Choosing an Eating Disorder Treatment Program

By Meghan Vivo

When you or a loved one is faced with an eating disorder, where do you turn for help? Is the answer psychotherapy, nutritional counseling, support groups, medication, residential treatment, or a combination of all the above? 

The right approach depends on the severity of the disorder, as well as the individual’s specific symptoms, background, strengths, and physical and psychological issues. In general, residential treatment programs that carefully tend to medical or nutritional needs, encourage a healthy relationship with food, and introduce constructive ways to cope with stressors and challenges are highly successful. For most eating disorder sufferers, effective treatment includes the following features: 

A Caring, Nurturing Approach to Treatment 

Every individual, and every experience of an eating disorder, is unique. However, in the past decade, eating disorder specialists have begun to come to a consensus about the most effective type of treatment for eating disorders. Although a harsh, confrontational approach may be highly effective for some drug addicts and alcoholics, research shows that eating disorder treatment has maximum impact when it is caring, nurturing, and esteem-building. 

A Staff of Eating Disorder Specialists That Works as a Unified Team 

Recovery from an eating disorder requires a support group made up of eating disorder specialists and people who are closely connected with the victim. Though there are many different approaches to treating eating disorders, the most important aspect of any program is that all members of the treatment team utilize the same treatment method and put up a united front. 

In her book, The Eating Disorder Solution, Barbara Cole, MFT, Psy.D., clinical director at The Victorian of Newport Beach, a world-renowned residential facility for the treatment of women with eating disorders and co-occurring substance abuse issues in Southern California, explains why a unified team approach is so critical: 

The enemy, or eating disorder thought process, will intuit any small difference among the ranks of those attempting to interfere with it, and use this difference of opinion to create utter chaos in any perceived group going against the e/d. This chaos typically looks like one caregiver pitted against the other, one story regarding the eating disorder relayed differently to one family member, and some friends knowing or attempting to intervene in one way while other friends are attempting to intervene on the illness another way. 

The eating disordered mindset results in the victim going to any lengths necessary to turn her loved ones or caregivers against each other. When treatment consequently fails, the eating disorder sufferer receives validation of her belief that she is unworthy and unlovable, and the family feels more hopeless and discouraged. 

Although the eating disorder sufferer appears to stubbornly refuse or resist help, this resistance is actually a call for help, says Dr. Cole. In order to respond effectively, the treatment team must not only be cohesive and unified, but also extremely patient and supportive. 

Well-Rounded Healing of Mind, Body, and Spirit 

Eating disorders are marked by serious medical complications, ranging from dehydration and anemia to seizures and heart arrhythmias, which require intensive monitoring and treatment. But addressing the physical struggles is just one important component of the recovery process. An effective eating disorder treatment program must also make a thorough assessment of the victim’s mental state and work systematically to change the concrete, negative thinking that is characteristic of eating disorder sufferers. 

Treatment programs that emphasize service and the importance of giving back, in addition to nurturing oneself, can be nourishing to the soul and remind the eating disorder sufferer that she is part of a larger community. According to Dr. Cole, victims of eating disorders often are altruistic in nature, with a strong drive to give back. Nurturing this character trait can give the victim renewed purpose and passion for life. 

Residential Treatment over Individual or Outpatient Treatment 

Recovery from an eating disorder requires consistent, individualized, and structured assessment and treatment. For most people, individual treatment or treatment in an outpatient setting isn’t sufficiently structured to permanently change eating disordered thoughts and actions. 

“ … [I]ndividual therapy is seldom successful in effectively eradicating an eating disorder thought process,” explains Dr. Cole. “Many people who report being helped out of active eating disordered behavior by individual therapy only can still be observed harboring eating disordered thinking which then attaches to other addictive behaviors.” 

Even when it seems that the eating disorder has disappeared, it often has simply transferred to other outlets, such as substance abuse, promiscuity, relationship issues, workaholism, or other addictive behaviors. To achieve the best outcome, the treatment team must be alert to this trend and trained to identify other addictive patterns and behaviors. 

Families often prefer outpatient treatment because the eating disorder seems to be weakening (i.e., the victim appears to be gaining weight) and the victim can continue working, going to school, and going about his daily life. But in many cases, the eating disorder is stronger than the victim or family realizes and treatment fails. 

In The Eating Disorder Solution, Dr. Cole warns: 

As soon as someone with the e/d thought process leaves the therapist, psychiatrist, nutritionist or outpatient group, they are plagued with an increasingly stronger set of negative thoughts that must be acted upon since there is nothing beyond the outpatient experience to attempt to stop the behavior. … Seeing someone who is suffering from a strong eating disorder thought process in outpatient therapy, then, inadvertently contributes to the progression of the disorder. 

Residential treatment facilities tend to achieve better results for a number of reasons: the staff closely monitors meal plans and meal times, the eating disorder sufferers have constant support and access to therapy, and the families are actively involved in family therapy and monitoring their loved one’s progress. 

“When considering treatment options, it is less expensive and more effective to do this process ‘right’ the first time, rather than have to do it half-way (meaning, listening to and following the victim’s way of treating his or her own e/d) and have to undergo primary treatment an average of five times,” notes Dr. Cole. 

Aftercare and Step-Down Levels of Care 

“Eating disorders generally cannot be overcome with just 30 days of treatment,” explains certified eating disorder specialist Elaine Alexander, MA, LMFT, the Vice President of Eating Disorders for CRC Health Group (a leading provider of specialized behavioral health care services in the U.S.). “To change any type of behavior, we say it takes 30 days to accept change, 60 days to implement change, and 90 days to habituate change. For eating disorder sufferers, it takes time to gain weight, restore function to the body and brain, practice new life skills, and address the underlying emotional and psychological issues that have likely been building for many years.” 

The most helpful eating disorder treatment programs understand that recovery is a gradual process and that treatment in some form must be ongoing. Dr. Cole recommends that following discharge from primary treatment, men and women healing from an eating disorder should gradually increase their exposure to real-life stressors and activities for at least the first year of recovery, eventually ending up in an outpatient program (such as Overeater’s Anonymous). 

If eating disordered thoughts threaten to return, the “step-down” program should allow the patient to “step-up” his recovery activities and reduce stressors for a time. Relapse is extremely common among eating disorder sufferers, and aftercare and a gradual step-down approach can reduce the hopelessness and despair that are associated with relapse. 

In most cases, eating disorders don’t disappear quickly or on their own. Even with treatment, recovery happens gradually over a long span of time, often with a number of ups and downs and threats to leave treatment in between. Finding a permanent solution to an eating disorder requires immense effort and a relentless commitment to treatment by a group of caring professionals and loved ones. But recovery is possible – and with the right treatment – likely.