Comprehensive treatment for eating disorders
With perhaps a little riff from Hillary Clinton, it takes a village to treat an eating disorder. That not only involves the utilization of friends and family to support the sufferer as he/she makes their way through recovery, but it also requires the use of a multidisciplinary treatment team: a physician, a therapist, a dietitian, a psychiatrist, etc. For most people, finding even one treatment provider who is both knowledgeable about eating disorders and reasonably local is the equivalent to hitting the jackpot.
I'm lucky: my dietitian and therapist are in the same office, kind of like one-stop shopping. My psychiatrist is only a 30-minute drive away (45 in traffic, but I schedule my appointments around rush hour as much as possible). When I lived in DC, ironically, it was much more difficult to find treatment providers, since many didn't have evening/weekend hours--a must when you work full-time--and the ones who did made liberal use of the phrase "control issues" in intake sessions.
In the most recent issue of World Psychiatry, Katherine Halmi tackled the issue of "Salient components of a comprehensive service for eating disorders." In the article, Dr. Halmi addressed such topics as the need for better intake and referral services, goals of inpatient treatment, use of step-down programs, types of group therapies to be used, and the overall therapeutic framework of treatment.
Which is all well and good, except for one nagging little detail that Dr. Halmi addresses: there really isn't much evidence for any of these treatments. A study titled "Management of Eating Disorders" that looked at treatments for anorexia, bulimia, and binge eating disorder by the Agency for Healthcare Research and Quality in 2006 found that "No or only weak evidence addresses treatment or outcomes difference for these disorders."
(Note: the link is to the abstract of the research. The link to the full text is at the bottom of the page, but the document is 1,000+ pages. Insomniacs, you can thank me later...)
We need better research on treatment for eating disorders. The latest range of studies on Family Based Treatment for adolescent eating disorders is fantastic, but we also need to find a way to treat adults with AN, and increase the rates of remission and recovery for BN and BED. We have a much better grasp on what we don't know and what we need to know, we now just have to start figuring it out.
7 comments:
Very interesting post and I agree - especially about the need for more information on treating adults.
"it takes a village to treat an eating disorder."
I love it!!!
Yes, I so agree with this post. I also have an RD and a therapist (and a psych, though I see him for adhd) at the same treatment facility, and it is so helpful to have them all there and in regular communication with each other!
I've heard it lamented that so much research is going into trying to figure out "The cause" for eating disorders, while so little goes into actually finding out if the treatment that is out there is actually helping people who already have e.d.'s! With the current state of things, I agree. But wouldn't it be nice if e.d.'s got enough research funding to do BOTH?!
one danger of the lack of evidence of effective treatments could be a collective hopelessness and the decision of funding bodies not to pay any of the village.
Hi Carrie,
I'm not sure how to just email you- this isn't a comment on the previuos post- but I was wondering if you'd seen this article from this weekend's NY Times Magazine- http://www.nytimes.com/2009/10/11/magazine/11Calories-t.html?ref=magazine
I'd be interested to hear your thoughts.
A doctor, dietician, etc. Wow. In the UK i see a mental health nurse who has chosen to specialise in EDs. But i don't see anyone else, i think if i wanted i could be refer to a dietician i could ask. Maybe if it was inpatient treatment i expect it would be different, and they'd all be under one roof.
susie
xx
Although I definitely advocate research on ED treatment, it doesn't get rid of the need for research into what causes eating disorders. Why? Because what we think causes eating disorders will help guide how we treat them. If people think that parents cause eating disorders, parents will be excluded from treatment. If people think that our thin-is-in culture causes eating disorders, then we will focus our efforts on eliminating too-skinny models.
I wonder if the weak correlation with these important elements and outcome is due to the fact that the people who were very dissatisfied were not engaged in treatment and therefore unavailable for follow up! I find that most individuals are ambivalent to say the least to initiate treatment and it takes a lot emotionally to make the initial contact and when this contact is negative that can be adequate reason, at least in an emotional state of mind, to not follow through! Sadly, it is frequently reported that an individual seeking treatment will contact at least 3 providers and not receive a return call for up to 2 weeks and sometimes never! That is pathetic!
More research is needed especially in the areas that you identified Carrie: adults, relapse prevention, evidence based treatment!
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