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Key points
- Traditional treatments can fall short for chronic or resistant eating disorders.
- Personalized and adaptive treatments are crucial for addressing the complexities of severe eating disorders.
- Systemic issues in healthcare often impede treatment success, highlighting the need for improved care design.
Eating disorders are complex and serious conditions that affect millions of people around the world. While there are evidence-based treatments that are effective for many individuals with eating disorders, however, these methods don’t work universally. For a significant number of people, traditional treatments may only offer limited benefits or fail to address the complexities of their condition. This variation highlights the necessity for personalized and adaptable treatments that resonate with individual needs and circumstances.
Chronic eating disorders are defined by their long duration and persistence despite ongoing treatment, manifesting in entrenched eating behaviors like restriction, bingeing, or purging. These disorders often lead to significant physical and psychological consequences, including chronic health issues, social and professional limitations, and chronic emotional distress. Resistant eating disorders, characterized by severe or atypical symptoms that complicate standard treatments, require adaptations to standard methods to address both the eating disorder and co-occurring mental health conditions.
Three Cutting-Edge Approaches for Chronic and Resistant Eating Disorders
Recovering from chronic or resistant eating disorders requires perseverance, patience, and both a creative and adaptive approach to treatment. Whenever possible, it’s ideal to enlist treatment professionals with a high level of expertise and access to advanced treatment interventions designed specifically for higher complexity conditions.
Several highly specialized treatment approaches show promise in severe, complex, and enduring eating disorders.
1. DBT for Eating Disorders
Dialectical Behavior Therapy was originally designed to address severe emotion dysregulation, self-injury, and chronic suicidality but has expanded well beyond this original scope. DBT is now well-respected as an intervention for a wide range of mental health challenges including eating disorders. DBT-ED is a hopeful solution for individuals whose eating behaviors are used to regulate intense emotions, such as anxiety, sadness, or anger. In other words, someone might engage in restrictive eating, bingeing, or purging to block or escape from overwhelming feelings. When standard treatments fail to offer effective emotional coping strategies, these disordered behaviors can become entrenched as essential, albeit problematic, coping tools. DBT-ED addresses this by providing alternative, health-reinforcing strategies to manage emotions, offering crucial support where traditional methods may fall short.
Of note, DBT is also an important solution for individuals with disordered eating alongside dangerous behaviors or impulses like urges to self-harm or take one’s own life. The structure of DBT helps the therapist and patient collaboratively monitor these impulses and behaviors and block them through the use of more adaptive skills for coping.
2. Specialist Supportive Clinical Management
SSCM offers a promising approach for treating chronic and severe anorexia nervosa in adults. The approach centers on adapting to the client’s evolving goals and supporting them through varying degrees of willingness and resistance. As an outpatient treatment, SSCM combines clinical management with supportive psychotherapy, addressing gaps left by traditional methods that often fall short for patients who have undergone multiple treatments with minimal success.
SSCM focuses on educating patients about their condition, providing responsive and empathetic support, and fostering self-determination through a strong therapeutic relationship. While weight restoration is a key component, the primary emphasis is on improving the patient’s overall quality of life. The approach integrates regular monitoring of physical health with weigh-ins and blood tests, alongside ongoing nutritional education, ensuring that treatment is tailored to the patient's needs and delivered in a less intimidating manner.
3. Family-Based and Dialectical Behavior Integration for Adolescents
For some adolescents, standard first-line treatments for eating disorders may fall short, especially when emotion dysregulation, self-harm, and suicidality are present and complicating factors. In these cases, traditional treatment approaches need to be adapted to effectively address the full scope of the patient's condition.
One of the leading treatments for adolescent eating disorders, family-based therapy (FBT), involves a central role for parents or caregivers, who are charged with the task of guiding their teen’s eating and weight stabilization until the teen can take responsibility for their own nourishment. This approach is highly effective in many cases but can be more challenging when there are high levels of impulsive, suicidal, or self-injurious behaviors; dialectical behavior therapy is typically the treatment of choice for these complex concerns. That said, DBT does not specifically engage parents in managing food and nourishment, which may be necessary if the teen is refusing much-needed nutrition. Integrating DBT with FBT enhances parental involvement. This combination equips parents with skills in regulation, communication, mindfulness, and distress tolerance, enabling them to support their child more effectively as they guide the teen toward restoring nourishment and physical health.
People Don’t Fail Treatment; Treatment Fails People
At times, responsibility for unsuccessful treatment is placed solely on the patient, suggesting that they are to blame for “failing” to overcome their eating disorder. The reality is that people rarely fail treatment; rather, treatment fails the individual.
When therapies aren’t tailored to fit an individual’s unique needs or lack integration of cutting-edge practices, patients may not see the results they’re hoping for. Furthermore, gaps in access to specialized care and continuity of support can leave individuals without the comprehensive help they need to tackle their complex challenges effectively.
Blaming individuals for treatment failure also overlooks significant systemic issues within healthcare. Many face obstacles such as inadequate access to skilled professionals, financial barriers, and insufficient insurance coverage, which can impede their journey to recovery.
Hope for Full Recovery
By enhancing treatment methods and providing more nuanced support, we can more effectively address the needs of a wide range of individuals struggling with eating disorders and help them achieve the recovery they deserve. As we advance and expand these sophisticated treatments, we have a growing opportunity to improve outcomes and assist people in overcoming even the most severe and persistent eating disorders.
