Anorexia – Bulimia

Nightingale Hospitals Paris – Clinique du Château has not least specialises in the treatment of eating disorders (ED) including mainly anorexia nervosa and bulimia.

Two main aims direct our therapeutic strategy.

  1. Personalised medicine

We do not have just one single treatment protocol for all, with restriction of freedom on entry until clinical improvement. On the contrary, we offer personalised care, based on a treatment programme determined by mutual agreement during one or several pre-admission consultations with the specialist psychiatrist (Sébastien Machefaux) before hospitalisation. Definition of the objectives and resources required result from in-depth discussion between the patient and the physician.

For all that,

  • The objectives should aim for ‘normality’ in terms of:
    – Body mass index (BMI)
    – Food intake as much in quantity (calorie intake) as in quality (more or less gradual reintroduction of prohibited foods)
    – Calories loss (physical activity), with weaning from all purging methods.
  • The somatic medical assessment (clinical and paraclinical, especially biological) is essential. It imposes a reality which prevails over the care system.

The context in which treatment is dispensed also meets the requirements of personalised medicine. The hospital is not a closed unit in which only anorexic and/or bulimic patients are hospitalised. On the contrary, it is an open space and the architecture looks nothing like an asylum.

  1. Multidisciplinary care and multifocal approach

Like other mental diseases, there are many causes of eating disorders (ED). Our approach is therefore multifocal and multidisciplinary.

  • Close psychiatric and psychological follow-up:
    – Daily psychiatric consultation
    – Individual therapy consisting of twice-weekly specialist psychologist consultations (Leslie Radon)
    – Weekly specialist psychiatric consultation (Sébastien Machefaux)
  • The corporeal approach:
    – Individual weekly consultation with a specialist psychologist/somatic therapist/physiotherapist (Jean-Yves Jacquet)
    – Non-specific group activities several times a week: gentle exercise, yoga, mindfulness by a relaxation therapist (Christophe Alamovitch)
    – Group, twice-weekly, non-specific physical and sporting activities, depending on somatic state, by a sports instructor (Marc Bobin).
  • The nutritional approach:
    – Individual or group therapeutic meals several times a week
    – Weekly individual meeting with a nutritionist (Eva Roussel)
    – It is compulsory to take meals together three times a day, supervised by a carer, along with one or two snacks.
  • Family participation:

Family participation is central to the management of the eating disorder and has a dual objective:

  1. To help the family better understand the diseases, to adopt a kind attitude to the patient, to reinforce their parenting skills and to prevent the feeling of isolation. It is also a way of managing the carers’ suffering.
  2. Detecting and deconstructing potential relationship functions. Like for other mental illnesses, the hypothesis of overlapping biological and genetic, but also psychological and social (life events) causes is put forward. In eating disorders more than in other disorders, there may (or may not) be a relationship function inherent to the symptoms.

It involves two types of treatment:

  1. Family consultations (patient, family, psychiatrist), or more structured family therapy
  2. Family management, by a specialist psychologist (Leslie Radon), including:
    – A parents group: work on difficulties encountered by parents from a psychological and educational standpoint
    – A therapeutic meal with parents and patients
    – A wider family group (parents, patients and brothers and sisters) in order to work on diet, communication and relationships within the family, and future changes.
  • ED weekly discussion group:

It is a time for discussing various concerns and is led by the specialist psychiatrist (Sébastien Machefaux). The concerns discussed are as much ED-specific as more general and existential: experience of the disease and its multiple consequences (relational, medical etc.), experience of care, resources and individual vulnerabilities. Sharing, authenticity, respect and confidentiality are essential for the group to function properly. The discussion group aims to create emulation, to remove stigma, to improve self-esteem and broaden thinking.

  • Weekly self-assertiveness psychological and educational group:

Self-esteem and self-confidence are essential to getting better. The treatments described above mainly target this objective, however, self-assertiveness is also a specific cognitive and behavioural method. A psychologist (Michel Naudet) is in charge of psychological education.

Also, some disorders are commonly associated with ED, among them are depression, alcohol abuse or other alcohol-related diseases, and obsessive compulsive disorder (OCD). Firstly, a weekly group on depression led by a psychiatrist (Lionel Waintraub) is indicated.
Secondly, the two weekly groups, a support group led by two former alcohol-dependent women and the alcohol psychological education group led by a psychologist (Michel Naudet) are offered.
Finally, cognitive therapy sessions are offered for OCD as part of individual psychological treatment.

Subject to exceptions, other activities, less specific to ED treatment, especially artistic expression (art therapy, percussions, theatre), offered by the clinic are also indicated. Among other things, they aim to improve self-esteem and self-development.