Eating Disorders Treatment in Turkey

What is an Eating Disorder?

Eating disorders are a serious illness that negatively affects your health and functioning in important areas of life. Symptoms can vary depending on the type of eating disorder. Anorexia Nervosa, bulimia Nervosa, and binge eating disorder are the most common eating disorders. Other eating disorders include rumination disorder and avoidant/restrictive eating disorder. Most eating disorders involve placing too much value on your weight, body shape, and food, leading to dangerous eating behaviours. These behaviours can significantly affect your body’s ability to receive the proper nutrition. Eating disorders can damage the heart, digestive system, bones, teeth and mouth and lead to other diseases. It usually develops during adolescence and young adulthood, although it can develop at other ages. With treatment, healthier eating habits can be gained and dermatological, cardiovascular and stomach-related problems caused by eating disorders can be prevented.

What Are the Types of Eating Disorders?

Anorexia Nervosa

Anorexia Nervosa is characterized by abnormally low body weight, intense fear of gaining weight, and a distorted perception of weight or shape. It is a potentially life-threatening eating disorder. Anorexia Nervosa sufferers make excessive efforts to control their weight and body appearance. This effort significantly affects their performance and health in other areas of their lives. Patients tend to limit calories excessively. They use methods such as excessive exercise, laxatives or dietary aids, or vomiting after eating to lose weight. Patients may also use drugs such as laxatives (diarrhea) and diuretics (water removers) in order to reduce the weight gaining effect of food.

Bulimia Nervosa

Bulimia Nervosa is a disease characterized by vomiting followed by binge eating attacks. Patients often eat large amounts of food in a short time and then unhealthy try to save themselves from the extra calories. They may force themselves to throw up because of guilt, embarrassment, and intense fear of gaining weight from overeating, or they may exercise too much or use other methods, such as laxatives, to get rid of calories.

Binge Eating Disorder

Eating more food than most people can eat in a short period of time, under similar conditions and for a similar period of time. The person may experience a feeling of loss of control, such as not being able to control the amount of food they eat and not be able to stop eating. The person has eating attacks, especially when he is in stressful, unhappy and anxious situations. Here, the person sees eating as a way out in order to cope with his stress, anxiety or unhappiness, and in the future this situation turns into a situation that he cannot get out of because it becomes a habit.

Mental problems that often accompany Eating Disorders can be listed as follows:

Depression
Anxiety Disorders
Personality Disorders
Alcohol Substance Use Disorders

What Are the Symptoms of Eating Disorders?

Eating disorder is one of the behavioural disorders that can be seen in men and women. Both the family and the social environment of the individuals who engage in this behaviour are negatively affected by this situation. The reason for this is that the individual’s excessive interest or obsession with food in order to lose weight or not gain weight also affects his social environment. It is the inability to stop the situation that usually starts with the desire to lose weight, despite being in the healthy weight range. Nowadays, it has started to be seen frequently in the society and most individuals tend to make a diagnosis by themselves or by their environment. So what are the signs and symptoms of eating disorders and when should individuals consult a specialist?

Symptoms of eating behaviour disorders;

Trying to diet to lose weight despite being under the limit,
Being overly concerned with the calorie and fat content of food,
Developing rituals related to eating, such as dividing food into small pieces, eating alone, and hiding one’s eating
Being overly interested in recipes, liking to cook, but serving them to others or making them to eat,
Depression and lethargy,
Avoidance of family and friends, social environment, isolation,
Sharp transitions between binge eating or fasting behaviours

Along with these symptoms, if the individual is under the limit (Body Mass Index <18) or above (Body Mass Index >26), he/she should definitely seek help from a specialist.

How Are Eating Disorders Treated in Turkey?

Moodist Hospital’s Eating Disorder Treatment Program uses current evidence-based treatment approaches. Eating disorders treatment is carried out under the leadership of a psychiatrist, together with a psychologist, dietician and an internist. In the treatment process, individual therapies, group therapies and the participation of families in treatment are very important.

After the psychiatric evaluation of each patient, a personalized treatment program is prepared. The treatment is a 4-stage treatment lasting approximately 20 weeks. However, this period may vary depending on the patient’s cooperation with the treatment and the severity of the symptoms.

First stage: The client is engaged in the treatment, and the treatment plan is prepared together with the patient. Psychoeducation, weekly weighing and regular eating are started (4 weeks, 2 sessions per week).

Second stage: Progress is evaluated. Factors preventing change are identified (2 weeks, 1 session per week).

Third stage: The factors perpetuating the eating disorder are addressed (8 weeks, 1 session per week).

Final stage: At this stage, it is aimed to maintain the acquired well-being and the risk of relapse is minimized (6 weeks, 1 session in 2 weeks).

Moodist Treatment Methods

Treatment of eating disorders is carried out under the leadership of a psychiatrist, together with a psychologist, dietitian and an internist. As well as treating the physical symptoms of your eating disorder, our experts help you understand the psychological and social effects that cause it. This approach not only reduces the risk of relapse, but also increases the success rate of treatment.

Our eating disorder treatment programs can be grouped under 3 headings:

Outpatient treatment programs: Outpatient programs include weekly scheduled doctor, psychologist and dietician appointments at our hospital. Each patient participating in this program can participate in group therapies specially made for eating disorder patients, conducted by Prof. Dr. Bedirhan Ustun, with the guidance of a doctor and psychiatrist. After the psychiatric evaluation of each patient, a personalized treatment program is prepared. The treatment is a 4-stage treatment lasting approximately 20 weeks. However, this period may vary depending on the patient’s cooperation with the treatment and the severity of the symptoms.

Day Hospital Program: Within the scope of this program, you can continue your eating habits in the hospital while you stay at home and you can participate at;

Art therapy
Group therapy
Mindfulness exercises
Sharing groups
Psychologist, psychiatrist and dietician interviews

Inpatient treatment programs: Hospitalization is mandatory, especially in severe cases. Conditions that require hospitalization include:

Extreme and rapid weight loss
unstoppable vomiting,
Presence of different medical problems,
Failure to recover from outpatient treatments,
Having different psychiatric diseases in addition to eating disorder

Inpatient treatment is only part of the treatment. It is aimed to maintain the well-being gained after the person leaves the hospital. With this program, it is aimed that patients diagnosed with eating disorders learn the right ways to eat, reach a healthy weight, treat accompanying medical problems, and prevent vomiting, if any.

Therapy and Treatment Approaches We Offer in the Eating Disorder Treatment Program:

Cognitive Behavioural Therapy (CBT): It is an evidence-based treatment approach with the strongest scientific support in the treatment of eating disorders. Body mass index (BMI) is taken into account when determining session intensities. BMI is a good method used to classify people’s weight according to their height. It is obtained by dividing the weight by the square of the height.

For patients with a BMI greater than 17.5: Treatment consists of 20 sessions and an evaluation session in 20 weeks, with the first 8 sessions being 2 times a week, the next 10 sessions being once a week, and the last 3 sessions being once every 2 weeks.

For patients with a BMI of 15.0-17.5: Treatment includes 40 sessions in 40 weeks, with the first 20 sessions being twice a week.

Dialectical Behavioural Therapy (DBT): Dialectical Behavioural Therapy is used in cases where eating disorders are caused by emotional disorders. DBT aims to stop binge eating and purging with the acquisition of skills (awareness skills, emotion regulation skills, distress tolerance skills) that teach ways to cope with negative emotions.

Group therapy: Group therapy sessions are used to complement individual sessions. This has the advantage of efficacy and supports self-disclosure, mutual support, and learning from improving patients while helping patients deal with privacy and shame. Group therapies are carried out once a week under the leadership of Prof. Dr. Bedirhan Ustun. Our patients, both inpatient and outpatient, can participate in group therapies under the guidance of physicians and psychologists.

Psychoeducations: Psychoeducation has an important place in treatment. It is used to recognize the symptoms of eating disorders, to identify the factors that cause and maintain the symptoms, and to enable the person to make sense of their experiences and draw a new framework.

Family Therapies: If the patient wants it and doing this will speed up the treatment, adult patients and their relatives are also interviewed. Relatives are people who have a significant influence on the patient’s eating. In the sessions, the parents are assisted to create a positive home environment that will support the patients’ efforts to change. They are also taught how families can use problem solving to address daily challenges and more serious family crises.

Medication: Medications can help control binge eating or purge urges and manage mental preoccupations with food and diet. Antidepressants and anti-anxiety medications are used to treat symptoms of depression or anxiety that accompany eating disorders.

Bibliotherapy: Bibliotherapy can be defined as bringing the right book with the right person at the right time. Myths about eating and weight control abound. We recommend that patients read one of the authoritative books on eating disorders written for the general public so that they have a reliable source of information. Bibliotherapy provides the therapist with additional information about the patient’s pathology, allowing the patient’s concerns to be addressed in the session. In this way, guided reading ensures that the patient is educated about the eating disorder in an efficient, complete and personal way.

Nutritional Therapy:

The patient’s nutritional history (evaluation of eating status, personal and family history, physical health, etc.) is recorded.
Anthropometric measurements (height, weight, fat, muscle, water ratio, BMI) are made.
Planning is made according to biochemical findings and nutritional needs.
The amounts of daily energy and macro-micro nutrients are calculated in accordance with the data in the evaluation of the patient.
The diet of the patient is decided by the internal medicine doctor. Meal planning is made after the appropriate choice is made for the patient from oral/enteral/parenteral nutrition. Creating a regular eating habit and preventing dieting without dietary restrictions are among the first goals.
Foods that should not be eaten are determined. Foods are grouped on a scale from hardest to medium. Starting with the easiest to eat, small amounts of food are gradually included in the person’s diet. He is asked not to vomit when he eats them.
Weekly body analysis is done. When necessary (life-threatening patients with very low BMI, less energy intake than basal metabolic rate, etc.), these frequencies are increased. Weighing in the session allows the wrong evaluations about the weight to be talked about immediately. Bringing order to weighing reduces body control behaviour. Body weight shows natural changes from day to day according to fluid balance, bowel movements, menstrual period, etc. Frequent weighing results in misinterpretation of these natural changes.
Daily eating follow-up is done with one-to-one observation (with the kitchen team and the body in the treatment team), nutrition diary or online communication in polyclinic patients. The problem is made controllable by raising awareness with the eating behaviour that was previously considered automatic and uncontrollable to the client.
A target of 0.5-1.4 kg/week is set for controlled weight gain at low BMI in anorexia nervosa patients. Almost every client is afraid of gaining weight. The aim of treatment is to develop control over the eating behaviour of the person. If there is no life-threatening risk regarding weight, muscle and fat percentage, it is necessary not to set a weight target until eating habits stabilize. In very low weight patients, the first target is weight gain.
Nutrition education (including ideal weight range, effects of food on physical and mental health, physical consequences of vomiting and laxative use behaviours, energy balance, and effects of hunger, adequate and balanced nutrition) is given with weekly plans.

Eating Disorders Treatment Centre