Living With Food: The Science Supporting Eating Disorder Treatment

I was at my block party last night and fell into a conversation about being in your 40's with an eating disorder. Turns out a friend, Meagan (note- all names have been changed in this blog post), who is a dancer, has been pulling away from a friend of hers because her friend's eating disorder was just too intense. Her friend has been hospitalized a number of times, is still unable to acknowledge her ED, likely is in renal failure, and is probably going to die soon. Another neighbor, Tina, happened by and with some sense of disgust started explaining that she, Tina, couldn't understand eating disorders, had no food issues, loved to run just for the endorphin high, and wasn't eating at the party because she had already had dinner beforehand. I felt like Meagan at that point, just wanting to pull away. (It was a party, after all.) I made a few attempts to say that everyone has food issues and that it wouldn't be so strange if Tina had a couple of things to work on, and so on, which only served to end the conversation.

So why is this important? Because it is so clear that your best chance to get better is to get help early, have aggressive and effective treatment, and get on with your life.  If you are 45 it probably means there was nothing close to effective treatment when you were young. If your illness didn't get better through caring, family, eating and fortune, you are likely very ill now. But there is still help for many. If you are younger, or know someone who is, get yourself or them into treatment now. Don't expect anyone to just figure it out. The thoughts, feelings and behaviors are too deeply set. Don't wait to see what will happen. The odds are high that what will happen is getting worse, not getting better. There is effective treatment now. You can get better.  Now I have to go follow up with Tina.

Next week: Why don't all therapists use effective treatment?

Contributions by Sarah Emerman 

This is an article from the Swedish medical data bank on family education and development of Eating Disorders.  It is one the first epidemiological studies of this sort.  The information may not be complete, but it is an interesting addition to the literature.  Check it out below:

Note also that very few patients got any treatment at all.  Hopefully we can change that. 

There are a great number of therapists and programs that treat eating disorders. Since there is no national qualification to be an expert, it is crucial that the patient and family know if therapy is working as soon as possible.

When you first meet a therapist or talk to a program, find out why they think they know how to treat eating disorders. If they say they’ve had training, ask where and when their training was obtained. If they say they have treated other patients, ask how many and if the therapist has tracked their progress. Training and experience are crucial. Expert care for eating disorders is almost always needed to see improvements.

It is important to remember that all effective eating disorder therapies involve changes in behavior. If treatment for your eating disorder is working, your eating disorder behaviors should be lessening. The behaviors that should be decreasing may include:

• Restriction
• Binging 
• Purging 
• Over-exercise
• Pill use 

People may be surprised to learn that talking about your family and the cause of your eating disorder are not effective ways to reduce behaviors. These are things to discuss after your behaviors have ceased. Because nobody really knows what causes an eating disorder, therapies that look for causes before symptoms are under control are likely to be ineffective. If you are being told that you have to know why you have an eating disorder before it will get better you probably are not getting effective therapy.

Next week: The importance of getting treatment early on. 

Contributions by Sarah Emerman

The term “evidence-based treatment” refers to therapy that has demonstrated statistically significant improvements or changes in behavior. In most kinds of healthcare, the only kind of treatment a person would accept is something that is evidence based. If someone was getting treatment for cancer, diabetes, or another life threatening illness, they would seek out care that had significant evidence that it worked. Unfortunately, the history of psychiatric treatment is filled with ineffective care used because it was marketed well or because there was nothing else available. Luckily this is no longer true.

Evidence-based therapy for the treatment of eating disorders has only existed for the past 15 years. Although various types of therapy have been proven to show progress in some clients, evidence to support any given treatment is not as good as we would like it to be. It is, however, better than it used to be. The major limitations to research are the short length of many trials in what we now know are long term illnesses, and the difficulty of doing randomized controlled clinical trials. Nonetheless, given that there was no effective treatment prior to 15 years ago, what we know now is a significant improvement.

For adults, evidence-based treatments include Cognitive-behavioral therapy, Dialectical-behavioral therapy,and Interpersonal therapy. If you are 18 years or older and are currently suffering from an eating disorder, these are the therapies to try first. If you are under the age of 18 and have anorexia, the Maudsley method is the only treatment that is evidence-based and should therefore be tried prior to any other treatment. We will cover each of these treatments separately over the next few weeks.

Next week: How can I tell if my therapy is working?

Contributions by Sarah Emerman