What are my Treatment Options when my Child has an Eating Disorder?

I’m sure you are feeling lost, overwhelmed, confused and even frustrated. You thought- OK I got my child assessed, we got a diagnosis-great! Now we know what to do! -But then you were confronted with multiple treatment options and many opinions on what you should do. This blog is intended to help lay out the various treatment options for adolescent eating disorders and provide you with information to help you make the right decision. There are many options when it comes to treatment of eating disorders and many routes you can go.

Outpatient Treatment

 This means your child stays at home with you and has appointments ranging from 1-2 times per week.  There are different treatment options or modalities when it comes to outpatient treatment. We will discuss these in further detail.

Psychological Treatments

CBT (Cognitive- Behavioral Therapy), FBT (Family-Based Treatment), AFT (Adolescent-Focused Treatment), more specifically Individual psycho-dynamic therapy. In randomized studies, FBT has been more effective or as effective as other treatment methods. FBT also has been found to promote quicker weight gain and avoid hospitalizations. AFT was not found to be as effective as family therapy.  CBT is widely used to treat a variety of menta health disorders and has proven to be effective, though when it comes to eating disorders, it is not as effective as FBT. New research on CBT-E for anorexia nervosa looks promising, but is still in the early stages.

The most research supported option of those, is FBT. It has been shown to be helpful to have families involved in treatment, especially when the child is younger and has more severe symptoms. FBT views families not as the problem, but as the best resource to help their child get better. FBT has proven to be the most effective treatment for adolescents in both the short term and long term outcomes.

Adolescent-focused therapy has many downsides due to the power of anorexia nervosa, the lack of insight, and the delayed processing due to malnutrition that is often present in patients. AFT relies on very sick individuals to make changes on their own, when often times they do not have internal motivation to make change and do not think anything is wrong. Another important thing to consider is your therapist, counselor or treatment provider- are they experienced with eating disorders? Have they had training on eating disorders? Make sure whoever you are working with is an expert on eating disorders and not a general mental health therapist, because there are many nuances to eating disorder treatment that most mental health counselors are not trained on. You don’t want to waste precious time on something that will not be effective.

Nutritional counseling

This is a common approach to treating eating disorders. Nutritional counselors provide meal plans, recommendations and support for families in feeding their sick child. There has been little research on this treatment option. Nutrition counseling or working with a dietician is best supported in conjunction with other psychological treatments such as Family Therapy.

Psychiatric medications

Many psychiatric mediations have been studied to see if they are helpful in the treatment of eating disorders. Unfortunately, we still know very little about the effectiveness of medications in the treatment of eating disorders. SSRI’s have been studied and results have been inconclusive. Medications may be helpful for patients who had preexisting depression or anxiety and is very specific to the patient. Another issue with medication effectiveness is malnutrition- if your child’s body does not have enough nutrients to function properly, medication will not be absorbed and dispersed properly and it’s effectiveness can be compromised. Overall, most clinicians agree that the best medicine we have to treat eating disorders is food! It should be taken in the prescribed amount, just as a medication would.

Intensive Treatments

Some children with eating disorders may require and be recommended for higher levels of care than outpatient treatment, where they have to stay away from home for all or part of the day and their day to day care is mostly on the professionals. Programs will have varying levels of involvement from parents depending on their treatment philosophy.

Inpatient treatment is the highest level of care and that would be hospitalization to stabilize medically. This treatment is typically shorter- only until your child is medically stable and can be stepped down. Typically days to weeks. Unfortunately, many studies have found that patients quickly lose the weight that was restored in the hospital.

The level below that would be residential treatment, where your child would go to live at a facility with 24/7 care, treatment and monitoring for a certain amount of time. This usually consists of individual, family and group therapy, as well as nutritional counseling and rehabilitation. Residential care can be longer treatment in order to make sure your child is restoring weight and behaviors can be managed at home. Anywhere from 3 weeks to 3 months.

The level below residential would be PHP, or partial hospitalization program. This is anywhere from 4-7 days per week and 22-40 hours per week. Your child would be sleeping at home with you each night, but would have programming most days. Individual, group, family and nutrition therapy would likely be part of PHP. PHP typically lasts anywhere from 4-12 weeks.

Below PHP is IOP or intensive outpatient, which looks very similar to PHP in it’s structure, just with less time in treatment. This is typically 2-4 days per week and 5-15 hours per week.  IOP often last 4-12 weeks as well. IOP helps you to figure out how integration back to school and daily life will be.

Conclusion

The most important take away is to act when first signs of an eating disorder arise and do not hesitate to get your child into treatment. It is very important that no matter what treatment you chose for your child, that you are involved as much as possible. You also need to make sure that treatment is addressing any medical problems or issues that your child may be experiencing from the eating disorder and that there is a plan for a medical professional to monitor improvement or decline in symptoms throughout treatment.

Ultimately, the treatment decision is what works best for your child and your family. Do your research and talk to those you know who have been through it. Find experts and professionals who are experienced and knowledgeable about eating disorders. Don’t be afraid to seek second and third opinions. Know that it won’t be easy, it will take a lot of time, energy and commitment and that your child is worth all of it.

An eating disorder evaluation is the first step on the journey to full recovery for your struggling child. Please schedule a free consultation call to see if an eating disorder assessment is recommended for your child.

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References

Lock, James, and Daniel Le Grange. Help Your Teenager Beat an Eating Disorder, Second Edition. Guilford Publications, 2015.