How Are Eating Disorders Treated and Managed?

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Eating disorders are serious mental health conditions that require professional support. However, with effective treatment, young people can make a full and lasting recovery.

There are several different evidence-based treatment approaches for eating disorders. Some approaches focus on changing eating habits within a family setting, while others emphasise the way that thinking patterns and behaviours interact to maintain eating disorders.

Eating disorder treatment can also involve different levels of care, including inpatient treatment (also known as residential treatment) and outpatient treatment.

Every young person is different. This means that the best treatment approach for one teenager may be different than it is for another. When a young person is diagnosed with an eating disorder or an eating problem, they may work with a mental health professional to choose the best treatment approach for them.

In this blog, we outline some of the most common treatment approaches for eating disorders and explore the different levels of eating disorder care.

Family-Based Treatment (FBT)

Family-based treatment is an outpatient treatment approach developed for adolescents with anorexia nervosa and adapted to treat bulimia nervosa. FBT may be offered to young people who are medically stable and don’t require a higher level of inpatient care.

FBT aims to support teenagers to become physically healthy and develop positive eating habits at home. Therapists work with parents to create positive mealtime environments, provide nutritional meals (that gradually increase in energy intake), and monitor their child’s physical activity.

At the start of FBT treatment, parents are asked to take full control over a young person’s eating and movement, monitoring all the food that they eat. As a young person moves through treatment, they start to share responsibility for their meals and exercise routines.

FBT is an established, evidence-based therapy that effectively supports many young people with anorexia nervosa to recover their weight and physical health. For many practitioners, FBT is the go-to treatment for young people with anorexia.

FBT for Bulimia Nervosa

FBT for bulimia nervosa shares many of the same core methods as FBT for anorexia. Therapists support parents to intervene in binging and purging cycles while monitoring a young person’s physical activities. 

However, FBT for bulimia usually involves the young person more in the treatment process than it does for anorexia. This is partly because young people with bulimia are more likely to recognise that their behaviours are harmful and want to change them.

Therapists also work to reduce parental criticism and the shame and secrecy associated with binge and purge cycles. Adaptations of FBT for bulimia are also often more flexible, allowing space to address co-occurring disorders and other behavioural problems.

When Does Family-Based Treatment Not Work?

While FBT is the most established treatment for adolescents with anorexia, some experts point out that family-based treatment may not be suitable for all young people and their families. 

FBT for anorexia uses physical recovery (based on BMI) as the main measure of a young person’s recovery. It focuses on restoring physical health and changing a young person’s eating behaviours. 

However, it usually doesn’t address the underlying emotions, thoughts, or memories that cause disordered eating behaviours. This means that young people may leave treatment despite continued anxiety, depression, low self-esteem, or other psychological distress. In some cases, this can lead to a relapse.

One study found that while 90% of adolescents with anorexia gained weight during a course of FBT, around 40% still had significant psychological distress at follow-up.

As a result, some experts suggest that FBT may not be effective for young people with more complicated psychological concerns, including experiences of trauma or co-occurring mental disorders. It may also be less effective when families face internal challenges or when parents themselves have mental health issues.

It’s normal for young people and their families to feel disheartened if FBT doesn’t work for them, especially if it’s been presented to them as the only treatment available. However, in reality, there are several other treatment approaches that can support them in recovery.

Enhanced Cognitive-Behavioural Therapy (CBT-E)

Enhanced cognitive-behavioural therapy (CBT-E) is a type of cognitive behavioural therapy adapted for eating disorders. CBT-E takes a transdiagnostic approach to eating disorder treatment, using the same core approach for binge eating disorder, anorexia nervosa, and bulimia nervosa.

CBT-E focuses on young people’s over-evaluation of shape and weight as the core attitude that drives disordered eating behaviours. Teenagers and young adults who over-evaluate their shape and weight place all or a large amount of their self-value in their bodies’ physicality, rather than valuing themselves for their personality, actions, or other parts of their identity.

Through a series of one-to-one sessions, therapists support young people to challenge and overcome these perceptions, while developing healthy eating routines. 

CBT-E involves four main stages:

  1. Stage one involves engaging the young person in treatment and collectively creating a treatment plan. It also includes establishing helpful practices, such as self-monitoring of thoughts, emotions, and behaviours related to food and developing regular eating patterns. Therapists will also provide education about eating disorders and involve significant others in the process.
  2. Stage two is an evaluation stage to assess if an individual is ready to move on to Stage three.
  3. Stage three focuses on addressing the underlying causes of disordered eating, including over-evaluation of shape and weight and dietary rules. The ‘broad’ version of CBT-E also treats issues like perfectionism, interpersonal difficulties, and low self-esteem.
  4. Stage four aims to make change and recovery last. It involves establishing an aftercare plan and developing strategies to navigate future challenges.

Studies exploring the effectiveness of CBT-E initially involved adults. Research shows it successfully treats several types of eating disorders, including binge eating and anorexia.

Research now suggests that CBT-E also effectively treats eating disorders among adolescents. In one study, over two-thirds of adolescents completed the program, both recovering their physical health and making positive changes to harmful thought patterns and behaviours.

Trauma-Integrated Treatment

Experiences of trauma are common among young people with eating disorders. Research suggests that a majority of adolescents entering treatment for eating disorders may have experienced at least one type of childhood trauma.

Unprocessed trauma can have a lasting and persistent effect on a young person’s inner and outer world. It affects their emotional responses, self-esteem, sleep, and ability to trust others and feel safe in the world around them.

Disordered eating behaviours may develop as a way to cope with memories of trauma or emotional or behavioural problems that it causes. If trauma is left untreated, it can be tough to overcome these behaviours and young people are vulnerable to relapse.

In the past, eating disorder programs often waited until the later stages of treatment before addressing experiences of trauma. However, research now suggests that integrating trauma treatment into eating disorder treatment can have lasting positive effects.

Integrating trauma treatment from the start of a recovery program helps young people understand the causes of their disordered eating behaviours from the beginning of treatment. It also instills hope that they can recover from both their eating disorder and other kinds of emotional distress, building motivation to commit to and stay in treatment.

Other Treatment Approaches

Several other treatment methods may also support young people with eating disorders. These include:

  • Interpersonal therapy
  • Cognitive analytic therapy
  • Psychodynamic therapy
  • Medication, such as anti-depressants

Outpatient and Inpatient Treatment of Eating Disorders

When young people begin eating disorder treatment, they may start in inpatient or outpatient care. Inpatient treatment of eating disorders involves either hospitalisation or staying in a residential centre during the treatment process. Inpatient programs usually provide 24-hour medical monitoring, medical support, and facilities for emergency medical interventions.

Alternatively, outpatient services offer treatment sessions and other appointments on an outpatient basis while a young person continues to live at home. Outpatient program schedules may range from several sessions a day to weekly appointments.

Before a young person starts treatment, they may work with a mental health professional to determine the best level of care for their needs. Usually, inpatient treatment is necessary for young people at the highest risk who require round-the-clock medical care. But other adolescents and young adults may also benefit from residential treatment, engaging in their recovery program away from the stresses, triggers, and destructive cycles of everyday life.

Outpatient programs, on the other hand, support young people to recover from eating disorders in their everyday environment. They can help to build strong and lasting support systems, such as the family, from the start of treatment and work with young people to overcome the daily challenges they face in real-time.

Some eating disorder approaches, such as family-based therapy, are most suited to either inpatient or outpatient treatment. But other approaches can be delivered in either setting and easily adapted from one to another. Many young people move between different levels of care as they progress through treatment.

Moving Forward: Aftercare for Eating Disorders

Effective eating disorder treatment programs typically provide follow-up care after the program has ended. Follow-up care aims to support young people through particular challenges they face and intervene if previous behaviours start returning. 

If a young person is leaving a residential centre, follow-up also helps to manage the transition between their treatment environment and daily life. It usually involves connecting a young person with local therapists and services to ensure continuous and ongoing support.

The Wave Clinic: A Safe-Haven for Recovery

The Wave Clinic is a youth mental health centre that specialises in eating disorders. We offer residential and outpatient care to young people from all over the world, providing a whole-person approach that focuses on the future.

Our world-leading programs combine exceptional clinical care with education, social responsibility, and a gap year experience, supporting young people to recover from eating disorders while building invaluable life skills. 

Our eating disorder treatment programs integrate trauma treatment into residential care from the start of a treatment program, encouraging inner healing and whole-person change. Everyone on our team is trained in the management of eating disorders, from our highly qualified medics, psychologists, and nutritionists to our support staff.

If you’re interested in discovering what The Wave can offer, please reach out to us today. We’re here to make a difference.

Fiona - The Wave Clinic

Fiona Yassin is the founder and clinical director at The Wave Clinic. She is a U.K. and International registered Psychotherapist and Accredited Clinical Supervisor (U.K. and UNCG).

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