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17 - Assessment and treatment of chronic medical complications

from Part IV - Evidence-based care

Published online by Cambridge University Press:  02 December 2009

Brett McDermott
By
Richard E. Kreipe
Edited by
Tony Jaffa
Brett McDermott
Affiliation:
University of Queensland
Richard E. Kreipe
Affiliation:
Golisano Children's Hospital at Strong,Rochester, NY, USA
Tony Jaffa
Affiliation:
Phoenix Centre, Cambridge
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Summary

Approach to young patients with chronic medical complications

Patients with chronic medical complications associated with an eating disorder (ED) often elicit negative countertransference from medical care providers (Franko & Rolfe, 1996). Common reactions by professionals include frustration with treating conditions that patients ‘bring on themselves’ or anger at a patient's resistance to treatment or intentional falsification of body weight during weigh-ins. What makes these conditions especially vexing is that they often occur in extremely bright, talented young people who seem to be unaware of the harm that they are doing to themselves. As noted by Strober (2004), the chronically ill patient requires a unique approach to care, one that minimizes the risk of iatrogenic effects of too-rapid weight restoration or failure to be aware of potentially negative effects of countertransference ‘by integrating clinical experience, empirical psychological findings and a conceptual understanding of developmental and phenomenologic aspects of the illness’.

Given the tendency for younger patients with chronic medical complications to resist efforts to change, it is worthwhile for practitioners to apply the biopsychosocial approach in a manner that optimizes the likelihood that patients will cooperate with treatment recommendations. Promising in this regard is the use of motivational interviewing, closely linked with readiness-to-change.

Keywords

adolescentsamenorrhoeabrainchronic medical complicationseating disorderpatient
Type
Chapter
Information
Eating Disorders in Children and Adolescents , pp. 212 - 224
Publisher: Cambridge University Press
Print publication year: 2006

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