I have been working with individuals with Eating Disorders (ED) for 5+ years. My colleagues and I have witnessed how EDs affect individuals in multiple aspects of their lives.
It is not merely the “eating” or the “weight” what becomes impaired.
People with EDs display a decline in their physical and physiological health. They report social, academic, and work performance impairment. They also report co-morbid conditions of depression, anxiety, OCD, PTSD, trauma, and others; many times these mental health conditions are correlated with their ED. Meaning that as the ED develops and intensifies, other mental illnesses develop or worsen (and vice-versa). Therefore, ED treatment must target the individual in a holistic and integrative manner.
Optimal ED treatment includes individual therapy, nutritional guidance, healthy exercise practices, meal support/exposure, spiritual grounding, family involvement, as well as, psychiatric and medical evaluations. There are many facilities in the country that offer programs that integrate all of these practices.
The treatment services available for individuals with EDs include inpatient hospitalization, partial hospitalization, and residential and outpatient programs (also known as "levels of care"). Inpatient hospitalization represents the highest level of care (usually offered at a hospital setting), and outpatient is the less intense level of care. In order to know what level of care your client needs, they will have be evaluated by an ED facility (usually free of cost), a licensed clinician, or a medical doctor.
How to find the best treatment for your client?
RESEARCH THE TECHNIQUES THAT ARE EFFICIENT AT TREATING EATING DISORDERS
Treatment approaches that have shown evidence to help improve ED symptoms include: dialectical behavior therapy (DBT), cognitive-behavioral therapy (CBT), mindfulness, wellness planning, meal preparation and support, nutritional education, exercise guidance, psycho-educational groups (e.g. body image, perfectionism, food and feelings, process of change…).
FAMILIARIZE YOURSELF WITH THE TREATMENT OPTIONS
INDIVIDUAL THERAPY: (i.e. Psychotherapy sessions with a therapist or mental health practitioner). There is extensive research in the literature that supports the benefits and outcomes of CBT and DBT in treating EDs. Recent studies suggest that having a strong therapeutic relationship with a therapist is great predictor for successful ED treatment. Many clients with EDs display resistance to treatment. Based on my personal experience, I can say with certainty that a significant amount of clients are not ready to let go of their ED. They lack the motivation and willingness to recover. That being said, an ED therapist must be assertive and have a strong personality. Also, have knowledge in CBT and DBT practices.
GROUP THERAPY: Group therapy is a service included in all levels of care offered (residential, partial hospitalization, and intensive outpatient treatment). Research studies have confirmed that group therapy is successful in treating EDs, eating addiction, exercise addiction, poor body image, and purging behavior. Group therapy is an affordable alternative, when compared to other therapeutic services. There are many support groups offered in the community. So if your client does not require a HIGH LEVEL OF CARE, and cannot afford individual therapy, you can refer them to an ED support group.
NUTRITIONIST / DIETITIAN: A nutritionist will be an essential piece in your client's treatment team. Indeed, high levels of care include weekly sessions with a nutritionist. If you are not attending an ED facility, guidance from a nutritionist can help decrease disordered eating. Keep in mind that nutritionists that specialize in ED would offer optimal treatment practices. Moreover, Nutritionists/Dietitians that have recovered from an ED, are highly sensitive and understanding of the complexity of EDs.
MEDICAL DOCTORS/PCP: Believe it or not, some medical doctors specialize in ED. They can be hard to find, but if you can help your client find an ED doctor, please do so. It is very common to hear from clients that their PCP was insensitive or made "triggering comments" that invalidated their struggles about weight and body image. Many times, clients report that after hearing such comments, they began to engage in their ED behaviors more vigorously. We have also have had cases where PCPs have overlooked the ED symptoms; thus, the client did not seek appropriate treatment that could have prevented the ED symptoms from worsening. Doctors with ED experience will not only be more empathetic and cautious, but they will also make sure that the client performs relevant medical/physical checkups to ensure that the client does not fall at risk of refeeding syndrome or a hospitalization -Remember that EDs have a high mortality rate. They will also do blind weighs and educate clients on the physical, biological, and physiological factors associated with the ED.
PSYCHIATRISTS: Psychotropic medications can improve ED symptoms and behaviors. Yet, as mentioned previously, EDs affect people at multidimensional levels. There are no “magic pills”. Medication alone will not necessarily eliminate all aspects of the disorder.
FAMILY THERAPY: Family involvement is sometimes necessary to promote ED recovery. Particularly, if the individual is an adolescent or a child. Through family therapy, caregivers learn effective skills and approaches to support their loved ones at home. Moreover, many problems start at the "family of origin". Hence, improving family dynamics can be beneficial to sustaining long-term recovery.
Your Hustler,
Daniela M
References
Turner, H., Bryant-Waugh, R., & Marshall, E. (2015). The impact of early symptom change and therapeutic alliance on treatment outcome in cognitive-behavioural therapy for eating disorders. Behaviour Research and Therapy, 73, 165-169. doi:10.1016/j.brat.2015.08.00
Wagner, R., MacCaughelty, C., Rufino, K., Pack, T., Poplack, J., George, K., & Ruscitti, C. (2016). Effectivenes of a track-based model for treating eating disorders in a general psychiatric hospital. Bulletin of the Menninger Clinic, 80(1), 49-59. doi:10.1521/bumc.2016.80.1.49
Accurso, E. C., Fitzsimmons-Craft, E. E., Ciao, A., Cao, L., Crosby, R. D., Smith, T. L., … Peterson, C. B. (2015). Therapeutic alliance in a randomized clinical trial for bulimia nervosa. Journal of Consulting and Clinical Psychology, 83(3), 637-642. doi:10.1037/ccp0000021
Ben-Porath, D. D., Federici, A., Wisniewski, L., & Warren, M. (2014). Dialectical Behavior Therapy: Does It Bring About Improvements in Affect Regulation in Individuals with Eating Disorders? Journal of Contemporary Psychotherapy, 44(4), 245-251. doi:10.1007/s10879-014-9271-2
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