Living With Food: The Science Supporting Eating Disorder Treatment

By, Dr. Mark Warren

As evidence-based care has progressed over the last 20 years the ways we think about eating disorder treatment have also changed. In the world of eating disorder treatment historically there has been much focus on underlying causes of the eating disorder prior to the cessation of behaviors. The advancement of effective care for eating disorders has shifted the focus of treatment in that medical stability and behavioral control should be the primary focus until the client’s physical health in no longer in danger. After this is accomplished the focus shifts to feeling better about self, body, and life. The reason we think about it in this way is relatively straightforward, although it may not appear as clear if you are the one receiving treatment. From a patient or family perspective it is often the misery of the eating disorder, the associated physical pains, discomfort, and anxiety that drives a person to seek treatment. While these issues will eventually become prioritized, from a treatment perspective, the risk of sudden death or significant organ damage is real and often stays primary for a significant amount of time. Studies on sudden death from an eating disorder, particularly in those who have a restrictive component, tend to be correlated with heart rate and EKG changes. Both of these are likely invisible to patients and family but may be the dominant issue for the treatment team. It is not until medical issues are resolved that it becomes safe to move on to the next phase of treatment.

The best way to handle medical issues related to an eating disorder are typically re-feeding and decreasing life threatening behaviors. So, regardless of what may have brought someone into treatment, this will be the first treatment priority. As medical stability is reached the treatment focus will shift towards specific eating disorder behaviors and urges of the client. The presence of these behaviors presents a forward medical risk and until these behaviors are resolved the risk of relapse and the return of medical instability is a primary concern. This may feel quite frustrating, as the movement away from eating disorder behaviors may be associated with greater distress. Although we will try to manage the distress, the behaviors continue to be the primary focus because they continue to present the life-threatening part of the illness. Only after behaviors are resolved to an extent that the life-threatening component is no longer present can we move to the more quality of life issues and appreciation of what recovery can look like.

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Contributions by Sarah Emerman