What is evidence-based eating disorder treatment?
Written by ‘Ai Pono Hawaii Staff Writer
One of the first things you see if you search for eating disorder treatment professionals and programs is "evidence-based eating disorder treatment." You may also notice "holistic eating disorder treatment" in some search results.
What exactly do these terms mean? Are they completely different concepts? How do they work?
In this article, you'll get vital information on eating disorder treatment practices, including:
The definition and theory behind evidence-based treatment
How it's used to treat eating disorders
How and why evidence-based eating disorder treatment should be used to treat co-occurring disorders
How this treatment modality is incorporated into holistic eating disorder treatment plans
Evidence-Based Treatment: A Three-Part Definition
Many medical professionals hear “evidence-based” and immediately think of published papers or higher level course material from school.
But in all spheres of healthcare, including the mental health field (because mental health is just as important as physical health), “evidence-based” treatments are actually made up of three parts.
1. Research Evidence
When a new treatment method is being refined, researchers observe how different individuals with eating disorders respond to them. They create objective ways to tell how effective these treatment modalities are — for example, study participants may be asked how many times a week they purge after doing cognitive behavioral therapy for three months.
Once they gather these numbers, they can analyze how well the treatment method works for different types of eating disorders. The information gathered from research studies can indicate what works, but there are also challenges that come with research studies.
Many studies focus on one specific disorder, despite the fact that many individuals have symptoms from across the eating disorder spectrum. A prime example of this: Many patients with anorexia get stuck in a binge-purge or binge-restrict cycle. but many studies focus on strictly restrictive anorexia.
Related: Stuck in a binge-restrict cycle? Here’s how to get out of it.
Studies are usually conducted in inpatient or residential settings. Many people who suffer from an eating disorder do not meet the requirements or have the privilege of a higher level of care. A huge population of people with eating disorders is, by default, excluded from most current research. A lot of sufferers are afraid to come forward, so researchers can’t study them. This is why “evidence-based treatment” cannot be based on research papers alone.
Related: Whether you participate in a higher level of care or not, your eating disorder is just as serious as anyone else’s. This is what to do when you feel invalidated about your eating disorder.
2. Clinical Expertise
So many medical professionals fail to diagnose someone with an eating disorder, let alone effectively treat them for one. But why would a certified doctor not be able to spot an eating disorder?
Simple — they just don’t have any clinical expertise in the field of eating disorders. They do not treat eating disorders, so they don’t know how to take care of someone who is suffering.
Clinical expertise in the field of psychology includes a range of competencies (or abilities), including:
Assessing and developing diagnostic judgments, case formulations, and treatment plans
Making clinical decisions, implementing treatment, and monitoring patient progress
Forming and using interpersonal expertise (i.e. leaning on the experience of other providers to help when needed)
Continuing to reflect on treatment outcomes and develop professional skills
Understanding how the individual and their environment can affect treatment outcomes
That last part is very important. The best providers understand how a patient’s gender, age, comorbid disorders, physical state, suicidality, and psychosocial contexts will play a part in the most effective treatment approach.
Providers use clinical expertise to make decisions like:
What level of care someone needs
The best treatment approach for each particular person
Whether it’s helpful to involve an individual’s loved ones
Whether they need to twenty-four hour support due to the risk of suicide
If an individual’s dietary restrictions should be honored
Related: If you don’t eat gluten, meat, dairy, etc. — are you doing it for the right reasons?
Of course, there are challenges to this source of evidence too. Individual treatment providers may be biased in some way. They may not specialize in a co-occuring disorder, or they just don’t have enough knowledge on different cultural experiences to treat people from different backgrounds.
Related: Take into account these four factors — including a possible treatment provider’s specializations — when you search for an eating disorder professional.
3. Patient Values, Preferences, and Characteristics
It may not seem like it initially, but patients have a wealth of internal knowledge to provide as evidence that may influence their course of treatment.
Your values provide clinicians with insight as to what motivates you and what treatment approach aligns with your values. For example, if you highly value your relationships with your family, family-based treatment may be the best treatment approach for you. If you are an athlete with an eating disorder, then one of your treatment goals could (eventually) involve getting back into sports.
What kind of characteristics do you identify with — are you creative, outgoing, shy, perfectionistic? Do you identify as a student, a career professional, an artist? Your personality and defining features (nonphysical, of course) naturally guide what kind of treatment you engage with.
For instance, a creative person is much more likely to respond well to music therapy than someone who struggles with perfectionistic tendencies. Someone with that “Type A personality” may really benefit from exposure therapy, with a focus on exposure to imperfections.
Related:. This is how and why exposure therapy is beneficial for almost everyone with an eating disorder.
Patient preferences are absolutely one of the most difficult aspects of evidence-based treatment. Sometimes these preferences are straightforward and easy to accommodate. If you really prefer staying close to home, most providers will work with you to find treatment close to home. If you’d prefer to work on your anxiety before you work on body image issues, then your treatment plan will reflect that preference.
But other preferences don’t come from you — they come from your eating disorder.
Do you think you’d prefer to stay at a low weight, or a “minimum healthy weight,” and prefer not to have a weight-gain meal plan?
Does it seem like you would prefer to continue weighing yourself every day, so you don’t want to start exposure therapy to help stop this behavior?
Those “preferences” aren’t actually yours. A provider with clinical expertise will immediately recognize how these requests hinder your recovery, and they won’t be able to honor them.
Related: This is a comprehensive list of evidence-based treatment options from the Academy of Eating Disorders.
What is Holistic Eating Disorder Treatment?
The main tenents of holistic eating disorder treatment are:
Patients are more than their disorder. Holistic treatment providers treat people, not symptoms.
Each individual has a unique background that needs to be considered when developing their treatment plan.
“Treatment” is not just stopping eating disorder behaviors. It’s tackling the root cause of the eating disorder.
Without fixing the root cause, full eating disorder recovery is not guaranteed. It may not even be possible.
Patients play an active part in shaping their course of treatment.
Holistic eating disorder treatment can include a number of nontraditional practices: nature therapy, mindfulness practices, and narrative therapy, to name a few.
Related: View specific methods used in holistic eating disorder treatment programs.
Evidence-based and Holistic Eating Disorder Treatment are not Mutually Exclusive
Holistic eating disorder treatment can involve nontraditional methods that have not been as thoroughly researched in the scientific community. Most of these methods are newer or lie outside the realm of numbers and statistics.
This does not mean holistic eating disorder treatment professionals and programs don’t use evidence-based treatment modalities.
In fact, most treatment plans require patients to acquire a range of therapeutic skills neurological rewiring. It’s the best chance an individual has to make a full recovery.
DBT : Evidence-based Treatment for Eating Disorders
Dialectical behavioral therapy (DBT) is an evidence-based practice that was first used to treat individuals with borderline personality disorder. Since then, it has been used to treat any individual who struggles with emotion regulation.
This means that DBT is used to treat illnesses like depression, anxiety, trauma, and eating disorders. Many people who suffer from eating disorders face these disorders as well, so DBT is an effective way to treat all co-occurring disorders at once. (And treating everything at once ensures that no one disorder gets intolerable as you lean into recovery.)
The Main Components of DBT (and what they’re used for):
Distress tolerance: Survive anxiety attacks and crisis situations without using eating disorder behaviors.
Core mindfulness: Learn how to identify your true emotions, then take charge of them.
Emotion regulation: Understand what emotions do for you, how they influence your urges, and whether or not to act on your urges.
Interpersonal effectiveness: Have positive, thoughtful interactions — not ones that are fuelled by emotions.
Related: There are too many aspects of DBT to include in this post. Click here to learn all about DBT and why it’s so effective for treating eating disorders.
When it comes to your treatment options, take this simple advice…
Try several treatment methods from different sources.
Take and use what works, and leave behind the ideas and skills that do not serve you.
If you or someone you love is suffering from an eating disorder, take the first step today and talk to talk to someone about recovery or simply learn more about the eating disorder recovery programs we offer.