Flexibility in Eating Disorder Treatment Planning

Too often, I see patients struggling for years with an eating disorder feel entirely misunderstood. The EDIC is so focused on meal planning, medical stability and weight that the underlying psychological and emotional suffering and extreme isolation are ignored.

Yes, medical stability and adequate nutrition are essential. The old adage of the field is that food and health need to stabilize first before any therapy can lead to gains in recovery. On the whole, I agree with that statement, but seasoned clinicians also know that treatment is never one size fits all. There is no one right way to treat people with eating disorders.

For many people—who are easy to find congregating on online communities trying to find a different way to get better—the standard protocol for treatment does not work. They are often more traumatized by rigid treatment rules or hardened by an inflexible system into an even stronger fixed belief system governed by the eating disorder.

For this not small cohort, there needs to be another way to recover. For some, they need support to build identity outside the eating disorder before they can even contemplate changing behaviors. Others need sustained trauma work to calm their nervous system in order to make changes in food possible. Yet another group might need a period of time to establish trust with a provider, often after a series of difficult clinical relationships, in advance of any talk about food stabilization.

None of these decisions obviate the need to work on changing eating patterns, but the plan for recovery needs to take into account all elements of a person’s physical, medical and psychological circumstances before developing the initial treatment.

In a common treatment plan currently, the EDIC urges clinicians to focus on admitting sick people to their programs, putting them through the treatment mill followed by discharge into their outpatient program. The independent outpatient team may be in limited contact, at most, with the patient during this period of time, but the therapeutic relationship becomes less central, often for months.

Discharge leads to a high chance of relapse for two reasons: the patient’s lack of experience eating outside a treatment setting and the prolonged separation of the patient from the outpatient team. Discharge planning tends to be haphazard and often last minute so there is little chance to prepare the patient for a smooth and successful transition. For this reason, the decision to refer to residential programs needs to made judiciously when more intensive intervention is necessary.

The treatment plan for a patient with an eating disorder must take into account all factors needed for recovery and not just follow a standard protocol. Any plan needs to factor in what each individual needs rather than follow a series of steps for all people with eating disorders. Although certain steps are necessary at some point, the path to recovery needs to be flexible.