What are the treatments for eating disorders? There are different treatments to treat eating disorders. It depends on the disease they have and how far long they are in the disorder. Patients with eating...
Patients with eating disorders would do relatively well while they were in a confined environment but tended to not do well when they left the environment because their meals where no longer being prepared for them. They weren't monitored and basically they were in an artificial setting. So in research following from that background there were two ways in which to test pharmaceuticals and two ways in which you treat people. One is called in vitro where it is in the laboratory, so in a sense when someone is in a hospital environment, it's an in vitro environment or controlled environment and then the other is an en vivo which means in life. So the other environment which I had been doing for the last 22 years in treating this is a residential environment where it's a non-hospital setting where patients go grocery shopping with supervision, prepare their own meals and in effect the treatment has a lot to do with doing things while they are in a supportive of environment that they are going to be doing when they leave here. So the success rate is much higher in a residential environment than it is in an inpatient environment when you follow-up a year after they have been treated. The medical definitions for anorexia nervosa, bulimia and binge eating disorder or what's called eating disorder not otherwise specified. Those definitions come from a diagnostic manual put up by the American Psychiatric Association. Sometimes referred to as a DSM4 or Diagnostic Statistical Manual and this is the fourth edition.
In treating eating disorders, just like the other aspects in medicine, there is some controversy and basically there are two different schools of thought in treatment. There are also two settings, the inpatient setting versus the residential setting. The two schools of thought have to do with approaching treatment. One school of thought has the inherent assumption that eating disorders are caused by either genetic or environmental pressures and early childhood that predisposes someone to the psychiatric illness and frequently involve some type of trauma, physical, sexual, verbal or what have you that precipitates or predates the onset of the eating disorder. In that school of thought, treatment takes the form of either insight oriented psychotherapy and/or medication management or with the passive assumption that if someone can gain an understanding as to why they developed an eating disorder then that information would have a therapeutic effect and "cure or resolve the eating disorder." For instance, if someone who is anorectic and they were in treatment and they have a distorted sense of size or phobia about gaining weight and the therapist through multiple conversations with the patient found out that the patient had been sexually abused, prepubertally let's say at the age 10 or 11. The trauma resulted in the patient not wanting to deal with their own sexuality and hence their anorexia or pursuit of weight loss was an attempt, biologically speaking to prevent them from dealing with sexual thoughts because part of the symptoms of anorexia is the body rivets to a pre-puberty state. Hormones are lowered; sex drive is almost nonexistent, etc. The second school of thought, which is the one that I adhere to, has a few assumptions, one assumption is that no one has a definitive answer as to what causes an eating disorder whether its bulimia, anorexia or compulsive overeating. There are lots of theories but it is a complicated problem or illness and probably had multitude of factors that contribute or predispose someone to it genetic, behavioral, environmental, cultural, etc. In the school of thought that I adhere to, the focus is not based on the assumption that if we can find out why someone developed one then that leads to a cure or resolution of it. I don't think you will find definitive answer and I don't know that it has any utility because I think insight or traditional modes of therapy are very poor ways of treating an eating disorder. Again I borrow from the analogy with alcoholism since I look at eating disorders as addictive process rather than psychiatric. I don't know anybody who is a recovering alcoholic that was able to abstain from drinking and became recovered from alcoholism until they stopped drinking and I don't know that anybody has ever availed themselves of psychoanalytic behavioral, cognitive behavioral or any other form of psychotherapy that helped cure their alcoholism. What helped cure their alcoholism was probably attending either a treatment center that allowed them to just start thinking independently of why they were drinking and then followed up with support groups such as Alcoholics Anonymous, etc. So knowing why you drink is not as important as knowing how to stop drinking. Likewise with eating disorders in the second school of thought it's not so important to know why you started losing weight, binging, purging, and compulsively overeating. What's more important is to know or having guidelines and having experiences in how to stop and normalize their relationship with their body and eating.
