Types of Treatment
The main components of professional treatment for eating disorders are: physical health management, nutritional advice and mental health management. In addition, drug treatment, support groups and some alternative therapies may be useful.
Physical Health Management
Nutritional Counselling and Advice
Mental Health Management
Cognitive Behavioural Therapy
Dialectical Behavioural Therapy (DBT)
Intensive Short-Term Dynamic Psychotherapy (ISTDP)
Mindfulness Based Therapy
Family Based Therapy
The Maudsley Approach
Although an eating disorder is a mental illness, it often has major impacts on physical health.
There are many physical complications that can result from an eating disorder. Left unattended, these can lead to serious health problems or can even be fatal. It is important that physical health is monitored, preferably by a medical practitioner with experience in the area of eating disorders. For adolescents and children with eating disorders, a paediatrician is normally involved in the medical care.
A medical examination may involve a large number of tests.
Medical problems that may require treatment and care include anaemia, heartburn, disturbances in heart rhythm, low bone density (osteoporosis), kidney problems, dental problems.
There will be variations in the medical team that may be involved in the care and treatment of a person with an eating disorder, depending on the severity of the illness, but it may include a paediatrician, dietitian or nutritionist, physiotherapist and dentist, ideally working in conjunction with mental health practitioners such as a psychologist and/or a psychiatrist.
Establishment of a well-balanced diet is essential to recovery. For this reason dietitians or nutritionists are usually involved in the treatment, working in conjunction with other professionals in the treatment team.
Nutritional counselling and advice may be useful to help the person identify their fears about food and the physical consequences of not eating well. Education about the nutritional values of food can be beneficial particularly when the person has lost track of what ‘normal eating’ is.
In addition to medical and dietary management, most people with eating disorders will need some kind of therapy, counselling or psychological intervention. This section below explains the basis of the most commonly employed approaches to mental health management for eating disorders.
The basis of psychological treatment is in forming a trusting relationship with the therapist and addressing pertinent issues to the person such as the thoughts, feelings and behaviours that led to the development and maintenance of the eating disorder. This may include issues with anxiety, depression, poor self esteem and self confidence and difficulties with interpersonal relationships. The treatment is ultimately aiming to empower the person to realise their own resources to overcome their difficulties.
Psychotherapy aims to identify the psychological stresses that may have contributed to the onset of the eating disorder. Through talking and other techniques (personal development exercises, etc) the aim of this process is to reduce the feelings of inadequacy, low self-esteem, negative body image and guilt etc and help people to develop their life skills.
For more information on psychological treatment offered at EDV click here.
Some particular models of psychological therapy that may be used in the treatment of eating disorders include:
CBT has become a popular form of treatment for people experiencing eating disorders. Based on the premise that thoughts and feelings are inter-dependent, CBT encourages people to re-examine and challenge existing thought and behaviour patterns. Challenging distorted or unhelpful ways of thinking can allow healthier behaviours to emerge.
In relation to eating disorders, CBT aims to change the way the person thinks about food and themselves. It aims to identify the characteristic thoughts that reinforce disordered eating behaviour and encourage more positive ways of thinking. Some thought patterns that CBT may challenge include black and white thinking, magnification (of importance of events etc) and errors in attribution (misunderstanding of the relationship between cause and effect).
IPT has been used successfully in the treatment of eating disorders, particularly bulimia and binge eating problems. IPT focuses on interpersonal difficulties in the person’s life which are considered to be the basis of the eating disorder. Generally, therapy involves three phases including the identification of interpersonal difficulties, the development of a contract to work on several specific issues and the assessment of changes. The therapy is usually medium term (16-20 weeks).
In the initial stage, the therapist will generally explore the history of eating problems, interpersonal relationships prior to and after the development of an eating disorder, significant life events and self-esteem and depression issues. Major problem areas are identified and typically fall into four categories; grief, role disputes with other people, role transitions and interpersonal skills. A therapeutic contract is developed between the client and the therapist based on the major problem areas in the person’s life.Mindfulness traces its origins to Buddhism. In the medical and psychological arena, it's been seen as a way to promote better health, lower stress, decrease anxiety, and gain control over unwanted behaviours, like binge drinking, substance abuse, overeating or undereating.
DBT is also a popular form of therapy used to assist people with eating disorders. Based on an emotion regulation model, the idea is that eating disorders (and disordered eating) are a way to deal with emotional distress in the absence of more appropriate coping strategies. DBT aims to help people manage, process and deal with their emotions in a healthy and productive way. Most studies so far have looked at people with Bulimia Nervosa and Binge Eating Disorder.
ISTDP is a brief, focused therapy designed to help people deal with a number of mental health issues. It uses an interactive approach where the professional and the client work together to identify unhelpful ‘defences’ and emotional triggers that can lead to disordered eating and other problems. ISTDP aims to help the person focus on how they experience emotions, and skills are then developed to help the person change the way they think, feel and behave.
Mindfulness based therapies have in common an emphasis on the practice of mindful meditation, mindful eating, yoga and a range of other techniques, aimed at increasing awareness and acceptance of eating behaviour and the self. Unlike CBT, the aim of mindfulness is 'letting go' or disengaging with negative thoughts, rather than learning to challenge them.
Mindfulness based therapies include Acceptance and Commitment Therapy (ACT), Mindfulness Based Stress Reduction (MBSR), Mindfulness Based Cognitive Therapy (MBCT), Dialectical Behaviour Therapy (DBT) and Mindfulness Based Eating Awareness Therapy (MB-EAT). All these approaches have been investigated empirically and have been found to benefit individuals with eating disorders.
The main purpose of group therapy is to provide a supportive network of people who have similar issues to explore issues around their eating disorder. Groups may address many issues from alternative coping strategies, underlying issues, ways to change behaviours, triggers to personal needs and long-term goals. Groups are generally closed in attendance for a specific period of time (eg. 8 weeks).
Family based therapy (FBT) is based on the idea that changes within the family unit will result in a reduction of eating disordered behaviour. It usually involves the people that are living with or are very close to the person with the eating disorder. This commonly includes parents, siblings and/or spouses, although it can also involve grandparents, aunts or other close carers.
The family, as a unit, is encouraged to develop ways to cope with issues that may be causing concern including, but not limited to, the eating disorder. The success of this treatment is dependent upon the family being willing to participate, often in weekly therapy sessions for a number of weeks or months, and make changes to their behaviours. Family therapy can also offer education to other family members about the eating disorder and how better to support the person they care about. Overall the family is encouraged to develop healthy ways to deal with the eating disorder.
Family based therapy does not imply that family factors were involved in the development of the eating disorder, but acknowledges that every family has issues that are difficult to deal with, and that the family can work together to help overcome these issues. As a part of a person’s recovery from an eating disorder, it can be useful to address issues in the family context such as conflict or tension between members, communication problems, difficulty expressing feelings, substance abuse or physical or sexual abuse.
The Maudsley Approach is a particular method of family based therapy for adolescents with anorexia, that was pioneered at the Maudsley Hospital in London. It is applied to adolescents 18 and under who are living at home with their families, and whose anorexia is of recent onset. Recent research has shown that it has also had some success with adolescents (18 and under) with bulimia; and a modified Maudsley Approach is showing some success with young adults.
The Maudsley Approach builds on evidence that family therapy approaches are superior to individual therapy approaches with younger patients. It involves the family right from the start of treatment and relies heavily on parent involvement in the re-feeding of the child with an eating disorder. The family is moved away from seeking the causes or blaming itself for the disorder, and is encouraged to focus its resources and strengths on moving their child towards recovery.
This treatment model, like all treatment models, isn't for everyone. The responsibility for re-feeding a child, while empowering for parents, is also labour-intensive, time-consuming and exhausting. Parents, like the nursing staff in an inpatient setting, and are effectively "on duty" all day for feedings, including snacks. At least one parent or carer needs to be present for all planned snacks and meals. Parents also need to be on the look-out for purging behaviours such as vomiting or compulsive exercising, and to try to employ strategies to distract and prevent these behaviours occurring.
Drug Treatment (Anti-depressants)
Drug treatment may be used to treat hormonal or chemical imbalances. In the treatment of eating disorders, anti-depressants belonging to the Selective Serotonin Reuptake Inhibitor (SSRI) group such as Zoloft, Prozac, Aropax and Paxil are commonly prescribed.
Research suggests that anti-depressants such as Prozac are useful in suppressing the binge/purge cycle, particularly for people with Bulimia Nervosa. For people experiencing Anorexia Nervosa, they may be useful in stabilising weight recovery. However, like all medications, not all anti-depressants work for everyone as people respond differently. Some people experience side effects in varying degrees of severity such as anxiety, nausea, loss of or increase in appetite, nervousness, insomnia, headaches, rashes, abnormal dreams and blood pressure changes.
The effectiveness of drug treatment increases when combined with other forms of therapy such as Cognitive Behavioural Therapy.
Anti-depressant medications have been found to be useful for treating some instances of depression and anxiety that may accompany an eating disorder.
EDV has compiled a fact sheet providing general information on eating disorders and anti-depressant medication for your reference. Please click here to view the document.
Support groups differ from therapy groups in that they are intended to offer mutual support, increased understanding and information. Where a therapy group is generally closed in attendance and runs for a specified period (eg. eight weeks), support groups are generally open in attendance (people can attend as often as they wish) and meet on a regular basis (eg. fortnightly). Generally, support groups are not run by professionals, but by people who have had experience with the issue, either personally or indirectly.
EDV runs separate support groups for people with an eating disorder and for families and friends who are caring for someone with an eating disorder. EDV also runs regular combined groups where people with an eating disorder and relatives and friends meet together. For more information on support groups, including dates and locations, please click here.
Information about eating disorders, their effects, treatments and recovery stories etc, can be a useful resource for people experiencing an eating disorder and their family and friends. Books are also obtainable from most book stores. Eating Disorders Victoria has a reading list and a library; for more information on borrowing please click here.
Alternative therapies can be useful for some people as an adjunct to psychological, nutritional and medical treatments. For instance meditation can help with reducing anxiety levels or massage can help us to reconnect with our bodies. Each approach is different, however alternative therapies are generally concerned with treating the person as a whole, including their mental and physical health and may include:
-Naturopathy is a herbal treatment method aimed at stimulating the body to heal itself.
-Acupuncture is an ancient Chinese therapy using needles and herbs to stimulate the body’s energy flow.
-Aromatherapy incorporates the use of essential oils for relaxation and stress relief.
-Meditation can be effective in promoting mental relaxation intended to create an inner calmness.
Homoeopathy aims to stimulate the body’s natural defences (anti-bodies) to illness, by introducing the problem substance into the body.
Traditional hypnotherapy typically involves a sleep-like state or altered state of consciousness usually induced by a therapist. It is based on the premise that during this altered state of consciousness, a person is more responsive to suggestions and has greater access to influential functions usually outside their conscious control.
However, more recent theories of hypnosis may include role playing, story telling and interpersonal influence between the therapist and the client.
- Last revision date: Wednesday, 27 May 2015 11:33