Treatment of Eating Disorders for Everyone

Eating disorder treatment originated with adolescent girls in the 1970’s who had been influenced by the societal pressure for thinness. The advent of mass media drove the diet industry to spread widely and precipitated the overall acceptance of food restriction—the number one risk factor for eating disorders.

This population of girls and young women has been the primary target for eating disorder clinicians. Virtually all treatment philosophies are geared to the pressures on girls and young women and espouse feminism and empowering women’s voices as central to recovery.

Granted, this approach to treating eating disorders still has its place but can no longer be the sole clinical vantage point.

As financial companies now dominate the eating disorder residential treatment model, financial gain is a driving force in the field. The result is a corporate approach to treatment. More experienced clinicians take management roles while newly minted practitioners get extended training on the front line of eating disorder work.

Incorporated into the capitalist structure, eating disorder treatment is now mainstream. These disorders are a part of what the newest generation has grown up experiencing. The monetization of body image, food consumption and wellness inundates the youth with the building blocks of developing and understanding eating disorders. Accordingly eating disorders don’t know gender anymore.

Ten year old boys, sixteen year old girls, twenty three year old men,

thirty year old women and thirty five year old non-binary people seek help these days. The lack of resources for people who don’t fit the old model of teenage girls reveals the outdated nature of treatment and recovery.

Treatment can’t focus on the pressures on young women anymore. Instead, eating disorders need to be seen as pervasive psychiatric illnesses with significant medical co-morbidities.

Cognitive behavioral therapy is the most effective option for all eating disorders and is gender-free. This approach has been used for binging disorder for many years, and treatment programs are using this method more often for all eating disorders since it does not espouse any bias towards a specific population and can be applied by younger, less experienced clinicians.

In addition to this treatment approach, there is and will always be a strong emotional component to eating disorder work. Eating disorders serve powerful emotional purposes for people, and letting that go is necessary to get well. It feels like facing the world alone. Any successful treatment must address the emotional fallout as well.

However, all forms of treatment also need to follow the cultural norms and adapt to our current population. So the emotions are not just those of young women but all people.

The clinical field is just starting to consider all those who need eating disorder treatment. These patients need our creativity, thoughtfulness and the broadest approach to recovery.

Gender in Eating Disorder Diagnosis and Treatment: An Introduction

Gender has been central to the diagnosis of eating disorders since the field first began in the 1970’s. Seen initially as a woman’s response to the pressure to be thin, eating disorders remain focused largely on women’s mental health. For decades, treatment philosophies and residential programs have been steeped in feminism and women’s rights, and for good reason.

Accordingly, the changing understanding of gender also heralds a shift in the foundation of eating disorder treatment. Most clinicians and programs remain fixed on the gender binary world. Most treatment focuses on women. The resources and understanding of eating disorders in men are scant, but the concept of eating disorders not reliant on gender barely exists.

Many in the newest generation of people struggling with eating disorders live in a world with a broader understanding of gender. One central message is that gender is not a defining element of being a person, and the goal is to treat a person, not a man or woman.

Adaptations in the eating disorder treatment world are slow and minimal. Paying attention to pronouns is a start and one of the few things clinicians have begun to consider.

The larger impact on this field remains to be seen but will likely lead to several significant changes.

Diagnoses are still dependent on gender and need to be seen from a gender neutral, clinical standpoint.

Many treatment approaches see gender as a focus of the philosophy. Feminism and the way women are seen in society are a large part of the history of eating disorder history and recovery. Treatment needs to be revamped to focus on recovery and not gender.

The gender binary understanding of eating disorders will become increasingly moot in a world of seeing people as people. Accordingly, clinicians need to learn how to treat people as individuals. Although this statement may seem clear, the profound effects of separating gender from treatment are yet to be seen.

Last the societal pressures that engender eating disorders such as the drive for thinness, an ideal body type, fatphobia and social media influence are equally powerful drivers for these illnesses for all people. This assumption needs to be central to all clinicians on the field.

The underlying reason for the continued increased incidence of eating disorders has changed enormously in the last forty years. I’ll look more into this decades long shift and how treatment needs to change with the changing idea of gender in subsequent posts.

The Role of Psychiatric Medications in Eating Disorder Recovery

Psychiatric medications are a part of most eating disorder treatment plans but are usually a secondary element of the path to recovery.

Although medications can help with some eating disorder symptoms, mostly Binge Eating Disorder and Bulimia, the purpose of psychopharmacology is usually to treat the symptoms secondary to the eating disorder itself.

I have written many posts about which medications treat binge eating and how effective they are. In this regard, medications play a clear and specific role in treatment.

For most other people with eating disorders, psychiatric medications are used to ease other symptoms. It is common to confront depression, anxiety obsessive-compulsive disorder and panic attacks as part of recovery. In addition, trauma is frequently connected to eating disorders and treating PTSD symptoms can help as well. Addressing these symptoms can help the person feel more able to eat regularly while managing the eating disorder thoughts and urges.

Often as the eating disorder improves, people taking medications for secondary symptoms find they can lower or even stop the medications in time. Many people, though, continue to find that the medications remain effective after recovery as well, so each individual needs to consider the best use of medications through the process.

A much smaller percentage of people with eating disorders learn that the eating disorder is the secondary diagnosis. This means that treating the primary diagnosis with medications can successfully lead to remission of the eating disorder as well. In these unusual cases, the psychiatric symptoms cause the eating disorder. Depression, Bipolar Disorder, Post-Traumatic Stress Disorder and even Attention Deficit Disorder can cause an eating disorder as a secondary condition. It’s important to recognize how rare this situation is and not to think this outcome is likely.

Seeing a psychiatrist knowledgeable about eating disorders is an important part of any recovery program. It’s crucial to know medications rarely play a central part of treatment but are necessary for many people to help them get well.