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Weight problems: a word about biopsychiatry. treatment of eating disorders WEIGHT PROBLEMS: A WORD ABOUT BIOPSYCHIATRY. TREATMENT OF EATING DISORDERS
A word about biopsychiatry
In the past thirty or so years, there's been a revolution in the way psychiatrists look at mental disorders and their treatment. The discovery of important new medicines of the mind, including antipsychotics and antidepressants, helped fuel this revolution. The study of neurochemistry reveals how tiny molecules interact with brain cells and trigger not just physical activity, but thoughts, moods, and feelings as well. Through these and other discoveries, we have become more aware of how the body's biological malfunctions can lead to emotional disturbances-thus the term biopsychiatry.
As a biopsychiatrist, I'm aware of the interlocking relationship between the healthy body and the healthy mind. I see people as biological organisms operating under certain physical rules that in turn affect mental function. Actually, all psychiatry is-or should be-"biopsychiatry." Psychiatrists can't afford to overlook the biological causes and effects of mental disturbance. If they do, they will inevitably misunderstand the problem and select treatments that will fail.
Eating disorders occupy a special place in the field of biopsychiatry. After all, eating is a basic and necessary biological function. The components of food-the amino acids that make up body proteins, for example-are the building blocks of the body. Thus it is quite literally true that you are what you eat.
A food imbalance can dramatically affect how we think and feel. Eating and weight also possess extremely powerful social and symbolic significance. Thus you are "how you eat" as well.
New research regarding weight control has recently become available. From this research has emerged a key concept known as the "set point model." The discovery of the set point has enormous implications for the biopsychiatric management of eating disorders.
Set point theory holds that your body has a certain predetermined weight range-the set point range-that it attempts vigorously to maintain. If anything threatens to disrupt this set point range-either overeating or starvation-the body will fight to stay at its preferred weight. In scientific terms, your body is a homeostatic system (homeostatic means "preserving the same condition"). If your weight drops below the set point range, your body becomes more efficient at retaining calories from the food you have taken in. Your body may also signal you to eat (possibly to binge) to get the weight back up where it should be. Mistaking these physical signals as simply "emotional" in origin neglects the complex feedback loops through which the body maintains its homeostasis.
Treatment of eating disorders: reason to hope
Anorexia and bulimia are life-threatening conditions that must be treated aggressively and thoroughly. Fortunately, in many cases, they are curable.
No case is ever "hopeless." What is required in all cases is time-time to correct misconceptions about eating and weight, time to unlearn bad habits, and time to restore disrupted relationships with family, with friends, and with oneself. As a physician, I bring into play every resource that might have some chance of helping the patient get better, whether that strategy is labeled educational, behavioral, cognitive, medical, psychological, or interpersonal.
If you are the parent of a child whose eating appears to be dangerous to her health, you may find it reassuring to learn that you don't have to wait for your daughter to ask for treatment. You can intervene in ways that will help her realize the need for therapy. Intervention is necessary-indeed, lifesaving-especially if your daughter is very depressed, suicidal, or at a low weight. If as parents you are sufficiently united in your purpose, you'll succeed in helping your child.
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