Present and Future of Eating Disorder Treatment

Eating disorders have complex and multifactorial causes. With our still limited knowledge of brain function, genetics, environment, behaviors and brain pathways all are part of what leads to an eating disorder. Dieting and food restriction may be the number one risk factor, but the still basic understanding of our brains leaves medicine with only a cursory sense of why and how a diet causes anorexia in one person, bulimia in another and only a few days of hunger in a third.

Since there is no standard approach to treating any eating disorder, clinicians or researchers tend to recommend treatment based on their own personal bent rather than overall knowledge about these illnesses. Some treatment is primarily pharmacological, some psychoanalytic and others behavioral or relational. The fact that clinicians have so many approaches reflects the difficulty finding adequate and successful treatment.

Some approaches seem to have benefit: high doses of Prozac for severe Bulimia or binge eating, cognitive behavioral therapy for bulimia, family based therapy for some adolescents with anorexia. However, there are no treatments known to work broadly based on repeated research studies.

These facts can be demoralizing for patients, especially those who don’t get better quickly after the first series of treatment. As they emerge from the initial shock and preliminary steps into treatment, families and patients can get bogged down in the difficulty finding the best treatment pathway, assessing the hodgepodge of residential treatment programs and combing through the informal training process for clinicians who treat eating disorders.

There is some research on the horizon that is promising. One direction is starting to delineate the hormones that modulate hunger, fullness and the gastrointestinal system. It is interesting and useful but not yet enough to lead to effective medications on the market. Perhaps these medications can open doors to at least moderating the strength of some eating disorder symptoms and improving outcomes.

In addition research into the experience of appetite and fullness in the brain is also present in academic circles, yet these neural pathways are complex and just starting to be understood.

For now, the most effective treatment aims to circumvent and weaken behavioral pathways for all eating disorders. By figuring out how to help people identify the repetitive eating disorder thoughts and behaviors and change them accordingly may be an involved and long process, but it’s one that works long-term and is effective. This therapy does the work medications may help do more quickly in the future.

The truth is that effective treatment is out there for everyone. It may be hard to find or take a long time, but it is important to keep trying and know that recovery is possible.