8/22/19

Individualized Treatment for Eating Disorders


Treatment ultimately needs to become individualized in order for more people with eating disorders to fully recover.
As financial companies have purchased smaller eating disorder programs, profit has become the driving force for treatment. Programs have leverage, connections to insurance companies and marketing strategies that easily overrun the small programs and clinicians in the community.

The result of this sea change in eating disorder treatment is a reflexive reaction by clinicians to immediately refer patients to a treatment program. If that patient does not benefit from a program, it’s too easy to blame the patient for being intractable than to begin to create a specific program that could help this patient.

Programs provide a very specific program that entails absolute compliance with the meal program, rigid structure for daily groups and goals, adherence to weight management plans and an ability to quickly ignore eating disorder thoughts. Accordingly, people who do well at programs have eating disorder symptoms that match the overall philosophy of a program.

People with more chronic eating disorders, stronger eating disorder thoughts, binge eating disorder or more complex psychological and emotional causes for their illness often do not get much help.

There are many forms of outpatient treatment that can be more flexible. Some people cannot gain weight rapidly without immediate relapse. Others need to do more work on emotional resilience before they can tolerate substantial changes in their food. Some need to manage traumatic reactions in new ways before being ready to move forward in recovery. Sometimes it just takes longer to quiet the eating disorder thoughts.

During this transition period for patients, it remains crucial for clinicians to manage medical consequences of the eating disorder and to maintain focus on confronting eating patterns while still making changes in the meal plan. The worst slips into eating disorder symptoms might be treated medically or with short-term stays in hospitals or residential programs.

Individualized treatment always involves taking risks for patients. It means tolerating difficult stretches of worsening symptoms while trying to ensure safety and leave open a path to recovery.

Residential treatment is always a viable option. But the caring clinician needs to consider all routes to recovery to give everyone the best chance to get well.

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