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An eating disorder is a psychobiological condition that affects and kills young people more than ever before. We cannot properly treat this condition without accurately assessing all the areas of the individual's life that are being affected by it.

An eating disorder is a psychological condition because it affects the way the person feels about herself, how she sees her body, how she perceives her being, and the self-worth attached to this perception. Most eating disorder patients have a wrong perception about their bodies. Often times they perceive themselves as being overweight, when in reality they are underweight. They also define who they are according to how they perceive their bodies.

An eating disorder is also a biological condition, because it affects the body functions. In anorexic patients it is easy to observe the gray color of their skin, dehydration, falling of the hair, interruption of the menstrual cycle, differences in body temperature, inconsistent heart rate, changes in blood pressure, fainting spells, and lack of energy and motivation. In bulimic patients the heart functions become irregular, the blood pressure, cholesterol levels, and other vital signs suffer major changes. In patients who overeat, some of the same changes take place in addition to all the risks of being overweight.

Treating one condition without treating the other (psychological versus biological, or biological versus psychological), will not help the patient. Only a multidisciplinary approach can help her. The multidisciplinary team should ideally be composed of a general physician, who will monitor the general health of the patient through blood tests and other procedures as required; a nutritionist, who will guide and teach the patient about her nutritional needs and how not to neglect or abuse her body; a psychologist or mental health counselor, to work on issues of self-esteem, past history of physical, sexual or emotional abuse, or any kind of trauma; and a psychiatrist to work with a possible chemical imbalance and evaluate for need of medication.

A person who suffers from an eating disorder has many irrational thoughts or ideas. Through the years, the person has developed an internal self-talk that is pessimistic and negative. Some examples:

• I am fat, therefore I am ugly
• I am not allowed to eat, because if I do, I feel guilty
• I cannot eat in front of others
• My eating disorder is all I have. I am not willing to give it up
• My anorexia/bulimia is the only thing in my life that I can control
• I don't deserve to be happy
• If I eat, I need to punish myself

When statements like these are repeated again and again, they become the rules by which the patient abides.

Eating disordered patients don't rely on their body signals, and they don't trust their intuition either. When their bodies tell them, "I am hungry," they cognitively respond, "no, you are not," and when the body gives signals of being full, the person ignores the messages, until all the available food is consumed in a binge. Therefore, because these patients don't listen to their body commands, the body ends up being confused. The confused body stops giving signals to the person's mind, and the person "dissociates" the mind from the body, the connection of which is the very essence of the human being. Accordingly, the periods of intuition become more and more rare, and the mind/body disconnection becomes more intense; to the point that the person might not be able to reconnect them without professional help. It is usually during this period that family members and friends encourage the person to seek help.

The person with an eating disorder might be brought to the emergency room because of dehydration, because she fainted or because of abnormalities in her heart rate. It is very important that the physician that comes in contact first with this patient makes all the appropriate referrals and contacts so the patient will benefit from the best treatment approach. If this condition is only treated as biological or only as physiological, the outcome will not be successful.

Another possibility is that the person with an eating disorder be brought to a counselor, psychologist or psychiatrist at the request of a parent who has observed some "secretive behaviors" such as throwing up, going to the bathroom after every single meal, being depressed or unmotivated, or at the request of a teacher who has observed that the adolescent is constantly putting herself down, doesn't have friends, does not eat at lunchtime, and has lost a lot of weight. In any event, providing psychotherapy to the person, without the medical and nutritional aspect being taken care of, is insufficient.

The person with an eating disorder needs help. If there is a history of emotional, sexual and/or physical abuse, the person needs to process her feelings regarding this past history and, hopefully, come to some kind of resolution. Usually this patient is not in touch with her feelings, much less with those feelings that contributed to her developing the eating disorder.

As the general physician, psychiatrist, nutritionist and mental health professionals work together in these cases, some of the goals of the multidisciplinary treatment team should include:

• Reduce/eliminate irrational thinking
• Improve self-esteem, body image and reduce/eliminate body distortions
• Develop self-confidence
• Develop assertiveness skills and feel comfortable with the idea of saying "no"
• Reconnect mind and body
• Exercise in moderation
• Develop the ability to eat in front of others, without feeling guilty
• Develop and maintain a healthy body weight
• Reduce symptoms of anxiety and symptoms of depression
• Learn new, appropriate ways to express feelings
• Develop a more positive, more optimistic internal self-talk

Although eating disorders are extremely difficult to treat because the patient does not want to get rid of them, progress is possible, and with the appropriate multidisciplinary treatment approach, the prognosis improves.

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