Types of Treatment
Just as every person is unique, the pathway to recovery will be different for everyone – there is no one-size-fits-all treatment approach.
The type of treatment best suited to the person and their family/carer will depend on factors including age, medical risk, symptoms and any additional medical and/or mental health problems. Whatever the issues, early treatment is always preferable.
Treatment typically involves collaboration between the person and a number of health professionals, including medical doctors (GPs, psychiatrists, paediatricians), nurses, mental health and allied health professionals (e.g. dietitian, psychologist, social worker). Carer involvement in treatment is also associated with better outcomes.
Different people have different ideas about what constitutes ‘self help’. For example, some people choose to try alternative medicine, naturopaths, kinesiologists and acupuncturists in an effort to help them to address the emotional issues that they feel may be causing or contributing to the eating problems. Others utilise self-help manuals, online or written programs targeting specific behaviours, others attend support groups run by consumer organisations.
Not all self help materials have been developed based on research evidence and many have not been tested to prove they are effective. In terms of eating disorders, ‘guided self help’ has been shown to be effective for people with bulimia nervosa and binge eating disorder. In guided self help, the person works with a trained clinician to implement a Cognitive Behaviour Therapy based self help program. Guided self help is not appropriate for everyone and not everyone will benefit – it’s important to talk to a health professional about all treatment options for eating disorders.
If you are interested, you may wish to find out more about whether our eTherapy may be appropriate for you.
Clinicians who are interested in learning more about guided self help and treatment for people with eating disorders please look at the eLearning section of this website.
Because the medical complications of eating disorders can be life threatening, a medical doctor always needs to be involved. A GP with knowledge, skills and experience with mental health issues, or special expertise in eating disorders is important. GP's can assess and monitor any medical risks and provide appropriate referral options.
Medical monitoring may involve measures of weight, fluid and electrolyte balance, cardiac functioning, bone health and other vital signs. In some cases, particularly adults with bulimia nervosa, medication, such as antidepressants, may be prescribed. For those who are severely underweight or have serious medical complications, admission to an inpatient program, emergency department or general medical ward may be necessary.
Psychological intervention is generally recommended for people who have an eating disorder and can be provided by psychologists, psychiatrists, mental health nurses, social workers, occupational therapists, and counsellors. Knowledge and experience working with people who have eating disorders is essential. It is reasonable to ask someone about their experience when you call to make an enquiry about services.
Some of the more widely used types of psychological treatments include:
Cognitive Behaviour Therapy (or ‘CBT’) focuses on the links between thoughts, emotions and behaviours. It helps people to identify and change unhelpful thinking styles or beliefs that perpetuate the eating disorder and to learn healthier ways of coping and relating to issues of food, shape and weight. There is a lot of evidence for the effectiveness of CBT for people who experience bulimia nervosa.
Interpersonal Therapy (IPT) is a treatment that focuses on the way in which the person interacts with others in their life, and how this may be related to the eating disorder symptoms. IPT helps people to change the problematic ways in which they may relate to others.
Dialectical Behaviour Therapy (DBT) is often useful for people who find it difficult to manage their feelings in a healthy way, for example using self-harming behaviours. DBT helps people to learn skills to manage their emotions appropriately and focuses on themes of mindfulness, distress tolerance, emotion regulation and interpersonal effectiveness.
Family Therapy For children and adolescents with eating disorders, family based therapy approaches FBT are the best supported intervention options available. FBT is an intensive outpatient treatment in which parents are actively involved in helping the young person restore their weight, then transferring the control and responsibility of eating back to the young person and supporting normal adolescent development beyond the eating disorder. For more info go to: The Maudsley Model of Family Based Treatment
Nutritional Counselling A dietitian can help someone with an eating disorder return to healthy eating by providing guidelines about how much and what types of food people need to eat in order to meet nutritional needs. It is best to seek out the advice of a dietitian who has knowledge, skills and expertise in working with people who have eating disorders, because they have particular skills and understanding of the psychological issues that impact on eating.
Support groups provide people who experience eating disorders, their friends, family or carers, with an opportunity to share information and talk about their experience in a safe and supportive environment. Talking to people who are going through a similar experience can inspire hope, create feelings of empathy, increase understanding of the key issues and can help people to develop new strategies for coping. Support groups can also help to reduce the feelings of isolation that eating disorders create for individuals and families.
In NSW Support Groups are provided by the BUTTERFLY FOUNDATION.