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Comprehensive treatment for eating disorders

Posted Oct 09 2009 10:00pm
With perhaps a little riff from Hillary Clinton, it takes a village to treat an eating disorder. That not only involves the utilization of friends and family to support the sufferer as he/she makes their way through recovery, but it also requires the use of a multidisciplinary treatment team: a physician, a therapist, a dietitian, a psychiatrist, etc. For most people, finding even one treatment provider who is both knowledgeable about eating disorders and reasonably local is the equivalent to hitting the jackpot.

I'm lucky: my dietitian and therapist are in the same office, kind of like one-stop shopping. My psychiatrist is only a 30-minute drive away (45 in traffic, but I schedule my appointments around rush hour as much as possible). When I lived in DC, ironically, it was much more difficult to find treatment providers, since many didn't have evening/weekend hours--a must when you work full-time--and the ones who did made liberal use of the phrase "control issues" in intake sessions.

In the most recent issue of World Psychiatry, Katherine Halmi tackled the issue of " Salient components of a comprehensive service for eating disorders." In the article, Dr. Halmi addressed such topics as the need for better intake and referral services, goals of inpatient treatment, use of step-down programs, types of group therapies to be used, and the overall therapeutic framework of treatment.

Which is all well and good, except for one nagging little detail that Dr. Halmi addresses: there really isn't much evidence for any of these treatments. A study titled " Management of Eating Disorders" that looked at treatments for anorexia, bulimia, and binge eating disorder by the Agency for Healthcare Research and Quality in 2006 found that "No or only weak evidence addresses treatment or outcomes difference for these disorders."

( Note: the link is to the abstract of the research. The link to the full text is at the bottom of the page, but the document is 1,000+ pages. Insomniacs, you can thank me later...)

We need better research on treatment for eating disorders. The latest range of studies on Family Based Treatment for adolescent eating disorders is fantastic, but we also need to find a way to treat adults with AN, and increase the rates of remission and recovery for BN and BED. We have a much better grasp on what we don't know and what we need to know, we now just have to start figuring it out.
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