent.  And there tends to be some issues around that time.  But as you say, that you can look back on a lot of the women that we see come through the program, and they’re saying things like, “I remember when I was six or seven or eight and feeling fat in a swimming costume,” or … you know.

Katherine:  Right.

Sue:  So, there was already the body issues manifesting.  But also, yeah, your example, I also know children who … they have their particular foods that they’ll eat, or they’ll have some sort of restriction around where they’ll eat, and they are definitely things that need to be addressed very early on …

Katherine:  Yeah.

Sue:  So as they don’t then manifest into a full-blown eating disorder.  Because the problem is that once that habit, if you want to call it that, begins, the neural pathways in the brain are laid down and it’s really difficult to change that when they get older.  And so, this is part of the problem with eating disorders, and we’ll probably talk about that a little bit more as we go through this.  But eating disorders can’t be treated quickly.  They’ve taken a long time to manifest, and they can often take some time to really make an impact on changing the behaviours.

Katherine:  Yeah.  What are some of the key issues around eating disorders that mental health professionals need to be aware of?

Sue:  I think one of the big things is – and this is something that Carolyn Costin, an eating disorder expert from America, says – is that, it is about the food and it isn’t about the food.  Often, treatment is focused on the food and trying to get the people to just change their behaviours around the food.  We actually need to look at what is the food trying to communicate to us, or what is the behaviouraround the food trying to communicate to us.

So, for example, one of the things that we do in our program is—and it’s really crucial to the treatment of the women in our program—is we get them to keep food journals.  So, they have to write down what they’re eating, how much they’re eating.  They put in a hunger scale, so whether they felt a little bit hungry, or a little bit … or full – whatever the hunger scale is.  Then, they also have to tell us what they’re doing, what they’re thinking and what they’re feeling.

Katherine:  Right.

Sue:  And so, we can actually look at these food journals, and sometimes we don’t even have to read them because how they lay them out can tell us a whole lot.  So, for example, someone who is typically … someone with bulimia will have quite … and if they’re binging quite a considerable amount and purging quite a considerable amount, will have food journals that are two or three pages long, and they will be full up with food.  And the entire food journal, the page would be filled up with information.

Now, to us, what that’s telling us is that when there’s a whole lot of food being eaten, then there’s very, very difficult feelings that aren’t being processed.  So, the bigger the binge, the bigger the feelings are that are difficult to progress.

Katherine:  Right.

Sue:  So, these are the connections that we make.  And similarly to someone with anorexia, their food journals will have very little information on them.  So, not only do they restrict food, they restrict in how they approach the food journal, how they approach relationships, how they approach therapy.  So, the restriction happens across the board, not just with food.  And I think this is the difference in how we look at eating disorders – is that it is about the food and it’s not about the food.


Katherine:  I think a lot of people, when they think about anorexia or bulimia, they do straightaway think about young, teenage girls.

Sue:  Yeah.

Katherine:  You know, those media clichés of girls wanting to look like fashion models and being thin, those are the clichés.  But it actually affects everyone, including, of course, men.

Sue:  Yeah, absolutely.

Katherine:  But I do think, especially … maybe more with men – this is my opinion, but – people who have bulimia or anorexia or any eating disorder, they are very, very good at hiding it.

Sue:  Oh yes, yes.  This is right, and this is why a lot of the women that come through our program, they come through either through looking at Google or Facebook, because they don’t want people to know that is the problem that they have.  So, it’s very, very secret.  And often, people will look … particularly at women who have bulimia, because often, they’re of normal weight.  They don’t look like they have an eating disorder.  And so, when they tell someone, they usually get quite a negative response, and it’s like, “What – you?  No, you don’t have an eating disorder.  Look at you!  You look fine.”

Katherine:  Yeah. 

Sue:  And that can really have an impact on them because they know there’s something wrong but people are telling them, “No, you look fine.”  So, that can sort of mess with their heads a little bit.

Katherine:  Exactly.

Sue:  And I think for men – men often will have the experience of not being believed because it is that cliché: young girl, wanting to look like the fashion models.  And men seem to be looked at as …

Katherine:  Yeah.

Sue:  And sometimes it’s also about … it’s gay men who only get eating disorders because they’re more focused on how they look – which is also not true. [laughs]

Katherine:  Yes, a lot of myths.  Yeah, that’s [indecipherable 08:48].  And, like you said, a lot of women that come to your clinic, they have found you through different methods?

Sue:  Yes.

Katherine:  … but mainly on the internet?

Sue:  Yeah.

Katherine:  But they’re actually the ones that know that they have a eating disorder and know that they need help, which is great.

Sue:  That’s right.

Katherine:  There are a lot of people out there that are … they don’t know … and they don’t …. If you have a loved one that you suspect that might have an eating disorder, what are some of the tell-tale signs? 

Sue:  I think whenever there is too much focus on food, that can be … because what happens is that they’re obsessed about thinking about food, what they’re going to eat, where are they going to eat, how are they going to eat.  And so, I think, if you can see that their focus on food is becoming obsessional, then something needs to be said.  And usually, in a way that is … sort of in a caring way, so try and say, “Look, I’m a bit concerned about how you’re thinking about food.  And I’m wondering what’s going on,” rather than … often people get told to, “Stop doing that.” [laughs]

Katherine:  Yeah.

Sue:  It’s like someone who has anorexia just gets told, “Why don’t you just eat?”  If it was that simple, they would be doing it.  It’s not happening for no reason.

Katherine:  Is having an eating disorder a life sentence, or can people recover?

Sue:  This is the big thing for us, in what we … try and instill hope in these young women that are coming into our program, because often, they feel like that, “This is going to be my life.”  And because they’ve suffered, sometimes for ten or more years, before they actually come into our program, or they’ve been suffering and they’ve been doing the revolving door thing – it’s going in and out of hospitals.

Katherine:  Yeah.

Sue:  So sometimes ten, twelve admissions – that they actually can’t think about what their life might be without an eating disorder.  And in some cases, that can feel really scary.  So, what we try and instil is hope.  And I think one of the great things about our program is, too, that we have Evonne, our program Director, who has recovered from bulimia.  And we also have another one of our therapists who has recovered from anorexia.  So, they’re in there working with people who are … modelling to them that, “You can recover from this.  This is not something you have to live with for the rest of your life.”

And I think, if you get the right treatment … I think this is the big problem in Australia at the moment.  I’m not saying our treatment is the right treatment for everybody – because it’s not.  But if you can get the right treatment and get to see someone who actually understands eating disorders, then you have every chance of recovery.  And it definitely doesn’t have to be a life sentence.

Katherine:  Yeah.  And you’ve been opened for over a year now, and already some very heart-warming and wonderful testimonials are coming through, about how much you’ve helped some of these young women.  It must be amazing for you to see the results.

Sue:  Look, whenever we have a graduation of one of the girls moving out of the program into our maintenance program, there’s always lots of tears, because it’s just so heart-warming to see them – where they were when they first come in, and then, eighteen weeks or so later, that they’re actually starting to feel like they’re getting their life back, that the young ones with anorexia are putting on weight and they’re eating and they’re actually changing the way they are being in the world, and to see the ones with bulimia to be actually purge-free, binge-free.

Katherine:  Yep.

Sue:  And really keeping their eye on their future and where they’re heading.  It’s one of those jobs you’d do for free. [laughs]  It may not pay you [indecipherable 13:16].


Katherine:  Yeah.

Sue:  And so, that’s the thing.  It just really is … we tell them it’s an absolute privilege to work with them and to watch them see how hard they work themselves to get themselves out of the eating disorder.

Katherine:  Yeah.  And you’re based in Sydney …

Sue:  Yeah.

Katherine:  However, you do do training for mental health practitioners.  Can you tell us a bit about that?

Sue:  Yes.  So, one of the things that we saw was going to be a problem in the future, as we’ve been growing over the last twelve months or so, is that we only have five of us on our team, and we saw that we were going to get to a point where we couldn’t see all the clients that were coming through the program.  Because when you’re in the program, you have to have individual therapy as well.  And that individual therapy goes on beyond the program.  And so – I’m an educator, I’ve taught for the last six years at theAustralia College of Applied Psychology in Sydney.

And I thought, “We actually really need to train some other people in what we’re doing.”  And so, we held our first one back in May, and we had sixteen practitioners made up psychiatrists, psychologists, social workers, counsellors, psychotherapists, who came in, and we did a two-day training and they just thought it was brilliant, and really got a whole different way of thinking about eating disorders.  So, what we’re going to do is go and hopefully, around Australia, and start to train practitioners up, because one of the things that came out of … the Butterfly Foundation did a report last year on eating disorders and the costs to Australia.

And one of the things that came out of that from people that they spoke to who had eating disorders was the difficulty in finding practitioners who actually understood what the eating disorder was about.

Katherine:  Yeah.

Sue:  And so, the other part of our philosophy is, in the long run, we want to change the way eating disorders are treated in Australia.  And, if that’s by just training practitioners up to understand better, then that’s the way we do it.  So, it’s, again, another really heart-warming experience of having these practitioners saying, “Wow!  This really makes sense.  Now, I understand it.”

Katherine:  Yeah.

Sue:  And if that can be passed on to the clients, then great!

Katherine:  Yeah.  Well, thank you so much for your time today.  For anyone that would like to know more, you can go to eatfed.com.au.  Thanks again for your time, Sue.

Sue:  Thanks, Katherine.  It’s been lovely talking to you.

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