Eating disorders can cause brief illness or lead to a chronic or life-threatening disorder. Prompt diagnosis and assertive treatment led by specialists in eating disorder treatment is essential. Caught early, and treated aggressively, the disruption to the patient's life and health can be temporary. Although optimism is appropriate and helpful, families should expect to make supporting their loved one's recovery and relapse prevention the number one priority for the next six to twelve months. Just as if your child had cancer or was recovering from a traumatic injury - jobs, school and social activities must temporarily become secondary to recovery from this life-threatening illness.
Unfortunately, there is no one standard of care subscribed to by all clinics and clinicians. Individual clinicians are not trained or able to advise the family on all options available, and patients, due to brain function problems caused by malnutrition, are often not able to evaluate treatment options. It is usually the responsibility of the parents to fully research and evaluate the appropriate treatment approach and location for their dependent children.
Evidence-based treatment approaches
Although eating disorders have been treated for centuries, treatment has been guided by the experience and beliefs of the individual clinician. Over time, countless ideas have circulated about both the causes and best treatments for anorexia and bulimia but few have been tested to see how well they work in practice. FEAST believes that just as is done with drug treatments, it is important for treatment approaches for mental illness to be ''evidence-based.
" In the past few decades, researchers have carried out careful research comparing approaches and have been able to identify some treatments as more effective than others.
There are, currently, no pharmaceutical treatments for eating disorders, though some psychiatric medicines can be helpful for co-morbid conditions. Medical treatments are often necessary for the medical damage done by malnutrition and purging behaviors.
Nutritional stability and body composition rehabilitation are the initial goals in modern eating disorder treatment, as the psychological symptoms cannot abate until the body (and therefore the brain) is healthy again.
Only two therapy approaches have been researched in controlled trials and found to be effective in the treatment of anorexia and bulimia:
Family-based Maudsley approach (also called FBT)
This approach is based on the idea that "food is medicine" and parents are responsible for decisions regarding food choices and amounts. The patient is seen as being under the strong influence of malnutrition and unable to make choices about food and activity until nutrition has been stabilized and the brain is able to think rationally again. In a 3-stage process, the parents and siblings and ill person engage in family therapy sessions focused on 1) restoring lost weight and stopping purging behaviors 2) giving back control of these functions to the patient 3) getting back to normal relationships and age-appropriate development. Research suggests that the Maudsley approach offers best outcomes for anorexic adolescents living at home who have been ill less than three years, but the approach is also used for bulimia and older patients when appropriate. For more information on the Maudsley approach: HERE
Cognitive Behavioral Therapy (CBT)
Cognitive behavioral therapy focuses on changing the thoughts and behaviors surrounding the eating disorder. Through the use of specific techniques, therapists work individually with the patient to explore maladaptive thoughts and beliefs as well as the eating disorder behaviors that are driven by the thoughts. Sessions are meant to be focused on results rather than insight, deal with the present and not the past, and to be short-term (6-12 months). CBT is a well-established treatment approach for other illnesses, like depression, anxiety disorders and obsessive compulsive disorders. An overview of CBT use with eating disorders is available HERE
. For more general information on Cognitive Behavioral Therapy: HERE
Other Treatment Approaches
For a list of other treatment approaches: Other Treatment Approaches
Treatment team members
Depending on the treatment approach, a patient may see only one clinician or a multi-disciplinary team of clinicians. All patients should be monitored by a medical doctor during recovery. It is important that the team include specialists in the physiology and psychology of eating disorders
- generalist clinicians receive little to no training in eating disorders and can not be expected to have updated training in this fast-changing specialty.
The parent is often responsible for compiling a treatment team, but it is ideal to work with a clinic with teams in place. When more than one clinician is involved, all team members should be given legal permission to communicate. One clinician, or the parent, will coordinate information and communication for the team. Due to the nature of the illness, many families and clinicians avoid having the patient be in charge of communication between team members or with the family. For a list of licenses, certifications, and degrees: HERE
Some of the possible roles on your loved one's treatment team:
* Primary care physician: to monitor medical issues and recovery goals set by a specialist in ED care
* Physician specialized in eating disorder recovery: to oversee and set recovery goals with special attention to medical issues of malnutrition, refeeding, activity, and purging
* Eating disorder therapist: a psychologist, psychotherapist, social worker, or psychiatrist specifically trained in the treatment of eating disorders who will see the patient or whole family in therapy sessions
*Nutritionist: an eating disorder specialist who monitors and educates patient and/or family in nutrition and meal planning specifically for eating disorder recovery
*Psychiatrist: board certified child and adolescent psychiatrist specializing in eating disorder recovery
Questions for parents to ask while interviewing clinicians: From the NEDA Toolkit HERE
Questions for parents to ask while researching inpatient or residential care: From the NEDA Toolkit HERE