By Dr. Tamara Pryor
The integration and utilization of the biological basis of eating disorders and the Temperament Character Inventory (TCI) have become important parts of treatment at Eating Disorder Center of Denver. On admission, each patient takes a computerized version of the TCI that is scored and rated by a trained clinician. The information is an integral part of the assessment data and is used to shape and formulate the treatment plan. Patients are educated regarding the bio-psycho-social model of understanding and treating eating disorders. Genetics data from the Price Foundation Study is explained to help patients and families understand that eating disorders are not “disorders of choice.”
With regards to the individual, EDC-D clarifies that while patients initially chose to diet or binge and purge, one’s temperament determines whether this behavior becomes a transient, misdirected coping mechanism or a life-threatening disorder. As evidence, we cite the high number of women who diet compared to the .5-1% of women ages 13-35 years who develop Anorexia Nervosa. Clearly, there is something that sets these individuals apart and predisposes them to the illness. One way to think of it is that for Anorexia Nervosa, “biology loads the gun and dieting pulls the trigger.” That is to say, an individual can have the genetic predisposition but if they never go on a diet, they will never develop the illness.
While no one chooses to have an eating disorder, it is important to help patients understand that recovery does involve a conscious choice. EDC-D provides a nurturing, safe environment; the dieticians provide the food plan for recovery and staff help patients alter meal time behaviors; the psychiatrists diagnose and effectively medicate co-morbid conditions; and finally, the multi-disciplinary treatment team teaches the patients and families the skills necessary to be able to implement the choice to be well. We clarify that families do not cause eating disorders and that the illness of a loved one seriously impacts the family. We explain that family members have a choice: they can be part of the problem or part of the solution. The primary focus in individual family sessions and multi-family groups is to identify strengths and provide tools to families so as to maximize recovery in the patient. In those situations where there are concurrent multi-generational issues, these issues need to be identified and addressed for treatment to move forward.
Sharing the TCI with the patient can be very helpful to the treatment process. For example, in Anorexia Nervosa, the classic TCI has very high harm avoidance and very low novelty seeking subscales. Helping the patient and family understand this profile facilitates self-understanding, communication, and decision-making. In general, change will be slow, transition will be difficult, and considerable planning, communication, and support will maximize the patient’s outcome.
In Bulimia Nervosa, the classic TCI has high harm avoidance, but is also accompanied by high novelty seeking. These individuals tend to be fearful of being hurt but are multi-impulsive, frequently putting themselves in dangerous or compromising situations. This inherent contradiction with regards to harm avoidance is clarified for patients and families and Dialectical Behavioral therapy tools are taught to help patients use mindfulness skills effectively accept their “hard wiring.”
By helping the patients at EDC-D to understand and accept their basic temperament, we can more effectively work on the “root system” of their eating disorder. This then, maximizes the possibility that patients will interrupt destructive behaviors on a more consistent basis and allow their authentic self the opportunity to move forward into health and recovery.