Evidence-based treatment is a catchword in psychiatry, and more broadly in medicine, in recent years. The general idea is to attempt to codify medical treatment by supporting proven approaches to illness. However, the concept is more or less meaningful in different branches of medicine.
When treating high blood pressure or diabetes, the overall effect of a treatment is fairly easy to determine. In each case there are specific measurements to be followed which can show clear evidence of improvement. A algorithm of treatment based on these results is easy to create.
Psychiatric diagnosis is itself a more creative endeavor. Although the DSM criteria for illness are very specific, translating a person's symptoms into a clear diagnosis is not always so simple.
For instance, questionnaires used to quantify the severity of depressive symptoms can seemingly create a quantitative measure of illness; however, these tests are nowhere near as objective as a blood pressure reading. Moreover, the results cannot make any clear correlation between medication and improvement in the way that blood pressure medications affect blood pressure readings. In addition, there is no evidence of long-term effect of treatment since mood is so variable and based on so many life factors. So doctors end up relying on clinical experience and signs of individual improvement, something more tangible but much less concrete.
Evidence-based data for treating people with eating disorders is even more limited. There are many short-term treatments that show reduction in symptoms, almost exclusively binging and purging, for up to 3-6 months. Although that relief is meaningful, people seeking treatment are interested in recovery, not temporary gains, and there is no evidence-based treatment for recovery.
The branch of mental health treatment focusing on evidence seems to lose sight of the goals of patients for the goals of research when it comes to eating disorder patients.
The increased interest in research in eating disorders is crucial to generate knowledge and potential long-term benefit, but the expertise in this treatment is still much too limited for clinical work.
More personal models which create community and alternative ways to cope with life outside the eating disorder offer one way out of these all-consuming illnesses. To be sure, there are other ways too, but the promise of research as an alternative is still years away. For now, patients seeking treatment need to understand the path toward recovery not short-term gains. They need hope for their own individual future.
The next post will explain the use of evidence-based treatment in eating disorder recovery and how it fits in with other treatment.