A treatment team & plan is about caring – not control
While you are feeling great concern, the person with the eating disorder may appear ambivalent about recovery.
Many people have trouble believing there is a problem or that the problem is serious, even when there has been a clear eating disorder diagnosis – read: Getting a Diagnosis.
The more anxious you feel about their ambivalence, the more treatment can be rejected.
So it’s important to keep calm and encourage them to seek appropriate treatment – reinforcing that a treatment team is about support, not control.
Persisting with getting commitment to a treatment program is vital.
Persisting with getting commitment to a treatment program is vital. As addressed in the Introduction, an eating disorder can be fatal. In How to have a Conversation we looked at stages of change which might be worth revisiting.
Understanding the Stages of Change in the Recovery Process. While reading, think about what stage the person you are concerned about is at.
Ideally there will be a number of health professionals involved in treatment. The usual recommended treatment team will at least involve:
- A Medical Practitioner: for ongoing medical monitoring
- Dietitian: for continuing to evolve suitable nutrition and patterns for eating, the attached information on RAVES gives an excellent overview. View PDF
- Therapist: to move them toward recovery and treat any underlying problems (if someone is significantly underweight therapy may not be effective until weight restoration)
If medication is required a psychiatrist will be involved. These various health professionals may liaise together for the recommended approach and monitoring process.
National Eating Disorders Collaboration gives an overview of the main specialist eating disorder professions.
As each person is an individual, their recovery approaches may also differ. There is no prescribed best practice treatment plan, however good treatment plans have the following characteristics:
- stepped (moves along the continuum of recovery)
- integrated approach (collaboration at its core)
- reviewed regularly
- actively involves client and their support/carer
The treatment continuum gives an overview of how this may work. Each individual is different and treatment needs to be designed and adapted to each persons needs.
Types of treatment and therapy available: an overview
As eating disorders differ the treatment is different. Individuals also respond differently to treatment types.
Below are the main approaches used but many people may only use a couple and some therapist practice a combination.
Different treatments are used for different presentations of eating disorders:
For Anorexia Nervosa: CBT, CBTE, SSCM, MANTRA, Motivation-based therapies, Family therapies
For Bulimia Nervosa and Binge Eating Disorder: CBT, CBTE, Self Helf, IPT, Pharmacotherapy, DBT
Used but does not have current evidence base, or used as part of a therapy process
Hover over each treatment type to see more information.
|Acceptance Commitment Therapy||Inpatient||Intensive outpatient||Outpatient||Community|
|Cognitive Behavioural Therapy CBT||Inpatient||Intensive outpatient |
|Cognitive Behavioural Therapy Enhanced CBT-E||Inpatient||Intensive outpatient||Outpatient||Community|
|Cognitive Remediation Therapy CRT||Inpatient||Intensive outpatient||Outpatient||Community|
|Dialectical Behavioural Therapy DBT||Inpatient||Intensive outpatient|
|Dietitian Management||Inpatient||Intensive outpatient||Outpatient||Community|
|Exercise Physiologist||Inpatient||Intensive outpatient||Outpatient||Community|
|Family Based Treatment (Maudsley) primarily children and youth||Inpatient||Intensive outpatient||Outpatient||Community|
|Group Therapy||Inpatient||Intensive outpatient||Outpatient||Community|
|Guided Self Help GSH||Inpatient||Intensive outpatient||Outpatient||Community|
|Interpersonal Psychotherapy (ITP)||Inpatient||Intensive outpatient||Outpatient||Community|
|Loughborough Eating Disorder Activity Therapy (LEAP)||Inpatient||Intensive outpatient||Outpatient||Community|
|MANTRA (Maudsley Model of Anorexia Nervosa Treatment for Adults)||Inpatient||Intensive outpatient||Outpatient||Community|
|Mindfulness based therapy||Inpatient||Intensive outpatient |
|Motivation-based therapies||Inpatient |
|Intensive outpatient |
|Narrative Therapy||Inpatient||Intensive outpatient||Outpatient||Community|
|Nutritional Rehabilitation||Inpatient||Intensive outpatient||Outpatient||Community|
|Nutritional Resuscitation||Inpatient||Intensive outpatient||Outpatient||Community|
|Peer Support||Inpatient||Intensive outpatient||Outpatient||Community|
|Pharmacological Therapy - anti depressant, anti anxiety||Inpatient||Intensive outpatient||Outpatient||Community|
|Specialist Supportive Clinical Management SSCM||Inpatient||Intensive outpatient||Outpatient||Community|
There are numerous types of therapy available and obviously you will need to find one that works best for your loved one.
Many people discuss ‘evidenced based treatment’ – put simply that means that the treatment has been monitored and reviewed over time and has had positive results. This does not exclude other treatment, they just may not have been rigorously tested.
Therapies may include:
- Assessment and treatment of underlying and comorbid psychiatric problems (eg anxiety, depression)
- Individual or group approaches aimed at increasing self–esteem, developing skills around anxiety and coping
- Cognitive behaviour therapy (CBT-E, CBT)aiming to correct thinking patterns and assumptions about food, eating and body image.
- Family therapy aimed at developing skills in families around communication, limit setting and solving problems.
- Specific counselling where indicated to resolve underlying issues.
Each adult with an eating disorder is at a different stage so different treatment approaches may need to be considered and options may require multiple aspects such as clinical interventions, social supports and other therapies that aid recovery.
Whilst the Maudsley Approach aka Family Based Treatment (FBT) is well documented for having positive outcomes with children and adolescents, there is not one treatment for adults with eating disorders that has the same wide ‘evidence based’ support.
A 2016 NEDC presentation by Professor Hay on latest research for treatment of eating disorders in adults indicated the following.
Adults with Anorexia Nervosa – no specific ‘first line’ some evidence for Cognitive Behavioural Therapy (CBT), Specialist Supportive Clinical Management(SSCM), Maudsley Model of Anorexia Nervosa Treatment for Adults (MANTRA) and specialist psychological therapies and almost all patients will need longer term therapy including nutritional counselling and medical monitoring.
Adults with Bulimia Nervosa – Commence CBT-E or other CBT. If they are not available commence professional Guided Self Help CBT (GSH-CBT)or Interpersonal Psychotherapy or Dialectical Behavioural Therapy (DBT). If psychotherapy not available some Pharmacological Therapy may be prescribed.
Adults with Binge Eating Disorder – CBT or if not available Interpersonal Psychotherpay (IPT) or GSH-CBT.
There are a number of effective treatments for eating disorders that exist. These have been systematically appraised in the Australian, UK, Dutch and U.S. eating disorder guidelines.
Specific information for patients and carers regarding treatment can be found on this very extensive site at http://pathways.nice.org.uk/pathways/eating-disorders
For more detailed reading Royal Australian and New Zealand College of Psychiatrists eating disorder treatment guidelines, 2014
The road to recovery can be long. So, even when the person you care for agrees to treatment, they can stop believing that recovery is possible at any stage along the way.
Having supportive friends and family who believe in the possibility of recovery for them can be a very strong message – it also helps keep them on track.
Some professional members of the treatment team may be frustrating to work with.
This is often due to them not effectively including you in the process. See tips below on managing this situation…
- Ask questions about your inclusion
At the beginning of the treatment process set the tone of collaboration through questions such as:
“How will you involve me in the treatment of (the loved one’s name)?
“What is a way we can all work together within the limitations of privacy act to achieve the best treatment for (the loved one’s name)?”
“Can you explain to me what treatment you are doing so I can best support the process at home?”
- Use soft words
Stand firm and be assertive in a gentle, non-confrontational way. Using softer words can assist in strengthening the team approach – examples: options, explain, help me understand, what do you need me to do, how best can I help.
- Keep your poise
Regardless of how the professional team member is behaving, do your best to remain respectful while speaking with them. Avoid demands and statements. Instead, state your needs calmly.
- Don’t take your frustrations out on the health practitioner
Instead debrief with an EDA support worker or book an long appointment with your GP to discuss things
- Keep everyone focused on the common goal
Remind the team member/heatlh practitioner of the common goal: To get the person well and that it is now part of current evidence based treatment that inclusion of carers and family improves the treatment and recovery rate.
As eating disorders are primarily a mental health problem, the person with the disorder may avoid being 100% truthful about their eating and/or exercise.
This can often put the person with eating disorder at risk and also sabotage treatment. So it is important that as the carer/support person you are able to have an open conversation with treating health professionals where appropriate.
As you are not the person with the eating disorder there are privacy considerations that you will need to be aware of. Negotiate with the health professionals and your loved one so that you have permission to access information regarding treatment approaches, goals and current health status so you are best able to support recovery.
This will enhance treatment, create accountability for everyone involved and encourage a team approach.
- The commonwealth privacy act 1988 governs overall privacy in Australia, you can read up about it here.
- Queensland health has a booklet that is worth becoming familiar with if you are in that system. ‘Information sharing between mental health workers, consumers, carers, family and significant others’.
Eating disorders are serious and complex issues with medical and psychological components.
The inability and refusal to nourish one’s body adequately can result in serious physical and mental deterioration. As a result, the pathology of an eating disorder will sometimes lead to defiance and a refusal to seek help or compliance with treatment.
If someone you know is refusing medical intervention they could be putting their life at risk. In these extreme circumstances it may be appropriate to look into legal options for getting them to treatment.
If you can, get agreement from the person you are caring for to give you power of attorney allowing you to make decisions around their health care.
A guardian is a person appointed by QCAT (Queensland Civil and Administrative Tribunal) to help adults with impaired decision making capacity
As a last resort, emergency help is available under the Mental Health Act. An Involuntary Treatment Order can be taken out should the person you care about be at risk and not willing to undergo treatment.
EDQ Fostering Recovery
The 1-day Fostering Recovery Workshop is based on the work of Professor Janet Treasure. It aims to help Queensland carers understand more about eating disorders and ways to support recovery. You’ll learn how to make meal times less stressful, develop positive coping strategies and communication skills, and foster a healthier relationship with your loved one. For more information on EDQ’s skill-based training workshop, contact EDQ here.
ARAFMI Educational Carer Workshop
Arafmi’s Carer workshops are specifically designed for carers and families of people with a psychosocial disability. These workshops provide an opportunity to learn and practice the many skills used in providing care to another person with a mental illness. Arafmi is a uniquely carer-based organisation formed by families who experience the loss, loneliness, stigma and isolation of caring for loved ones with serious mental illness. For more information on the workshop, click here.
Eating Disorder Treatment Playlist
Caring For Loved one with an Eating Disorder v3 A Carer’s Guide to understanding the Illness and Keeping Well
Austin Health, St Vincents Hospital, January 2015 [AUST)
- page 9: Caring for a loved one with an ED talks about carer rights.
- page 36: Questions you can ask treatment provider about how you can assist the person you care about
- page 49: Consent and privacy
Goodbye Ed, Hello Me
By Jenni Schaefer
Written to help a person with eating disorder, Jenni shows you that being fully recovered is not just about breaking free from destructive behaviors with food and having a healthy relationship with your body; it also means ﬁnding joy and peace in your life.
If you need help, reach out.
If you need assistance, or are interested in any eating disorder services, get in touch.
We can help with more information, referrals and/or arrange an assessment appointment.
You can also contact us through Eating Disorders Queensland
Eating Disorders Queensland 89 Sherwood Road, Toowong Qld 4066