Clinicians with an Expertise in Eating Disorders

Most mental health clinicians learn how to treat the most common illnesses such as depression and anxiety. Certain psychiatric problems are not addressed in standard training, so finding specifically trained therapists and doctors is important. 

Eating disorders turn out to be among the most specialized example. 

The majority of training for psychiatrists, psychologists and social workers does not address how to treat people with eating disorders except in the most cursory ways. And eating disorders have the most medical complications of any mental illness, a fact which demands an added level of expertise. 

Clinicians need to be able to differentiate between the medical effects of binging, purging and starvation and the psychological effects of an eating disorder itself. They need to learn when to seek not only psychiatric help but medical help and work together closely on a team that attends to chronic medical issues. They need to understand the different levels of care available to patients, not only to choose between them but to understand if these options are even appropriate. 

Even more importantly, clinicians need to be aware that eating disorders cause severe medical problems and have the highest rate of death of all mental illnesses. Leaving one's fate to a minimally trained clinician seems foolhardy. 

It's best for patients to seek clinicians who claim expertise and significant experience treating people with eating disorders and then to ask in more detail about that experience and about possible treatment plans. The answers to those questions can give a lot of information quickly. 

Also finding a primary therapist with experience is likely to open treatment up to a team of clinicians who can start one's path to recovery. Wasting time seeking help from people with limited experience will only extend the time of suffering.

Individualized Eating Disorder Treatment

The standard treatment protocol for someone with a moderate to severe eating disorder is clear. Establish treatment with a team including a therapist, nutritionist and physician. Fully assess the medical and psychological state of the patient. Determine the appropriate level of care: outpatient team, outpatient program, residential program or hospital. Begin treatment. 

This standard approach is considered to be fairly straightforward. Like many other illnesses, the existence of a protocol implies that following the plan will lead to recovery. In the case of eating disorders, this is often not the case. 

The limited data supporting success of this treatment plan leave clinicians with their intuition and experience to make decisions rather than hard information to rely on. The promise that any step in treatment guarantees health and recovery is empty. 

The truth is that each person with an eating disorder needs an individualized treatment plan. The direction of treatment may often follow a standard protocol, but each step forward must be evaluated to see if it is right for the patient. It's not acceptable to confuse a failed treatment direction with low patient motivation. The key is to find a plan that works and not blame the person with the illness if the intervention doesn't help. 

Thus, I usually advise patients to find treatment providers they think they can trust and feel comfortable with. Also be sure this team is willing to collaborate on decision making. Having agency in one's life is essential to feel like recovery is really about wellness and life, not just following someone else's plan. Last, be sure everyone's goal is to create both recovery and a full life. Any other distractions or ulterior motives will only interfere with what recovery is all about.

Why is an Eating Disorder like a Virus?

The nature of an eating disorder is fluid and constantly changeable. Even though the thoughts and symptoms often seem fixed, any change in situation, context or environment will precipitate an immediate adjustment in the eating disorder. In this way it is like a virus in the mind, always ready to adapt to new surroundings, multiply and attack. This ability keeps the eating disorder powerful and enables it to dominate a life. 

For instance, when someone with an eating disorder moves to a new environment, the rules instantly change to suit the situation, mostly in order to maintain strict control over food. A new relationship will lead an eating disorder to find a way to inject itself into a situation. Changes in a food plan precipitate other, often hidden, changes to compensate.  

Paying attention to the subtle response of an eating disorder and fighting to avoid those pitfalls are challenging yet necessary in recovery. 

The ever-changing, insidious quality of an eating disorder demands a consistent, flexible treatment team. The people who comprise that team need to understand each other, be capable of quick response and be very familiar with each other's thought processes about recovery. There can't be a secondary agenda. The team can't isolate from each other and compartmentalize aspects of treatment. Working as a cohesive, directed unit will increase the likelihood of success and also take the responsibility of managing the team out of the patient's hands. 

From a biological perspective, a treatment team needs to mimic the effectiveness of antiviral medications. Viruses are highly adaptable organisms which can mutate in the blink of an eye to a new environment or to new medications. Any success treating viral infections stems from anticipating the likely responses of the virus to new treatment and blocking off all avenues of escape. 

The analogy is very similar for eating disorder treatment. If a clinical team can block off ways the disorder mutates, the person has a real chance of recovery. This level of success may scare some patients who aren't psychological ready for such a big step in recovery, but realizing recovery is possible can have a profound effect on even the sickest patients. 

A patient can identify a team working this well when it appears the clinicians work together fluidly and seamlessly. If a patient needs to manage the team, then there is a problem. If the team members need to spend lot of time getting on the same page, then that is also an issue which detracts from recovery and opens the door for the eating disorder to flourish. 

A treatment team is a crucial part of recovery. But finding any team isn't enough. Cohesive support aimed at cornering an eating disorder can make all the difference in true recovery.

Vocabulary of the Diet Industry: New Information or Corporate Propaganda

The purpose of diet fads is to create a novel way to approach food. If we refashion our daily diet into a prescription for health and well-being and simultaneously eliminate guilt and shame, somehow, some way our lives will magically improve. 

Typically, each successful invention in the diet industry finds new language to help rethink the role food plays in our everyday lives. It's not as if this new vocabulary alters the discussion. Instead, the shift in terminology creates the illusion of a brand new day. 

New views of a healthy diet quickly are coopted by people susceptible to eating disorders. The terminology always hides food restriction or limits under the guise of health and wellness. The insidious nature of the diet industry's mastery of marketing catches those on the brink of an eating disorder at a vulnerable moment. Swayed by the latest fad, many of them will unwittingly use the vocabulary to justify a full blown illness. 

Diet vocabulary is little more than propaganda for big business. The more new language seeps into the general zeitgeist of the culture, the more financially successful the diet. And the casualties left on the roadside are merely the necessary consequence of generating large profits. 

One latest example is the concept of clean eating. Ostensibly, this new language represents eating whole foods with limited processed foods. People can hide behind the overt definition of the term and feel fully vindicated. 

However, the word clean is loaded when applied to food. It implies that following these guidelines is inherently positive and healthy. Any other way of eating must be dirty in comparison so the combination of judgment and health appears foolproof. Feeling clean trumps the fear of judgment around food and becomes the new mantra of eating. 

New diet vocabulary only provides people a way to demonize eating and thereby justify feeling tortured by conflicting, loaded thoughts about food. Diets need to be called out for what they are: propaganda to exploit society's fear and confusion around food. Diet vocabulary is not an answer. It only creates more confusion when we all need to just learn how to eat again.