Learn what you need to know to treat eating disorders effectively

Whether you are a psychotherapist, nutritionist, physician or other provider of health services, whether you are an experienced and well-seasoned “veteran” in the field or a novice just starting out, whether you are in training as a Masters or PhD. student in the mental health field or a resident in adolescent medicine, you have probably treated, or will soon encounter, patients who will seek your help in overcoming an eating disorder. If you are not an eating disorder “specialist,” you have probably felt unprepared to treat “hard core” eating disorder cases and in some instances, perhaps have felt compelled to refer these cases out of your own practice to other professionals who have more experience than you do.

Treating eating disorders is indeed, a unique art, as well as science. Specialization in this field as a treating professional does require a highly refined understanding of the disease and its implications for patient and family, as well as a specialized skill set and an appreciation of the unique and highly specific treatment requirements. Effective treatment requires the practitioner’s unfailing awareness and responsiveness to the self, as well as a unique and facile use of self in ushering patient and family towards healing. The practitioner will need to acquire a clearly specialized body of knowledge, and become open to novel treatment goals, attitudes and techniques in addressing the complexity of these diseases. Ironically, few graduate programs educate their students to become experts or specialists in this field. As a treating professional, you no longer need to feel inadequate in the face of these diseases. The knowledge and expertise you need in this realm are easily within your reach.


Techniques for treating eating disorders are unique

Techniques for treating individuals with anorexia, bulimia and binge eating disorder will not be the same as those that have worked for you and your patients in the past in treating other mental health disorders. So, if in the past in preparing to treat an eating disorder, you may have assumed you could simply treat the “other” more familiar aspects of the patient’s problems with the expectation that the eating disorder could go untreated and would disappear on its own as the patient improves in these other spheres, you have been mistaken. In addition, such an assumption would probably have enabled the patient’s disease and denial about the implications of the disease, as well as the need for recovery. As the young child cannot beat an eating disorder on his own without the appropriate support of parents and family, as parents cannot consistently and appropriately provide the support their child needs without on-going guidance from both child and health professional, professionals too, need their own source of support to tweak their skills, confidence, and treatment techniques in the face of these hard-to- treat diseases.


Important pointers for professionals treating eating disorders

• Remember, these are not diseases that the patient will actively or readily self-report. The typical patient with an eating disorder is not aware that the condition is a problem, or that the problem can be life-threatening. If she does know that she has an eating disorder, she may believe that she cannot exist without it and may be eager to keep the disease hidden from others who might be prone to attempt to take it away from her. You as the practitioner will surely need to learn to “read their existence between the lines.”
• Don’t make the mistake of relying on medical diagnostic blood tests, urinalysis, or EKG to reveal these problems. These diseases will not show up in any of these tests until the lattermost stages. Parents will need to learn that because these diseases typically do not show up in the doctor’s office, parents will need to become “diagnosticians” of sorts around the kitchen table or in the family bathroom.
• Remember, the presenting problem that “walks in the door” may not be the only problem you will need to be treating. The behavioral tip of an emotional iceberg, an eating disorder will be an integral part of a wider configuration of physical problems and emotional disturbances. Eating disorders are problems that effect not only behaviors, emotions and physiology, but interpersonal relationships, attitudes and values and lifestyle as well. Look for them where they are not readily apparent.
• Because the patient who presents with depression, anxiety, fatigue, relationship problems, etc. may be abusing food and eating as a coping technique, learn to ask about food, eating and body image concerns as a normal part of every diagnostic interview. How a person eats is as significant and poignant a diagnostic question in your initial assessment as is how the patient sleeps, if she has ever abused alcohol or substances, if she has ever been suicidal, etc.
• Remember, eating disorders evolve over time and along a continuum. They come in all shapes and sizes, as unique in their personal configuration, from individual to individual, as a thumbprint. Disordered eating, vegetarianism, dieting, and various other forms of food restriction and eating quirks and idiosyncrasies have become so prevalent in our society as to be considered normal. Yet, in the genetically susceptible person, such behaviors can represent high risk triggers for the onset of an eating disorder.
• Because eating disorders evolve over time, be prepared to recognize them at every stage of their development, including the earliest warning stages before they have erupted in clinical symptoms. Professionals who are savvy enough to pick up on the earliest signs are in a position to PREVENT these deadly disorders before they happen, and before they have a chance to take young lives.
• Become aware that your own personal issues around eating, body image and weight management could possibly influence your ability to detect these diseases in others, and your emotional availability to treat them effectively.
• Eating disorders are not mental health diseases; nor are they physiological diseases. They are a combination of both, and both of these elements must be treated simultaneously for either aspect to begin repair. A person who is physically malnourished will be emotionally unavailable to benefit from the emotional work of psychotherapy.