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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.

 

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3 Comments

  1. KAZ

    My d 5 years in
    Living life but should be recovered by now but isn’t
    The wait lists in this country for services/help (and no doubt many others)are disgraceful IMO

    For such a serious illness these self help things seem ridiculous to me
    Yes I’m angry
    My kid missed the pivotal years of her life
    17-22
    Services now don’t include the family as she is an adult
    What to do???

    Trying to get on with my own life

    We are a loving supportive family and we Still support her but wow there’s got to be changes for the future surely????
    Her illness pretty much sucked the life out of me
    So frustrating to say the least

    • Judy Krasna

      As someone who has been where you are now, I very much understand your frustration and your anger, and I am so sorry for what you are going through. It’s so, so hard. I think that this post is helpful for people who are more at the beginning of their journey where early intervention is relevant. What I gleaned from this post is that there are things that parents can do and resources that may help them do it if the wait for treatment is too long.

  2. Hilda Rogers

    I would say that this article is particularly relevent for the siblings of someone who has been diagnosed with an ED and that it is the parents of these kids who would be more than likely to be able to spot and head off the descent of a sibling into a fully develped ED spiral. I myself have lately been implementing FBT methods for my younger daughter who has lost weight due to GI and anxiety issues – I would NEVER have been able to do this if I had not already spent the last 18 months caring for her sister who is in recovery from AN, I wouldn’t have known what to look for on a persons growth curve or how to support and encourage and sustain her to regain the weight she lost and you know what? Hopefully we will never know if she would have developed full blown AN over time from this very triggering medical and emotional situation and if we had waited for medical professionals to get lined up to help us, it would have taken way longer. It makes me realise that the ability to do FBT on a basic level and much earlier in the development of this illness would serve as really effective prevention for so many kids if only the primary care pediatricians would track growth dilligently, accurately and use that data to spot and implement basic prevention measures right away.

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