Each eating disorder is unique, and the appropriate treatment approach varies depending on the severity of the illness, as well as one's medical and psychiatric status. While one person may be able to spend an hour each week with a therapist and interrupt their maladaptive thoughts and behaviors, another may need to spend weeks or months at each stage of the eating disorder treatment continuum (inpatient, residential, partial hospitalization, intensive outpatient) before general outpatient care can sufficiently support their recovery. Even though each recovery journey is unique, more than three decades in this field has revealed a single best practice that I believe can benefit every eating disordered individual -- a multidisciplinary treatment team.
Simply put, a multidisciplinary treatment team means that professionals across multiple disciplines are involved in the patient's recovery process, including psychiatry, therapy, dietary and internal medicine. A multidisciplinary approach makes sense when we consider that eating disorders have psychiatric, medical, psychological and sociocultural influences, and thoughts and behaviors span body shape, size, weight, food, eating and exercise. In light of this constellation of factors, it makes sense that specialists in each area would collaborate to help patients address their disorder and work towards recovery. Below are brief descriptions of the important role each discipline plays in the eating disorder treatment process.
Psychiatrists: Psychiatrists are medical doctors specializing in the diagnosis and treatment of mental illnesses. Eating disorders are mental illnesses that significantly affect the chemistry and functioning of the brain. Psychiatric comorbidities, including depression, anxiety, bipolar disorder, obsessive compulsive disorder and substance abuse, commonly occur alongside an eating disorder, which highlights the important role of psychiatrists in eating disorder treatment. In addition to helping patients analyze their eating disordered thoughts and behaviors and develop healthy coping skills, they can prescribe medications to alleviate psychiatric symptoms. Psychiatric stability is very important in the recovery process, in large part because eating disorders have the highest death rate of any mental illness, and a significant percentage of those deaths are suicides.*
Therapists: Eating disorders are complex mental illnesses with significant psychological underpinnings. Patients use their eating disordered behaviors to manage their intense anxiety and avoid feeling painful emotions. Just like an addict uses their drug to numb the impact of trauma or pain, eating disordered individuals use restriction, bingeing and purging as their tool for emotional avoidance. Therapists and patients explore moods, feelings, thoughts and behaviors related to the eating disorder, as well as influences and triggers of the eating disorder. Therapy sessions also help patients learn healthy coping skills and application of those skills in challenging situations. Family therapists can be important in the recovery process as well -- eating disorders affect the whole family, and everyone deserves support. Family therapists work with patients and loved ones to provide education about the illness and ways they can be supportive during the recovery process. Alternative therapies, including art and movement therapies, can also help patients safely explore painful emotions that may be difficult to articulate using words alone.
Registered Dietitians: It's right here in the name -- maladaptive behaviors, thoughts and attitudes toward eating and food are at the heart of an eating disorder. Restricting, bingeing and purging food and the development of strange or unhealthy patterns of eating must be addressed as part of the recovery process. Registered dietitians specialize in helping people normalize their patterns of eating and in the case of anorexia nervosa, help patients to safely restore weight. In addition to the development of an individualized meal plan, dietitians can help patients address other issues related to food and eating, including exposure therapy (food challenges, grocery shopping and restaurant outings), cooking, plating and portioning, and embracing the social aspect of meals.
Internal Medicine Physicians: Prolonged eating disorder behaviors like starvation or purging often result in serious medical complications. Internal medicine physicians play an important role in managing these dangerous and uncomfortable symptoms to help patients maintain the necessary medical stability to interrupt behaviors and engage in the intensive therapeutic work of recovery.
Pediatricians: Eating disorders affect children and teens in addition to adults. In fact, nearly 95 percent of eating disorders develop between the ages of 12 and 25.** When addressing an eating disorder in a child or young adult, their pediatrician can be a valuable ally in the identification of the illness as well as the recovery process. Pediatricians are often the first line of defense in diagnosing an eating disorder when they notice significant changes in weight (compared to the normal growth chart) or common medical symptoms of eating disorders. They can safely address medical complications and comorbidities, or refer to other medical doctors specializing in the care of children and teens with eating disorders.
For many people struggling with eating disorders, a treatment team comprised of some or all of the aforementioned treatment professionals can help people achieve eating disorder recovery in an outpatient setting (where the patient continues to engage in the activities of daily lives while living at home). However, in some cases, the serious medical complications and psychiatric comorbidities associated with eating disorders may necessitate a higher level of care. Higher levels of care include medical hospitalization, inpatient or residential eating disorders treatment programs or partial hospitalization programs, in which patients participate in a full day of treatment programming and practice recovery skills during evenings at home or in apartment communities near the treatment center. In these higher levels of care, a patient's treatment team should consist of all of these professionals working together in a safe, contained setting to restore medical and psychiatric stability and facilitate psychological and dietary interventions to support eating disorder recovery.
If you're struggling with an eating disorder, call the National Eating Disorder Association hotline at 1-800-931-2237.
Need help? In the U.S., call 1-800-273-8255 for the National Suicide Prevention Lifeline.
* Mortality in Anorexia Nervosa. American Journal of Psychiatry, 1995; 152 (7): 1073-4.
** Substance Abuse and Mental Health Services Administration (SAMHSA), The Center for Mental Health Services (CMHS), offices of the U.S. Department of Health and Human Services.