Living With Food: The Science Supporting Eating Disorder Treatment

By Dr. Lucene Wisniewski and Sarah Emerman

Often times individual therapy is an indicated and vital part of eating disorder treatment. If the need for individual therapy is determined, our assessment clinician will match you to your individual therapist based on personality fit and the treatment that the therapist specializes in. For example, if a dialectal behavioral therapy treatment plan is indicated, she will want to match you with a therapist who specializes in dialectical behavioral therapy. While she will do her best to make the best match possible, when you first meet your therapist you will want to ask yourself if it feels like a good fit. Ideally this will be the person with whom you will share your struggles. Therefore, at your first individual therapy appointment your job will be to judge how comfortable you feel with your therapist, while taking into consideration how comfortable you typically feel when first meeting someone new. Your therapist’s job in the first session will be be to get to know and understand you. While you will have already told the assessment clinician details about your eating disorder symptoms, your individual therapist will often ask these questions again, as she will want to hear the answers directly from you.  

The other important part of the first session will be to discuss your expectations and goals for individual therapy. If you have an eating disorder, individual therapy will not just be about talking and feeling better, the focus will be on changing your behaviors and learning how to generalize skills. The therapist will therefore help you to determine your goals and figure out how to reach them. Each week you can expect to review food logs, discuss how the previous week went from a behavioral perspective, and set an agenda based on things both on and off your diary cards. You will also review any homework assigned from the previous session and set new goals for the week.

At CCED individual therapy is primary. Other services such as nutrition, psychiatry, skills group, and higher levels of care are considered to be adjudicative to individual therapy. It is with your individual therapist that you will discuss treatment planning and problem solve how to get your needs met and meet your goals in a collaborative way.  

If you are interested in finding a therapist at CCED, please contact us at (216) 765-0500.  

Join staff dietitian and yoga teacher Julie Norman for gentle yoga sessions focused on the tradition, rather than the trend, of yoga. Sessions are held Mondays from 6:15 pm - 7:30 pm.

• No experience necessary
• No charge or registration required
• Bring your own yoga mat
• Must be medically stable and over 18 to participate

Sessions are open to anyone interested in practicing yoga in a safe, fun, body positive environment!

This poem was written by one of our clients. We share it with her permission in hopes that it will inspire others to seek treatment and support. We will resume with "What to expect at CCED" next week. Should you have any questions or comments about this post, please email blog@eatingdisorderscleveland.org.

There's a war in my head that keeps raging within

I'm sure to most people my thoughts would be sins.

My heart wants to thrive and love without a net,

My head tells my heart...everything is a threat.

My heart wants to live and laugh and play,

My head tells my heart...no one will ever stay.

My heart wants to be cherished and give all it's got,

My head tells my heart...you'll never get that shot.

My heart wants to feel like I'm a pretty girl,

My head tells my heart...you'll never get that deal.

My heart wants to flourish, live, and bloom,

My head tells my heart...there'll always be doom.

My heart wants to grow and experience romance,

My head tells my heart...you will never get that chance.

All I ask is a chance in this life to be free,

Free to be loved and free to be me.

A primary care physician (PCP) is a necessary part of eating disorder treatment. In fact, the PCP is often the first person with whom you will discuss your eating disorder and eating disorder treatment. For many clients who come to CCED it is the PCP who makes the initial recommendation. PCPs have varying knowledge of eating disorders. Some are experts and some may only have a passing knowledge. As a patient, it is therefore crucial that you are able to share information with your PCP that will help them be most effective in your care. One of the things we can do at CCED is to provide you with resources to make your relationship with your PCP as therapeutic as possible. At CCED we have worked with the Academy for Eating Disorders to prepare guidelines for the PCP. Please go to the link through our resources page to see the guide that AED has prepared. Or click here.

Your PCP may be the only medical professional who knew you before your eating disorder appeared or became severe enough to require specialized care. As a result they will be able to share information with your eating disorder team that will help guide your recovery. The PCP therefore has multiple roles. One will be early recognition and diagnosis of the eating disorder. A second will be monitoring you throughout treatment to insure that medical side effects are not present. Third is to provide background information about previous health, weight growth, and development that will guide the goals of eating disorder treatment. Fourth will be to consult as a member of your treatment team for recommendations on the appropriate level of care. 

At CCED we will actively engage your PCP at all levels of care. If you do not have a physician to work with when you come here we will assist you in finding one who is comfortable working with patients with eating disorders.

If you have any questions or comments about this post please email blog@eatingdisorderscleveland.org.

Contributions by Sarah Emerman

Take a listen to this podcast on the Diane Rehm Show about the Maudsley Method of family based treatment. The podcast features Harriet Brown, author of Brave Girl Eating, Lynn Grefe, CEO of NEDA, and Dr. Ovidio Bermudez, the Medical Director of the eating disorders program at Laureate Psychiatric Clinic.

New Treatments for Eating Disorders

National Public Radio

Thursday August 26, 2010

With rare exception, eating disorders cannot be treated by medications alone. Nonetheless, part of your treatment at CCED may involve the use of medication. There are several reasons for this. First, some medications have been shown to be helpful in reducing some eating disorder behaviors. In particular, purging behavior can be significantly reduced for many people with the use of selective serotonin reuptake inhibitors. The most studied medication for this is Prozac. Prozac has also been shown in some studies to reduce the risk of relapse in patients with anorexia. Additionally, other symptoms besides an eating disorder may also be present when the eating disorder is severe enough to require treatment. Anxiety and depression are seen in over half of patients with eating disorders. For some of these individuals, the use of medications to treat anxiety and depression is critical and may lead to a significant reduction in misery and may also lead to an improvement in eating disorder symptoms. 

Not everyone welcomes the use of psychiatric medications. There may be well founded reasons to want to avoid these medications based on personal beliefs, previous use, or physical symptoms. At the same time, many people are very pleased to discover that medications exist that can provide them with more rapid relief of depression, anxiety, and behaviors. For this group of people, options may be available. 

In order to make good decisions about medications, it is quite common for all patients receiving an assessment at CCED to be asked whether they would also like a psychiatric assessment. Psychiatry is available at CCED for any patient having any treatment here. For patients in higher levels of care, a psychiatric assessment is necessary and is provided as part of that higher level of care. 

A psychiatric assessment does not mean that you will take medication. It does mean that medication options, risks and benefits, pros and cons, and personal choice can be discussed so that the best and most effective treatment plan can be created for each individual.

If you have questions or comments about this post, please email blog@eatingdisorderscleveland.org.

Contributions by Sarah Emerman