Ernæringsmæssig genopbygning er afgørende for en succesfuld behandling af spiseforstyrrelser. Derfor bør kostvejledning gå hånd i hånd med den psykoterapeutiske behandling af en spiseforstyrrelse. Ernæringsterapi til mennesker med en spiseforstyrrelse har fokus på at sammensætte en mere balanceret kost for klienten, men også på at genoprette de ubalancer, der er opstået som følge af spiseforstyrrelsen – eller som måske ligefrem har udløst spiseforstyrrelsen.
Af Nanna Ewald Stigel & Tine Grandjean, Ernæringsterapeuter
Artiklen blev bragt i magasinet sund-forskning – vinter 2013
Hver 4. unge kvinde udviser risikoadfærd
En undersøgelse fra Sundhedsstyrelsen fastslår, at hver fjerde unge kvinde udviser risikoadfærd i forhold til udvikling af en spiseforstyrrelse. Spiseforstyrrelser er den 3. hyppigste dødsårsag blandt europæiske teenagere (efter ulykker og cancer). Hertil kommer, at sygdommen ofte er invaliderende – både for personen med en spiseforstyrrelse, men også for de pårørende. Bekymringer og ikke mindst et ekstremt følelsesmæssigt pres hviler på begge parter. Ofte er indkøb, madlavning og spisning spundet ind i et net af kvælende regler og ritualer. Ligesom mén efter sygdommen kan have vidtrækkende og varige konsekvenser, hvis ikke der etableres et behandlingsforløb, der tager højde for de mange følgevirkninger.
Helhedsorienteret behandling er nødvendig
Der er sjældent bare én årsag til, at et menneske udvikler en spiseforstyrrelse. Ofte udspringer spiseforstyrrelser af et dårligt selvværd og følelsesmæssige belastninger. Sult eller overdreven spisning bliver en umiddelbar løsning, der ”bedøver” følelserne. Men man ser også spiseforstyrrelser, der opstår af biokemiske ubalancer, som i sig selv skaber trang til overspisning eller fremkalder spisevægring. Endelig er spiseforstyrrelser ofte et produkt af tidens skønhedsidealer, som igangsætter slanke- eller træningskure, der så eskalerer og tager magten. Netop de næringsstofmangler, der opstår som følge af skrappe kure, kan fremkalde selvdestruktiv adfærd og fordrejet virkelighedsopfattelse. En spiseforstyrrelse kan fx udvikles eller forstærkes under kraftig indflydelse fra et blodsukker i kaos, en svækket fordøjelse eller et højaktivt immunsystem, som skaber panik og angst i krop og hjerne. Ligesom den kan udvikles, forstærkes eller fastholdes af mangel på vitaminer, mineraler, fedtstoffer og aminosyrer. Det er derfor afgørende, at alle disse fysiske ubalancer opdages og behandles. Ligesom der ofte ligger flere årsager til grund for en spiseforstyrrelse, bør behandlingen spille på flere strenge og netop tage afsæt i det samlede felt af årsager og ubalancer.
Behandling med respekt for mennesket
I behandlingen af spiseforstyrrelsen er det vigtigt at møde mennesket bag den dominerende spiseforstyrrelse. Det er fristende at møde spiseforstyrrelsen med krav og kamp. Men bagved sygdommen er et menneske, som skal vokse sig stort og stærkt og lære at tage plads, så spiseforstyrrelsen ikke får overtaget. Det er dét menneske, vi skal møde. Det gør vi i ernæringsterapien bl.a. ved at anerkende nogle af de oplevelser, vedkommende har. Fx at få ondt i maven af bestemte fødevarer eller at acceptere, hvis personen gerne vil være vegetar. Det er det dog væsentligt at gøre det klart, at udelukkelse af nogle fødevarer nødvendiggør inkludering af andre. Desuden er det vigtigt ikke at tilføre yderligere skyld og skam over mad, der er blevet spist, ikke er blevet spist eller kastet op igen (afhængigt af spiseforstyrrelsen).
Mennesker med en spiseforstyrrelse har i forvejen ofte et indre negativt bekræftende tankemønster kørende – og det er overordentligt vigtigt ikke at fodre dette. I stedet skal vi skabe små succesoplevelser, der skubber klienten i den rigtige retning. I det konkrete arbejde med klienten er det derfor væsentligt i et vist omfang at give klienten medindflydelse, dels på tempoet i behandlingen, dels på den kostplan, der skal udvikles. Endelig er tålmodighed en dyd. Fra hjerneforskningen ved vi at sult, spisning ogtræning kan påvirke et område i hjerne, som udløser dopamin. Det er det samme område, som er ansvarlig for afhængighed af alkohol, nikotin og stoffer. Det kan være rart at vide, så både behandler og klient ved, at der skal kæmpes mod en afhængighed, og at denne ofte først slipper efter en abstinensperiode. Vedholdende samt opfølgende arbejde er derfor væsentligt i vejen ud af en spiseforstyrrelse.
Fra Gordisk knude til positiv sløjfe
Det er ingen nyhed, at maden har stor indflydelse på vores sindstilstand. Det nye ligger måske snarere i at afdække og behandle grundlæg-gende fysiske og biokemiske ubalancer i kroppen. Og vel at mærke at behandle ubalancerne ved hjælp af en skræddersyet ernæringsplan til den enkelte. En sådan er nemlig afgørende for klientens evne til at respondere på psykoterapeutisk behandling og blive rask af en spiseforstyrrelse.
Typiske mangelsymptomer ved en spiseforstyrrelse:
- B-vitamin: Kvalme, træthed, tristhed, uro, angst, depression, tvangstanker, fordøjelsesproblemer
- D-vitamin: Uro, depression, nervøsitet, træthed, inflammation
- Zink: Fordrejet virkelighedsopfattelse, tvangstanker, depression, nedsat smags-/lugtesans
- Magnesium: Uro, svært ved at sove, træthed, forstoppelse, depression, nervøsitet, forvirring
- Aminosyremangler: uro, hjertebanken, kvalme, nedsat mavesyreproduktion EFA: depression, uro, angst, inflammation
Diagnoser
Anoreksi er karakteriseret ved ekstremt kontrolleret spisning. Det indbefatter små kaloriefattige måltider, måltider som helt springes over, udelukkelse af en del fødevarer og/eller angst for maden. Ofte er der knyttet en del træning til spisevægringen. Anorektikeren er ofte (men ikke altid) meget tynd, men opfatter stadig sig selv som stor og fed.
Bulimikeren spiser ofte sparsomt og kaster efterfølgende maden op. Ofte er der overspisninger, som typisk kommer om eftermiddagen eller aftenen og til tider fortsætter ind i nattetimerne. Overspisningerne ledsages af provokerede opkastninger, afføringsmidler eller tvangsmotion. Bulimikeren er ofte normalvægtig og derved helt usynlig i gadebilledet.
Overspisning – BED har et ukontrolleret forhold til mad. Det falder svært at spise normale portioner mad. Der er et behov for at blive ved med at fylde på. Ofte i mad som kage, brød, smør, chokolade, kiks, is m.m. Overspiseren er ofte moderat til svært overvægtig. Overvægten giver vanskeligheder med fysisk aktivitet, hvilket forstærker vægtproblemer og en skæv hormonbalance.
Orthoreksi er en nyere diagnose, som dækker dem, der har en forestilling om, at de lever sundt. De har dog et fanatisk og skævt billede af det sunde. Der er ofte en stor angst for fedtstoffer og/eller kulhydrater, der er ofte restriktive regler om mængder og variationen af fødevare. Overtræning er tit koblet til denne spiseforstyrrelse. Orthoretikeren er typisk normal- til under-vægtig. Fælles for de forskellige typer af spiseforstyrrelser er en trang til at trække sig tilbage, eller direkte isolation. Ofte er der tristhed, humørsvingninger, uro, angst og depression som følge af det negative tankemønster og næringsmangler, som giver ubalance i neurohormonerne.
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