Chapter 9 In extremely stressful or hostile situations, such as
family gatherings where relatives are angry with the patient, you may suggest that your patient plan not to eat at the event at all, but to modify the meal plan before and after the event instead. If a patient seems unable to man- age the anxiety in advance of an event with appropriate planning and problem-solving, alert the other members of the treatment team. The team may conclude that attending the event is not supportive to the patient’s recovery, and a medical restriction may be the only acceptable way for the patient not to attend. If the inability to attend social or family functions is an ongoing problem, a psychiatric evaluation may be helpful in identifying a possible social anxiety disorder and corresponding treatment.
PREVENTION
Patients and their families may ask you whether eat- ing disorders can be prevented. Current understanding of eating disorders suggests that genetic predisposition (“nature”) and environmental triggers (“nurture”) both play a role (5). The genetic piece cannot be prevented at this time, but the environmental dangers can potentially be reduced. Box 9.4 lists suggested methods for decreas- ing the environmental load that can trigger eating disor- der development. Once an eating disorder has been set in motion, the most crucial dimension is obtaining care. Care should never be delayed by a parent or caregiver who fears being blamed for a child or other family member’s eating disorder.
