Program for eating disorders treatment in the Department of Child and Adolescent Psychiatry - comments and dilemmas after 20 years of experience

This article presents the program for eating disorders treatment in the Department of Child and Adolescent Psychiatry. At the beginning there is a description of history of eating disorders treatment, the dilemmas connected with the need of restricting patients' rights by introducing behavioural programs, which have led to the decrease of the number of deaths in a group of patients with anorexia, as well as the development of therapeutic programs, from the strictly behavioural to milder and more flexible ones. The authors present their own experiences of almost 20 years of treating eating disorders in the Department of Child and Adolescent Psychiatry. They describe the establishment and the improvements of the therapy program, which includes behavioural program, pharmacotherapy and broadly meaning psychotherapeutic treatment. They point out the importance of consistent effort taken by the entire therapeutic team (psychiatrists, nurses, psychologists, and teachers), the need of being strict and absolutely consistent throughout the entire program, and the meaning of patients' engagement (for example by getting their written agreement and consulting with them the planned changes to the program). The authors talk about the role of cooperating with the patients' families and present the most common problems appearing during the program like the lack of the expected weight gain, the divergence between the weight gain and the patients' psychological changes, or treating patients claiming to be vegetarians. Finally the authors also mention attempts to adapt the behavioural programs to the increasing number of uncommon eating disorders cases.