Acasa > Reviste de specialitate > Dietetician.ro > Instabilitatea emoţională şi anorexia nervoasă – o abordare dietetică
CASE REPORT

Instabilitatea emoţională şi anorexia nervoasă – o abordare dietetică

 Emotionally unstable personality disorder and anorexia nervosa – a dietetic approach and therapeutic progress

Iustin-Nicolae Bilibou

First published: 20 decembrie 2023

Editorial Group: MEDICHUB MEDIA

DOI: 10.26416/Diet.4.4.2023.9093

Abstract

Objectives. This study aimed to comprehensively evaluate the impact of a multifaceted treatment approach, combining nutritional intervention, antipsychotic medication and psychotherapy, to the recovery of a female patient diagnosed with an eating disorder. The objective was to delineate how these integrated modalities contribute to improvements in both physical health and psychological well-being. Materials and method. A mixed-methods research design was employed. Quantitative data were gathered through weekly monitoring the patient’s body weight and weekly assessments of vital blood parameters, to objectively measure physical health progress. Qualitative data were collected using semi-structured interviews with the patient and her multidisciplinary healthcare team, including dietitians, psychologists and medical staff, providing insights into the psychological impact and patient’s experience of the treatment. Advanced data processing and visualization techniques were used, employing Microsoft Excel for the creation of comprehensive charts and graphs to analyze and present the data. Results. The results indicated a notable improvement in the patient’s overall health status, with significant gains in body weight and the stabilization of blood parameters. Psychologically, the patient demonstrated enhanced coping mechanisms and emotional well-being, as evidenced by her responses to RO-DBT and EMDR therapies. The nutritional intervention, tailored to her specific needs, along with the judicious use of antipsychotic medication played a key role in supporting her recovery. Conclusions. The study underscores the efficacy of an integrated treatment approach in managing eating disorders. The synergy between nutritional intervention, antipsychotic treatment and psychotherapy emerged as a crucial factor in addressing the complex interplay of physical and psychological aspects of the disorder. These findings contribute with valuable insights into the holistic management of eating disorders, highlighting the importance of personalized and comprehensive treatment strategies. This research adds to the existing body of knowledge, suggesting directions for future studies and clinical practices in the field of eating disorder treatment.
 

Keywords
eating disorders, nutritional plan care, psychotherapy

Rezumat

Obiective. Acest articol prezintă un studiu de caz detaliat al unei paciente care a fost în tratament pentru o tulburare de alimentaţie începând cu octombrie 2020. Studiul se concentrează pe abordarea multidisciplinară a tratamentului şi pe eficacitatea acestuia, observată până în iulie 2021, când a fost scris acest articol. Tratamentul pacientei a inclus o combinaţie de intervenţie nutriţională, medicaţie antipsihotică şi psihoterapie, incluzând modalităţi specifice, precum Radically Open – Dialectical Behavioural Therapy (RO-DBT) şi Reprocesarea şi Desensibilizarea prin Mişcare Oculară (EMDR). Materiale şi metodă. Am folosit o abordare cu metode mixte pentru o imagine completă a evoluţiei tratamentului. Datele cantitative au fost colectate prin urmărirea săptămânală a greutăţii corporale a pacientei şi prin evaluări săptămânale ale anumitor parametri sanguini, oferind o imagine clară privind progresul sănătăţii fizice. De asemenea, au fost obţinute informaţii calitative prin interviuri aprofundate cu pacienta şi echipa multidisciplinară, oferind perspective asupra stării ei psihologice şi a răspunsului la diversele strategii de tratament. Rezultate. Printre constatările semnificative ale acestui studiu de caz, se numără îmbunătăţirile marcante atât privind sănătatea fizică a pacientei, evidenţiate prin creşterea în greutate şi stabilizarea parametrilor biochimici, cât şi privind starea ei psihologică, evaluată prin angajamentul şi răspunsurile ei la tratament, ca urmare a abordării psihoterapeutice. Concluzii. Aceste îmbunătăţiri subliniază eficacitatea abordării integrate a tratamentului. În iulie 2021, deşi era încă în îngrijirea noastră, pacienta a progresat până la un punct în care a fost implementată o cale structurată de externare, reflectând recuperarea ei substanţială. Acest articol nu numai că documentează evoluţia pacientei, dar serveşte şi ca o referinţă importantă privind complexitatea tratării tulburărilor de alimentaţie. Lucrarea evidenţiază nevoia unei abordări personalizate, holistice, a tratamentului, care să ţină cont atât de aspectele fizice, cât şi psihologice ale acestor tulburări.
 

Cuvinte cheie
tulburări de alimentaţie plan alimentar psihoterapie

Bibliografie

  1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders (5th Ed.). Arlington, VA: American Psychiatric Publishing, 2013.
  2. Livesley WJ. Practical management of personality disorder. New York: Guilford Press, 2007.
  3. Treasure J, Claudino AM, Zucker N. Eating disorders. The Lancet. 2010;375(9714):583-593.
  4. Gunderson JG, Links PS. Handbook of good psychiatric management for borderline personality disorder. Arlington, VA: American Psychiatric Publishing, 2014.
  5. Frank GK, Kaye WH. Current status of functional imaging in eating disorders. International Journal of Eating Disorders. 2012;45(6):723-736.
  6. Lis S, Bohus M. Social interaction in borderline personality disorder. Curr Psychiatry Rep. 2013;15(2):338.
  7. Sansone RA, Sansone LA. Eating disorders and borderline personality: Common bedfellows. Innovations in Clinical Neuroscience. 2011;8(9):10-13.
  8. Oldershaw A, Lavender T, Sallis H, Stahl D, Schmidt U. Emotion generation and regulation in anorexia nervosa: a systematic review and meta-analysis of self-report data. Clin Psychol Rev. 2015;39:83-95.
  9. Fortisip Compact Nutritional Fact Sheet. https://www.nutricia.co.uk/hcp/pim-products/fortisip-compact.html 
  10. Musolino C, Warin M, Wade TD, Gilchrist P. Integrating dietetic therapy for patients with eating disorders and borderline personality disorder: A qualitative study. Clin Psychol Psychother. 2021;28(2):310-323.
  11. Musolino C, Warin M, Wade TD. Integrating dietetic therapy for patients with eating disorders and Emotional instability: A scoping review. Clin Psychol Rev. 2020;82:101904.
  12. Walsh BT, Kaplan AS, Attia E, et al. Fluoxetine after weight restoration in anorexia nervosa: a randomized controlled trial. JAMA. 2006;296(7):694-701.
  13. Attia E, Walsh BT. Behavioral management for anorexia nervosa. N Engl J Med. 2009;361(1):74-81.
  14. National Institute for Health and Care Excellence (NICE). Eating disorders: recognition and treatment. 2017 [cited 2023 Mar 28]. https://www.nice.org.uk/guidance/ng69 
  15. Couturier J, Isserlin L, Norris M, et al. Canadian practice guidelines for the treatment of children and adolescents with eating disorders. J Eat Disord. 2021;9(1):7.
Citeşte mai mult