If more than 2% of adolescent girls suffer from anorexia, almost as many would have bulimic behaviors. How can we help them fight these eating disorders? Which treatment is most suitable?
Thursday, January 25, 2018, the house of Solenn (AP-HP) devoted a round table to eating behavior disorders (ATD) in adolescents. Disorders often associated with psychological problems impacting somatic, mental health and social integration. Among these eating disorders, theanorexia remains the best known. But the bulimia and thebinge eating – which is characterized by the absorption of a very large quantity of food over a short period, but without eliminating it by vomiting, and which affects both men and women – are more widespread disorders, but much less publicized and therefore more difficult to grasp. Especially since the young people affected by these disorders can “know both phases ofanorexia, bulimia or overeating“, explains Pr. Nathalie Godart, child psychiatrist specialized in the field of adolescents and young adults. And this at any age, even if”anorexia experiences a peak between 14 and 18 years, bulimia for its part appears a little later, around 16-20 years and overeating binge, around 21 years“Because they are more or less transient and more or less severe, “these TCA require early diagnosis and appropriate support”, adds Dr. Corinne Blanchet-Collet, endocrinologist-nutritionist, “all the more so since these disorders can heal in more than 80% of cases“. So, what are the keys to successful care? Which specialist (s) should you go to?
When should the child or adolescent be referred to a specialist?
Obviously, weight loss or gain can alert. But it is above all changes in behavior – brutal or gradual – academic difficulties, the propensity for isolation, disturbed sleep, irritability at the table or even over-investment in school which will reveal a problem. to be and which must arouse the vigilance of parents. Stomach aches or migraines are sometimes signals to watch for. “Faced with a suspicious attitude, parents must act and accompany the child to a doctor, as they would for a gastrointestinal illness or any other pathology“, immediately asks Pr. Marie-Rose Moro, psychoanalyst and head of service at the Maison de Solenn. To understand where this suffering comes from, parents can first discuss with the teenager and ask him what who is wrong, the possible problems he meets at school, the image he has of him … Of course, not all teens will be inclined to talk about their suffering and talk about it with their parents In this case, do not hesitate to consult a doctor and start a care process. Be sure to approach the subject gently, by expressing your concern clearly: “we are worried about you and we need help“. Think that very few young people refuse to seek treatment. And indeed,”the greatest reluctance does not come from adolescents“, certifies the director of the house of Solenn,”it is rather the parents who find it difficult to accept the idea that their child is suffering“.
Which address ?
“Eating disorders require real coordination of care, over the long term”
In France, each department has a home for adolescents: a place of welcome and advice for young people aged 11 to 25 (age may vary depending on the structure) and their families. The reception in these houses is completely free and anonymous if the teenager wishes it (no parental authorization is requested) and will allow him to meet different professionals (psychologists, doctors, nurses, nutritionists, social worker…) according to his needs. And since “TCA are complex pathologies which mix nutritional, somatic or psychiatric problems and which evolve in a sometimes difficult family context, they require a comprehensive and multidisciplinary care over the long term, which is offered in all adolescents’ homes. Because no, a single practitioner is not able to solve everything!“, summarizes Corinne Blanchet-Collet. This management is generally done in three stages:
- Teen is received in consultation by a doctor who will assess – “without judgement“wishes to clarify Dr. Blanchet-Collet – the” impact “of his eating disorder on his overall health (height, weight, BMI, attitudes towards food, body experience, body image, self-esteem…)
- In order to offer him an adapted outpatient follow-up, psychological or psychiatric assessment is carried out according to his needs.
- The coordinating doctor (the person who ensures communication between all the practitioners, but also with the school or the university) proposes to the teenager and his parents a global project (medical, psychological, psychiatric, educational and dietetic): this care project is individualized, scalable and negotiated with the youngster and his family.
If ambulatory care does not work, there is a vital risk for the teenager, but also in the event of family exhaustion, a day, full-time or sequential hospitalization (a few days a week or a month ) can be offered to the family, but “this one is programmed and prepared with the teenager and his parents“reassures Rose-Marie Moro.”We are always trying to get everyone’s agreement so that this hospitalization is as beneficial as possible. Compulsory hospitalizations remain very exceptional “. During a hospitalization, therapeutic and sports cultural workshops allow the teenager to rebuild himself through art therapy, play, exercise and creation. But, whatever the project defined, we want above all “include families and friends as much as possible during the care phase“,”keep the teenager as much as possible in his school environment“and offer him in parallel”somatic, psychiatric and psychological follow-up, academic evaluation and adjustment of schooling if necessary, and social and educational support if necessary“, specifies the endocrinologist. The goals of care? “Restore and maintain the weight, treat psychological suffering and minimize social and relational consequences“she specifies. The time for follow-up will depend on the somatic, psychological and social after-effects, but”long-term care, over several months or even years, is often considered“, in order to”minimize the risks of chronic TCA and promote long-term healing, ideally for life“, insists the director of the house of Solenn.
If the teenager lives far from the network of teenagers’ homes, the best thing is to consult his doctor. He will direct him to specialists adapted to his needs (psychiatrist, nutritionist, etc.). Nevertheless, “we are always there to give them a second opinion if necessary“, she concludes.
|How to inquire? For advice, families can contact “anorexia, bulimia info listening” at 08 10 03 037 (free number). To find the nearest adolescent home, go to National Association of Adolescents.|