What is the best treatment at any given time when recovering from an eating disorder?by Mark Warren, M.D.
By: Mark Warren, MD, chief medical officer at The Emily Program
What is the best treatment at any given time when recovering from an eating disorder? This is one of the great questions providers, clients, and families alike struggle to answer.
We know there are significant scientifically based therapies that deliver positive outcomes, including weight restoration and behavior cessation. In fact, The Emily Program incorporates these therapies in our programs — Cognitive Behavioral Therapy, Dialectical Behavioral Therapy, and Family-Based Therapy — and has experienced much success through them.
Having said that, however, we also know that many clients who are able to cease behaviors and achieve weight restoration may continue to experience physiological distress, urges, body dissatisfaction, and anxiety, among other eating disorder symptoms.
Further complicating the issue, eating disorders often occur in secret and many clients may not reveal the intensity of their behaviors, thoughts and feelings during treatment.
The key for clinicians is assessment. But when we work in a culture where there is hyperconsciousness around body size and shape, and where restricting, over exercise, taking laxatives and body cleansing are considered "normal" behaviors, therapists may not fully understand the intensity of an eating disorder and how it differs from the "norm."
What's more, therapists may have their own issues with body size and shape, which may affect their ability to assess their clients with full accuracy.
So when we combine a challenging culture with the difficulty of assessment and the reality of evidence-based therapies, we are left with the question: How do clients really get better?
As a professional in recovery who has worked many years with other experienced professionals in recovery, there are some significant thoughts we all should consider:
- For us, finding the right person to talk to and reveal the truths behind our eating disorder was critical.
- In addition, we needed that person to understand that we really had a disorder and it wasn't just a matter of being unhappy with our bodies or food.
- Lastly, even after weight restoration and cessation of behaviors, we weren't done with treatment. A variety of therapies — including experimental, body-oriented, emotion focused, meditative and movement, among others — often turned out to be critical to our ultimate recovery.
At The Emily Program, we have made it a priority to determine how best to assess our clients, when to treat and when to refer them, and what therapies are best to incorporate at any given time.
To further the discussion and learn more, check out the workshop that I'm presenting on, along with TEP psychotherapist Ellen Hoffman, "Embodiment, eating disorders and the brain: New discoveries, best approaches," on March 5 – 6.