Hope at the Start of Eating Disorder Treatment

I see hope in eating disorder treatment as integral to its success and woven into many parts of the process.

The first step is a clear, logical, reliable plan to start treatment. Initially, the approach needs to be concrete and specific to allow for a sense of accomplishment and the establishment of a team focused on recovery.

Although the DSM uses a list of symptoms to describe and diagnose eating disorders, the criteria don’t explain the confusing and tricky elements of how these illnesses work. A clinician can ask a series of questions and write an elegant medical note about someone’s eating disorder without a true picture of what any one individual’s daily struggle looks like.

The only way to establish a mutual understanding of an eating disorder is a food log. The log creates a way for clinician and patient to talk about food and elucidate the details of how the eating disorder works.

Fairly quickly, the timing of food each day, gaps in time between eating, the size of meals or snacks, urges to use behaviors and emotional triggers for symptoms become clear in the log very quickly. A therapist can ask specific questions that help the patient better understand how they are tricked into the same patterns by the eating disorder and also how to start to alter the patterns.

The log also creates a bond between therapist and patient. By having the log to examine together, the eating disorder feels separate from the patient, an entity between the patient and therapist which they can discuss honestly, openly and without judgment. Suddenly, the shame isn’t so present, and the goal of working together on getting well is paramount.

Last, that feeling of together, of not being alone, in the struggle to get well is the first glimmer of hope. The changes to daily behaviors may be small at first, but the log implies that the patient will have help directed at the most difficult moments of the day and that the therapist will be involved immediately in the actual behaviors themselves.

The next post will address identifying emotional and psychological development that never happened because of the eating disorder and how restarting this development generates hope.