Eating Disorder Treatment | Eating Disorders Victoria
Home ~ My recovery journey ~ Getting better

Getting better

Home ~ My recovery journey ~ Getting better

This page provides an overview of what to expect when recovering from an eating disorder. This includes what recovery means, your treatment team, types of treatment, treatment settings and your rights under The Mental Health Act (2014).

What is recovery?

The term ‘recovery’ means different things to different people. For some people, recovery means that they never have another eating disorder thought again. For others, the thoughts may never completely go away, but they can manage how ‘loud’ they are so that they don’t have an impact on their everyday life.

Recovery is often a deeply personal, unique process. It involves changing your attitudes, values, feelings, goals, behaviours and skills, so that you can live a satisfying, hopeful and fulfilling life.

Just as recovery looks different for everyone, so too does the time it takes to recover. There is no set time to recovery. For a few fortunate people, recovery is quick – a matter of months. For the majority of people, recovery from an eating disorder is a much longer process, perhaps taking years.

There is good evidence that generally, the quicker you start treatment for an eating disorder, the shorter the time will be until you are recovered. However, try to remember that anyone can recover, even if you have been experiencing your eating disorder for a long time.

RECOVERY STORIES

The labyrinth of recovery from an eating disorder

Recovery from an eating disorder is a complex and confusing journey. My experience is that it is not a linear pathway where one jumps a hurdle and then leaves it behind – conquered.

Read Jo's story

My treatment team

The management of an eating disorder often requires a multi-disciplinary team. This team of professionals can address the physical, psychological, behavioural, social and cultural dimensions of the disorder.

General Practitioner (GP)

For most people, a GP is usually the first point of call for a person with an eating disorder. A GP will assess symptoms, perform medical examinations and tests, and give diagnoses where appropriate. Where a moderate to severe eating disorder is suspected, GPs will often refer patients to specialist practitioners, such as a psychologist, for further assessment and treatment. GPs can also prescribe drug treatments such as anti-depressants.

GP’s often remain a constant part of someone’s treatment team. This is because they can continue to monitor a person’s physical health as well as provide referrals to services as needed. Finding a GP that you trust who has experience in treating eating disorders can make a big difference to your recovery journey.

Psychologist

Psychologists are health professionals that specialise in mental health. They provide psychological therapy to people who are facing a range of issues, including eating disorders. In Australia, psychology is a regulated profession, with all psychologists required to be registered with the Australian Health Practitioner Regulation Authority (AHPRA). You can check if your practioner is registered here.

When a psychologist is part of your treatment team, they will develop a treatment plan that will specifically address the issues connected to your eating disorder. They can also provide counselling for other issues not directly related to your eating disorder, such as family problems.

You may come across Clinical and Registered psychologists. The main difference between the two is the study pathway they have taken to become a psychologist. Clinical psychologists train for six years at university with practical experience in at least three different places. Registered psychologists train for four years at university, then complete two years in the workforce under the supervision of an experienced psychologist. Both clinical and registered psychologists can use the same treatment approaches with clients.

Psychiatrist

Psychiatrists have a medical degree and additional qualifications in psychiatry. They will be registered with the Medical Board of Australia and also be a member of the Royal Australian and New Zealand College of Psychiatrists (RANZCP). Because they are medically trained, in addition to providing therapy, psychiatrists can prescribe medication, are able to monitor how well the medication is (or is not) working, and can assess and monitor physical symptoms. A referral to a psychiatrist can be obtained from a GP or from another medical practitioner.

A psychiatrist may enter your treatment through a GP referral. Depending on the GP, this may be at the start of treatment, or further down the track if other psychological therapy isn’t proving to be as effective as hoped.

Dietitian

Dietitians provide nutritional assessment, eating plans, and nutritional education. Dietitians are vital in the process of nutritional rehabilitation and the development of healthy eating patterns. They work with the person with the eating disorder to identify fears of food, and discuss the consequences of not eating well. They also work with the individual to recognize feelings of physical hunger and fullness and a healthy response to these.

Dietitians have generally completed a four-year course in nutrition and dietetics. When looking for a dietitian, it is recommended you ensure they are an Accredited Practicing Dietitian (APD).

Social Worker

Social workers are graduates who provide counselling including individual, couple and/or family therapy. They may also facilitate self-help and support groups. Their role in the treatment team may include assisting with information and advice on living situations, relationships, financial resources, employment, health and education. Social workers may also be trained in Family-Based Therapy, an evidence-based treatment approach.

Counsellor

Many people who are not psychologists or psychiatrists offer counselling, and this can be a very helpful part of treatment.  Many counsellors have completed specialist courses in counselling technique or welfare, but a person can work as a counsellor in Australia without being a member of a professional body or having any specific qualification.  It is wise to ask any prospective counsellor about their training and experience, and be upfront if you have any concerns about their practice.

Pediatrician

A pediatrician is a doctor who provides specialist medical care to infants, children and adolescents. There are general pediatricians and specialist pediatricians such as pediatric cardiologists, gastroenterologists, developmental experts, etc.  Pediatricians are usually involved in the treatment and care of adolescents and children with eating disorders.

Do I need professional help? Can I recover on my own?

Recovery from an eating disorder can be extremely difficult on your own. It is advised that you engage with professionals to help you through the journey. Please remember that there is no shame in seeking help. Eating disorders are complex mental illnesses and facing it on your own may impact your recovery outcomes.

How EDV can help

EDV’s clinical team specialise in treating people affected by eating disorders. Find out how you can make an appointment with an EDV psychologist.

Make an appointment

Types of treatment

There are many different treatment approaches for eating disorders. What works for one person may not work for another. It’s important to not give up if you find a treatment approach isn’t working for you.

Physical Health Management

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.

Medical problems that may require treatment and care include anaemia, heartburn, disturbances in heart rhythm, low bone density (osteoporosis), kidney problems, dental problems.

The management of physical health can be quite demanding. It will often to require regular testing (blood tests, scans, monitors) to ensure your physical health remains stable.

Nutritional Counselling and Advice

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.

Find a dietitian

EDV’s dietitian works out of our consulting rooms in Abbotsford. The dietitian is available on Tuesdays from 9am-5pm.

Make an appointment

Psychotherapy

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.

Cognitive Behavioural Therapy

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).

Interpersonal Psychotherapy

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.

Dialectical Behavioural Therapy (DBT)

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.

Intensive Short-Term Dynamic Psychotherapy (ISTDP)

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 Therapy

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.

Group Therapy

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).

Find a psychologist

EDV’s team of psychologists operate out of our consulting rooms in Abbotsford. All EDV psychologists specialise in the treatment of eating disorders.

Enquire

Family Based Therapy

Family Based Therapy is traditionally a treatment approach used for children, adolescents and young adults living at home who have a diagnosis of anorexia nervosa. The model is based on evidence that family therapy approaches are more effective than individual therapy approaches with younger patients.

FBT centres around the idea that a young person needs to regain weight to restore normal thinking and functioning. For this reason, it focuses strongly on weight restoration rather than psychological aspects associated with the mental illness. The therapy is structured in three distinct phases: 1) weight resotration, 2) restoring control of eating to a young person, and 3) returning to normal adolescent development. The time period differs for each individual, however generally ranges from 6-12 months.

FBT is essentially an intensive outpatient treatment option, whereby the family become part of the person’s treatment team. The responsibility for weight restoring a child can be labor-intensive, time-consuming and exhausting for families, particularly in the early stages. It’s important that families are connected in with good support services, such as EDV, during this time.

The most common FBT model is also known as the Maudsley Method. This approach was developed in the 1980s in London and has a strong base of evidence from around the world. It is the most promising treatment for children and adolescents under the age of 19, and is most effective if implemented in the first 3 years of the illness.

Other approaches of Maudsley Family Therapy have been developed as an adjunct to other treatment options for older individuals and individuals with other eating disorders. It’s important to speak to your health care professional about a suitable approach for you or your loved one.

FBT is offered both publically and privately in Victoria. Contact your local Child and Adolescent area Mental Health Service (CAMHS) or Child and Youth Mental Health Service (CYMHS) to discuss accessing FBT via the public mental health system in Victoria.Some private practitioners also offer FBT. A team of professionals will be assigned to your family for the duration of the treatment. It is also possible to participate in FBT by compiling your own team of private practitioners. These healthcare\ professionals must be able to work together and keep in close contact, as well as have experience using FBT.

FBT Resources

Complimentary therapies

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. Other examples include acupuncture, aromatherapy, reiki, kinesiology, cupping and yoga.

Hypnosis

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.

Medication

Medication may be prescribed when an individual with an eating disorder is experiencing another mental illness or disorder, such as anxiety, depression or borderline personality disorder.

Treatment settings

The treatment settings for eating disorders can be divided into four main settings – Community, Day Program and Outpatient and Inpatient. Everyone’s journey is different, with some people moving through all three treatment settings.

Community treatment

Community based treatment can include private practitioners, university-run psychiatric programs, group programs and outpatient clinics. They are best suited to people who are still able to engage in everyday activities whilst undergoing treatment.

Community based treatment can be accessed via the public system and the private system. If you are an adult in the public health system, you will likely be referred to Adult Mental Health Services (AHMS). Children and adolescents in the public health system will be treated by Children and Adolescent Mental Health Services (CAMHS). AHMS and CAMHS services are determined by geographical regions.

Day Program Treatment

Day programs provide an intermediary level of support for someone in recovery from an eating disorder. Day programs provide a structured day with supervised or supported meals and eating, along with ongoing therapy during the daytime. Day programs can be up to five days a week and allow the individual to live at home and benefit from family interaction overnight and at weekends.

Inpatient Treatment

Inpatient treatment programs may be required for someone who is acutely medically unwell or has severe symptoms. Inpatient programs can be in a specialized eating disorder ward in a hospital, in a medical or mental health unit, or in a private clinic. 24-hour support and care is provided.

Inpatient programs generally focus first on medical stabilisation and weight restoration.  However, inpatient treatment can also be suitable for someone who doesn’t require medical stablilisation but still requires 24 hour support due to self-harm, suicidal thoughts and eating disorder behaviours.

People with Anorexia Nervosa in particular may be admitted to hospital for ‘re-feeding’ and weight stabilisation.  Intravenous drips or a naso-gastric tube may be used (a tube inserted through the nose to the stomach).

Outpatient Treatment

Outpatient treatment is generally a step-down from inpatient treatment. Many people with eating disorders do not need 24-hour care, but they do need ongoing treatment.  These people may attend outpatient units on a regular basis, where they may be seen by a team of health professionals from many different disciplines, or they may see a solo practitioner like a dietician, a psychologist or a psychiatrist.

People are encouraged to maintain everyday responsibilities, like attending school or going to work. Therapy and support is provided to enable that person to deal with the practical and emotional difficulties caused by their eating disorder, but they must ‘go it alone’ for much of the day.

Need help finding treatment options?

It can be difficult navigating the number of treatment options on your own. The EDV Hub can help you find a suitable treatment option in your local area.

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Know your rights

The Mental Health Act (2014) is the current law governing mental health treatment in Victoria. The Act promotes voluntary treatment (whereby a person willingly engages in treatment) in preference to compulsory treatment (person is compelled to engage) and seeks to minimise the use and duration of compulsory treatment and ensure treatment is provided in the least restrictive and least intrusive way possible.

Key Principles

There are Key Principles that guide the provision of mental health services in Victoria. Health service providers must have regard to these principles and consumers and carers should be made aware of them.

Summary of key messages

  • Assessment and treatment is to be provided in the least restrictive way possible
  • People are supported to make or participate in decisions about assessment, treatment and recovery (including decisions that involve a degree of risk)
  • Rights, dignity and autonomy to be respected and promoted
  • Holistic care (which encompasses mental and physical health) is to be provided in response to individual needs
  • Best interests of children and young persons receiving mental health services to be promoted
  • Needs, wellbeing and safety of children, young persons and other dependents to be protected
  • Carers to be involved in decisions about assessment, treatment and recovery whenever possible

To read the Act or Regulations go to: www.legislation.vic.gov.au

Mental health treatment and your rights

The Mental Health Act (2014) outlines a person’s rights during assessment and treatment for their mental health issues in Victoria. To find out more about your rights as a patient under the Act, refer to the Statement of Rights.

Compulsory treatment

The Mental Health Act promotes voluntary treatment in preference to compulsory treatment wherever possible. The Act also seeks to minimise the use and duration of compulsory treatment to ensure that the treatment is provided in the least restrictive and least intrusive manner possible. This is achieved by introducing specific criteria for compulsory treatment, creating Treatment orders that operate for a fixed duration and requiring timely oversight by an independent Mental Health Tribunal.

The following steps must be taken when establishing compulsory treatment orders:

Assessment Orders
Temporary Treatment Orders
Treatment Orders

Assessment orders

An Assessment order authorises the compulsory assessment of a person to determine whether the person needs compulsory mental health treatment. A registered medical practitioner or a mental health practitioner may make an Assessment order if they have examined the person and are satisfied that the criteria for an Assessment order apply to the person. A registered medical practitioner or mental health practitioner may only make an Assessment order within 24 hours of examining the person.

Following an Assessment order, treatment may only be provided for the person’s mental illness if:

  • they give informed consent to treatment, or
  • where the treatment is required as a matter of urgency to prevent serious deterioration in their mental or physical health or serious harm to the person or another person.

For further information about Assessment Orders, please click here.

Temporary treatment orders

Temporary treatment orders authorise the provision of compulsory mental health treatment. An authorised psychiatrist may make a Temporary treatment order if the treatment criteria apply to a person subject to an Assessment Order or a Court Assessment Order.

For information regarding Temporary Treatment Orders and Treatment Orders please click here. 

Compulsory treatment and supportive decision making

Supported decision making is central to recovery-oriented practice. The Mental Health Act 2014 enables compulsory patients to make decisions about their treatment and to determine their individual path to recovery.

The Mental Health Act promotes supported decision making through:

  • advanced statements
  • nominated persons
  • second psychiatric opinions and
  • advocates
Advance statements

Give patients greater control over treatment and informs about patients treatment preferences and enables a person to record their treatment preferences in the event that they become unwell and require compulsory mental health treatment.

Advance statements:

  • can be made at any time provided a person understands what an advance statement is and the consequences of making it
  • must be signed, dated and witnessed by an authorised witness which includes registered medical practitioner, mental health practitioner, person authorised to witness statutory declarations
  • will be flagged on CMI to assist services to locate advance statements
  • must be distributed to a health professional, healthcare team or hospital
Nominated person

A person can nominate a person to receive information and support them while they are a compulsory patient. A nominated person:

  • receives information and supports patients
  • must be willing, available and able to fulfil the functions and responsibilities of the nominated person
  • may be under 18
Second psychiatric opinion

A second psychiatric opinion can assist patients to understand and make decisions about their treatment.

  • Compulsory patients can also seek a second psychiatric opinion about their treatment at any time.
  • Compulsory and security patients can seek a second psychiatric opinion about whether the treatment criteria apply.
  • A second psychiatric opinion promotes patient self determination and a dialogue between clinicians and patients about treatment.
Advocates

Mental health advocates support patients to make or participate in decisions about their assessment, treatment and recovery and to understand and exercise their rights.

Advocates will assist patients to understand and exercise their rights and support them to participate in decisions about their assessment, treatment and recovery

Consultation with key stakeholders is occurring to inform the development of the advocacy service. For further information click here.

Mental Health Tribunal

The Mental Health Tribunal determines whether the criteria for compulsory mental health treatment (as set out in the Mental Health Act 2014) is required and if so will be responsible for ensuring someone is on a Treatment Order.

The Mental Health Tribunal will:

  • make Treatment Orders
  • decide the initial setting where treatment will be provided (inpatient or community)
  • decide the duration of the Treatment Order
  • be comprised of a panel of three members (legal, community and psychiatrist or registered medical practitioner)
  • encompass general and specialist hearing panels
  • ensure a psychiatrist sits on panels for ECT and neurosurgery for mental illness hearings

mht@mht.vic.gov.au | www.mht.vic.gov.au

Mental Health Complaints Commissioner

The Mental Health Complaints Commissioner is an independent voice working for positive change in Victoria’s mental health system.

The Mental Health Complaints Commissioner can:

  • assist people to speak up about their concerns
  • listen and work to resolve complaints about Victorian public mental health services
  • support Victorian public mental health services to develop effective responses to the concerns and complaints of people accessing their services.
  • use what they learn from complaints to assist mental health services make positive changes

info@mhcc.vic.gov.au | www.mhcc.vic.gov.au

Office of the Health Services Commissioner

The Health Services Commissioner:

  • provides a free and confidential service
  • helps people make their concerns known to health services providers
  • protects your right of access to your health information
  • conciliates formally or informally, between consumers and providers of services
  • assists in the resolution of complaints
  • provides information regarding the Health Records Act

hsc@dhhs.vic.gov.au

Office of the Victorian Privacy Commissioner

It’s important to be aware of your privacy rights under the Information Privacy Act and know what to do if you have a problem. The Federal Privacy Act protects personal information that is collected and handled by Federal Government organisations such as Centrelink and the Australian Taxation Office. For further information contact the Office of the Australian Information Commissioner.

The Office of the Victorian Privacy Commissioner can:

  • Answer questions and provide information
  • Help you put your complaint in writing
  • Help you and the organisation to talk about the problem

hsc@dhs.vic.gov.au | www.health.vic.gov.au/hsc/

Office of the Public Advocate

The Office of the Public Advocate (OPA) is an independent statuary body established by the Victorian State Government, working to protect and promote the interests, rights and dignity of people with a disability.

Services include:

  • information and advice relating to the rights of people with a disability, their treatment and care
  • advocacy
  • guardianship
  • advice service for the powers of attorney
  • consent to medical and dental treatment

1300 309 337 | www.publicadvocate.vic.gov.au

Legal advice

For legal advice, contact:

Legal Aid Victoria on 1300 792 387
The Mental Health Legal Centre on (03) 9629 4422 or toll free on 1800 555 887.

References

This information has been taken from the Health Services MH Act 2014 Information Session presentation provided to EDV as well as the Department of Health website.

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