Eating Disorder Treatment: Where to Start and What to Expect
by Laura Fewell, B.A.
 
Choosing an eating disorder treatment program can be overwhelming, especially when you are not sure exactly which treatment (if any) you need. Outpatient? Intensive treatment? A therapist, dietitian, or other specialist? And how exactly do you know if you have an eating disorder or disordered eating? If the thought of receiving eating disorder treatment feels overwhelming or too foreign to consider, read on below for helpful information on where to start and what to expect from treatment.

First things first: Do I have an eating disorder (or disordered eating)?

How do you know if your eating behaviors are problematic or maybe just a bit eccentric? One question to ask yourself is if your thoughts about your weight, shape, or eating habits interfere with your life (such as making you feel bad about yourself or preventing you from going out with others). Another is to pay attention to how you feel before or after eating—do you feel anxious, guilty, or upset? Other signs or symptoms of disordered eating include:

• Restricting food in order to control your shape or weight
• Going long periods of time without eating
• Intense fear of gaining weight
• Eating large amounts of food and feeling out of control
• Often “undoing” what you eat, such as vomiting, exercising, taking laxatives or diet pills, etc. specifically to try and “get rid” of calories
• Eating very fast and beyond fullness; feeling stressed as a result
• Unexplained weight loss that isn’t caused by a medical condition
  

If you can relate to any of these statements, you may consider talking to an ED professional. You can also access online screenings through trusted websites such as NEDA http://screening.mentalhealthscreening.org/NEDA or McCallum Place Eating Disorder Treatment Centers https://www.mccallumplace.com/do-i-have-an-eating-disorder.html.

I might have an eating disorder—now what?

If you think you might struggle with an ED or disordered eating, the best thing you can do for your health and well-being is reach out to a professional. You can start by talking to a therapist, dietitian, psychologist, or psychiatrist with experience in EDs about your concerns. Research shows that if you have an eating disorder you will have the best chance of recovery if you are treated by a professional who is an eating disorder specialist.  It is a good idea to ask about their ED experience or to find someone with a CEDS designation (Certified Eating Disorder Specialist). Although many professionals are willing to work with EDs, they are not all ED experts. Most ED professionals will recommend treatment options, such as going to regular outpatient appointments or looking into a higher level of care, like day programs or residential treatment. Some ED treatment centers offer free assessments and provide recommendations for levels of care to fit your needs.  You can find ED referrals through the National Eating Disorders Association (http://www.nationaleatingdisorders.org/find-help-support), Eating Disorder Hope (https://www.eatingdisorderhope.com/treatment-for-eating-disorders/therapists-specialists), or by contacting Dr. Cheri Levinson at [email protected].

Eating disorder treatment: What to expect

If you find that you need more than outpatient ED treatment (or a professional suggests you need a higher level of care), you may be referred to a day program or a residential program. Though spending most of your day (or overnight) at a treatment center may seem overwhelming, most programs are designed to take place in a therapeutic environment and have the goal of integrating you back into your normal life as quickly as possible. Below are general components of treatment programs that you can expect.

Prior to treatment: Once you find a program that looks like a good fit, call the admissions or intake office to inquire about an assessment. They will schedule a time to ask you about your personal information and history and will likely ask you to see your doctor for a medical workup. They will also call your insurance provider and discuss what types and portions of treatment they are willing to pay. Once they get this information, they will make treatment recommendations and set up an admission date if necessary.

Day 1: Arrive at the treatment center and expect to fill out lots of paperwork. You will be introduced to treatment professionals, other clients, and staff. Staff will go over program guidelines with you and layout what the program will be like. This day will probably feel like a whirlwind! I advise our clients that the first couple of days are the most difficult—between new faces, a new environment, and the fear of the unknown, there are lots of factors that can make the first few days feel scary. Typically by the 3rd or 4th day, though, clients are used to the routine and begin getting to know their peers and the staff. Soon after, they begin developing bonds with others and learn to trust the treatment center as a safe environment comprised of people who care about them. 

Weights: Most programs will collect weights regularly, such as daily or weekly. This can feel a bit awkward at first, but most people get used to it quickly. In fact, it is part of your treatment & recovery!

Treatment team appointments: Throughout treatment, you will meet with your treatment team regularly. Your treatment team will likely be made up of a therapist, dietitian, and doctor, all of whom will set up a treatment plan for you and work with you towards your goals.

Meals: This is often the most anxiety provoking component of treatment. People often wonder, “Will I be forced to eat or not be allowed to eat enough? What happens if I feel too anxious during meal times?” Rest assured that, while not always easy, you will be given a personalized meal plan that will be exactly what you need. Your dietitian will work with you to educate you on what types of meals and portions are best for you.

Groups: An important part of treatment is developing skills and insight that will assist you in recovery. There are a variety of therapeutic groups each day that take place outside of meal times. These often include skills and processing groups, nutrition, art, and other specialized treatment modules (like cognitive behavior therapy) that aid in the healing process.

Other components of treatment: Depending on the treatment center, there will be nurses and/or doctors on staff who are available if a medical issue comes up. Patient care staff are available if clients need something, such as using the restroom or just talking after a hard day. There may also be exercise specialists to help clients who struggle with unhealthy or limited exercise, and some programs even have specialists who help athletes seeking recovery from their eating disorder while training for their sport.

A sample day program schedule may include:*
9:30am: weights and vital signs obtained
10am: snack (if applicable)
10:30am-12:30pm: groups
12:30pm: lunch
1:30-3pm: groups
3pm: snack (if applicable)
3:30-5:30pm: groups
6:15pm: dinner
7:30pm: program ends
*During the day, treatment team members may meet with patients in place of attending groups.

Treatment discharge: As you progress through treatment and get your eating habits and health back on track, you will begin preparing for discharge. A good treatment team will help you make a plan for what you’ll do after treatment, and they should help you find outpatient professionals so you can continue care in a meaningful way. Though many people want to know how long they’ll be in treatment, it is hard to give an exact length of time because of the highly individualized components of care. Some people need a few weeks to get on track, while others require a longer treatment stay to reach their health goals.

Taking the next step
Deciding to seek help for an eating disorder or disordered eating is not easy, but it is worth it. There is hope out there! Below are a list of resources if you would like to begin your journey to recovery. You can also contact Dr. Cheri Levinson if you have questions or would like to discuss treatment options.
 
Resources:
Dr. Cheri Levinson: [email protected]
National Eating Disorders Association: www.nationaleatingdisorders.org
Eating Disorder Hope: www.eatingdisorderhope.com
McCallum Place Eating Disorder Centers: www.mccallumplace.com

Why Being Perfect Isn’t Always What It Seems: The Link Between Eating Disorders
and Perfectionism
 
By: Leigh C. Brosof
 
       We all know someone who is (or perhaps recognize within ourselves) a perfectionist: the person who gets good grades or excels at their job, is involved in a myriad of activities outside of school/work, and seems to never settle for anything but the best. This can’t possibly be a bad thing, right? While having high standards is not necessarily harmful, high levels of perfectionism can create vulnerability for certain problems to develop, especially in terms of disordered eating. In fact, perfectionism is recognized as a vulnerability factor for eating disorders.

         In order to understand why perfectionism can be harmful at times, it is first important to define exactly what perfectionism is. Colloquially, perfectionism is defined as anything less than perfect being unacceptable, where being “perfect” means living up to standards of extreme excellence or not making any mistakes (Merriam-Webster, 2016). This is actually a pretty complex definition when you look at it, and that’s why perfectionism is defined in a slightly different way by researchers. Researchers view perfectionism as a multi-dimensional construct, meaning that it’s made up of multiple parts (Frost et al., 1990).

            More specifically, perfectionism can be broken down into two parts: adaptive and maladaptive perfectionism (Hewitt, Flett, Turnbull-Donovan, & Mikail, 1991). Adaptive perfectionism is when an individual has high standards for themselves. Maladaptive perfectionism can also be called evaluative perfectionism. In this type of perfectionism, individuals become preoccupied over making mistakes, which then leads to self-critical evaluation. Whereas adaptive perfectionism is healthy because it pushes an individual to do his or her best and set high expectations (DiBartolo, Frost, Chang, LaSota, & Grills, 2004), maladaptive perfectionism is harmful because it means that nothing we do will ever be good enough and that we set unattainable standards for ourselves. This can obviously lead to disappointment and feelings of inadequacy.

            So, how does this relate to eating? If an individual sets unattainable standards for themselves in all areas of their life because of perfectionistic tendencies, then this can lead to negative outcomes for mental health, such as anxiety and depression, as well as disordered eating attitudes and behaviors (DiBartolo, Li, & Frost, 2008). In fact, some research has linked a specific type of perfectionism to eating disorders (Bardone-Cone et al., 2007). This type of perfectionism is  the excessive worry over making mistakes.

            Researchers have proposed different theories as to why perfectionism may lead to eating disorders. For instance, some researchers have proposed that disordered eating behaviors manifest after an individual high in perfectionism internalizes the thin-ideal (or the societal belief that being thin is the ideal body type). This thin-ideal set by society, however, is unattainable. The pursuit of this impossible thin-ideal along with the self-criticism that accompanies maladaptive perfectionism might lead to disordered eating. Other theories suggest that perfectionism may lead to other negative outcomes, such as low self-esteem or fears of being judged by others based on appearance and that these outcomes then lead to disordered eating behaviors (Brosof & Levinson, 2017; Mackinnon et al., 2011).

            Importantly, by better understanding how perfectionism relates to eating disorders, we now also know that we can create interventions to target perfectionism to help treat eating disorders. For instance, one type of treatment might be having a patient practice making mistakes to help them learn that making a mistake does not lead to terrible outcomes. We can also help prevent eating disorders by helping people already high in perfectionism through similar interventions.

          It is important to remember that everyone makes mistakes and that making mistakes is normal! In fact, making mistakes is how you learn. It is also important to know that there is no such thing as a “perfect” body or a “perfect” diet. All of our bodies are different in order to do different things and need to be fueled according to our own needs. You are worthwhile person and you are good enough, no matter what. If you are or someone you know is struggling with disordered eating or other mental health problems due to perfectionism, there is help. We are currently offering a perfectionism group treatment, please reach out if you are interested in joining. You can also call the National Eating Disorder Association helpline at 1-800-931-2237.