New Treatment Directions for Eating Disorders

The last post highlights a problem with eating disorder treatment: not listening to our patients. The field has been stuck in the same treatment paradigm for decades without much progress, yet there is little urgency to consider new ways to help patients. We still believe that eating disorders are largely volitional and emotional: getting to the root case will change behavior, medications can augment success and, when that doesn’t work, ship people off to a “higher level of care.”

Years of experience show this plan does not work for a significant number of patients. They often end up cycling in and out of treatment without much improvement, actually getting worse and more hopeless due to how ineffective treatment can be or just forgoing treatment altogether.

We as clinicians accept both a very long course of recovery and the unsubstantiated trope that eating disorders “never really go away.”

There is no codified treatment protocol for providers, no suggestions as to what kind of treatment to pursue or even what works. Trainees in various programs have limited education about eating disorders. The guidelines from professional organizations are vague and, more often, just superfluous.

Any changes in treatment in the past decade were driven by patients as a community discussing their experiences, largely on social media.

That’s the way I have learned most of the new things I have incorporated into my practice the last several years: the role of ADHD, autism, MCAS and other inflammatory disorders to name a few.

Patients bring me their concerns and explain their symptoms with the help of their online community. I gradually accumulate clinical data to use for treatment, review diagnoses I didn’t know or remember much about and begin to change course of treatment. These additions often enhance and sometimes even accelerate recovery.

Medical research cannot keep up with growing theories about illnesses, eating disorders included. Clinical fields often have their own biases about the patient population or the illnesses they treat. But these facts sideline what’s most important. Patients themselves just want to get better. And if they bring useful information to their provider, shouldn’t that person do what it takes for people to get better?

That last point may be the key. Medicine continues to change rapidly. Access to information online combined with AI offer a broad foundation of (mostly correct) data right away. Amidst these changes, maintaining a creative and thoughtful approach to diagnosis and treatment is harder than ever. Switching gears to see patients not just as someone to treat but as a collaborator in diagnosis is a challenging transition for clinicians. Yet this step is essential to improve eating disorders treatment.

ADHD is one shining example of an improvement in eating disorder care driven by patients. Others are on the precipice of having an equally powerful impact. I believe all providers in the field need to keep in mind that a static treatment plan is not the most effective one. There is a lot more we can do to help people get better, and sometimes patients themselves have some of the answers.