Early Intervention

by Karina Allen, PhD, MPsych(Clinical)

Early intervention makes intuitive sense. After all, if your child was unwell with cancer or diabetes, you would question any doctor who said “Well…let’s see if they get better on their own”. The quicker someone gets help, the quicker they can start to recover, and you don’t risk them becoming more unwell before treatment begins.

Unfortunately, early intervention for eating disorders can be hard to achieve. There are three main reasons for this. First, it can take time for the signs of an eating disorder to become apparent – especially for those eating disorders where weight loss isn’t a feature. Even when symptoms do become apparent, the person with an eating disorder may deny them, find it too hard to talk about them, and/or say they don’t want help.

Second, you may encounter medical professionals who have limited training in eating disorders and don’t realize how important early intervention is. Many doctors truly believe it is better to ‘watch and wait’ rather than act quickly, either because they believe symptoms will go away on their own or because they are worried about referring to over-stretched eating disorder services. Plus, many doctors don’t have the specialist training to spot eating disorders or to realize how severe they can be.

Third, many people don’t have quick access to good quality eating disorder care, either because there are no local services or the services that exist have long waiting times.

So, how to proceed? This post aims to (1) explain why early intervention is so important for eating disorders and (2) offer ideas for facilitating early intervention in your loved one or yourself.

Why is early intervention so important for eating disorders?

As mentioned above, early intervention makes intuitive sense – the sooner you get help, the sooner you can start to get better and you don’t risk becoming more unwell before treatment begins.

For eating disorders, early intervention is especially important because brain changes occur in response to eating disorder symptoms. Scans of  people’s brains show that the longer someone has an eating disorder, the more their brain changes. These changes can make eating disorder symptoms habitual and even rewarding – and it gets harder to overcome the eating disorder as a result.

It is really important to emphasize that recovery from an eating disorder is possible at any age and after any length of illness. However, recovery tends to be easier if you get help early. The first 3 years of an eating disorder seem to be a key ‘window of opportunity’ for early intervention. Even after this, the sooner someone gets help the better. And the good news is that with recovery, the brain changes associated with eating disorders seem to be reversible.

Early intervention also means that people with eating disorders are less likely to miss out on study, relationships and other opportunities because of their illness. This is especially relevant for young people who may be unwell at a time in their lives they would be completing school or starting work. Eating disorders can also cause long-term physical health consequences, particularly loss of bone density and gastrointestinal difficulties, and the quicker someone recovers the less likely they are to experience these long-term difficulties.

You may wonder if eating disorders do ever get better on their own. For some people, this can happen. There are some studies showing that young people with eating disorder symptoms will stop symptoms by themselves over time. However, there are many more studies showing that eating disorder symptoms tend to persist without treatment. ‘Sub-clinical’ eating disorder symptoms also tend to progress to full eating disorders over time.

On balance, it is always better to act early rather than wait and risk a long-term illness.

How do we make early intervention happen?

It isn’t always easy, but it is worth fighting for. The F.E.A.S.T. website already has lots of good ideas for talking with your loved one about your concerns and accessing professional support. You could also look at the early intervention website www.FREEDfromED.co.uk . The key first steps are expressing your concerns to your loved one, and talking with a health professional about your concerns.

Alongside professional help, and especially if you are faced with a waiting time for specialist eating disorder care, you might want to work on making initial changes yourself. This could take the form of family-based treatment for eating disorders in young people, particularly if you have a child or teenager living at home. There are excellent guides written for parents to facilitate this – although you will need at least a medical doctor onside to help ensure medical safety and physical health monitoring. The following book offers guidance for parents:

• Help Your Teenager Beat an Eating Disorder (James Lock and Daniel Le Grange, 2015)

For families with adult children or where family-based treatment isn’t appropriate, the ‘new Maudsley method’ offers practical skills to support your loved one and facilitate change:

• Skills-based Caring for a Loved One with an Eating Disorder: The New Maudsley Method (Janet Treasure, Grainne Smith and Anna Crane, 2016)

For older adolescents or adults with binge eating or purging difficulties, there is good evidence for cognitive-behavioral self-help approaches as an initial step towards change. Books that have been used in scientific trials include:

• Beating Your Eating Disorder: A Cognitive-Behavioral Self-Help Guide for Adult Sufferers and their Carers (Glenn Waller, Victoria Mountford, Rachel Lawson, Emma Gray, Helen Cordery, and Hendrik Hinrichsen, 2010).
• Getting Better Bite by Bite: A Survival Kit for Sufferers of Bulimia Nervosa and Binge Eating Disorders (Ulrike Schmidt, Janet Treasure and June Alexander, 2015).
• Overcoming Binge Eating, Second Edition: The Proven Program to Learn Why You Binge and How You Can Stop (Christopher Fairburn, 2013).

Free online cognitive-behavioral self-help modules and other information sheets are also available at https://www.cci.health.wa.gov.au/Resources/Looking-After-Yourself .

Eating disorders are challenging conditions and tackling them on your own is tough. However, self-help and family-driven change can be an excellent first step.

In summary

Early intervention is important for most physical and mental health conditions, but the effects of eating disorders on the brain and body make early intervention extra important for these conditions.

If it too late for ‘early’ intervention, intervention as soon as possible is still important and will offer benefits over further waiting.

Recovery is possible for everyone – but acting quickly can make it come sooner.