An eating disorder diagnosis can throw parents into a tailspin as they try to figure out the best course of action. The alarm you feel when your child is diagnosed is appropriate and necessary, because the sooner you mobilize treatment for your child, the greater their chances of recovery. It is never a good idea to “wait and see,” but figuring out what to do can be overwhelming. Take a deep breath. You’ve got this!
Research indicates that outpatient treatment for eating disorders is preferable to inpatient or residential treatment. Residential treatment for an eating disorder is recommended only when there is acute medical risk, severe suicidal risk, and when weight restoration is not taking place in outpatient treatment.
While there is no “silver bullet” for eating disorder treatment and recovery, the best evidence so far points to outpatient treatment with family-led treatment components. Outpatient treatment for an eating disorder typically involves a team approach including the following professionals:
1. Physician
While a physician doesn’t typically lead recovery, they are an essential part of outpatient treatment because they need to monitor health and physical symptoms. Very few physicians are trained in eating disorders, so it is important to evaluate your child’s doctor and watch for signs of weight stigma, which can negatively impact care.
Signs of weight stigma include downplaying or even praising significant weight loss in someone at a higher BMI, talking about food as “healthy” or “unhealthy” and warning a child about not gaining “too much” weight.
2. Therapist
Most eating disorder treatment involves psychotherapy. The most well-established therapy for eating disorders is cognitive behavioral therapy (CBT), however, there are many other options. It appears that the modality of therapy is less important than the “therapeutic relationship” that the therapist builds with their patient.
If a therapist creates feelings of safety and security, they can use a wide array of therapeutic techniques that support recovery. Therapists may recommend individual, group, and/or family therapy sessions depending on the circumstances.
However, it is very important that the therapist works from a non-diet perspective. Ask your child’s therapist directly whether they personally engage in weight loss and/or offer weight loss services. If so, they are not a good fit for eating disorder treatment.
3. Dietitian
Most people who have eating disorders benefit from oversight by a Registered Dietitian who specializes in eating disorders (CEDRD). The dietitian is qualified to provide medical therapy to support the person in gaining weight and restoring physical health. The RD can work with the person who has the eating disorder, their parents, and/or both. If parents are using the family based treatment (FBT) approach to recovery, they will meet with an RD without the child present.
As with doctors and therapists, parents must watch out for professionals who practice from a diet culture lens and who actively promote and support intentional weight loss. Ask your child’s RD if they offer weight loss services. If so, they are not a good fit for eating disorder treatment.
4. Parent education/coaching
Parents are integral to recovery, particularly if the person with an eating disorder is living with their parents. This is because eating disorders are heavily influenced by social relationships, and parents are the most important social relationship in their child’s life. When following FBT, parents will lead recovery by focusing on feeding and symptom reduction. In some cases, the child may not attend any therapy sessions until they have achieved weight restoration.
Parents can lead recovery in many different ways, and can make the difference in recovery. However, they must learn new skills. Eating disorders are complex, and they require advanced parenting skills. You do not have to do this alone! A therapist, RD, or parent coach can help you build the skills you need to support your child’s recovery.
How to get outpatient treatment
Insurance requirements and options drive most people’s access to outpatient eating disorder treatment. However, keep in mind that insurance agents are not experts in the complexities of eating disorders and parents should not trust them to make decisions about their child’s health treatment without doing independent research.
For example, just because your insurance company recommends a particular outpatient program doesn’t mean it’s the best solution or even the only solution. Parents almost always have options, but it will require doing your own homework to identify your options and the best course of action for your child. The main options for outpatient treatment are:
In-person or online outpatient programs run by eating disorder treatment centers or group practices
Independent treatment teams led by either a therapist or RD (either in-person or online)
In both approaches, all professionals should coordinate treatment for the best results.
Evidence-based outpatient eating disorder treatment
The best evidence-based treatment for kids and teens with eating disorders at this time is Family Based Treatment (FBT). This involves the parents taking the lead on weight restoration and symptom management. It is a massive challenge for parents to do this work, and yet it has the best evidence for recovery.
The original FBT is a manualized treatment led by a trained therapist. However, lately there are more options for parent-led treatments, including FBT-informed treatment in which parents receive coaching and training by a trained RD and/or coach.
If your child is a young adult or older, FBT may or may not be a fit depending on their situation and willingness to work with parents on treatment.
What to expect from outpatient eating disorder treatment
Treatment varies widely. Here are some key elements you should expect:
Medical monitoring
Therapeutic support to encourage facing food and body fears without using eating disorder behaviors
Dietary support to encourage competent eating and/or intuitive eating
Parent support to teach parents the skills that will facilitate healing
Unfortunately, outpatient treatment for an eating disorder is very expensive. Estimates place treatment at $100,000 and more. Many insurance companies will cover most of these costs. However, parents must jump through hoops and apply for grants and scholarships if available. The burden on parents is absolutely unacceptable, and yet it is a fact for anyone facing an eating disorder.
When outpatient isn’t enough
While outpatient treatment is effective for many people with eating disorders, there are times when residential treatment is necessary. This is why medical monitoring during outpatient treatment is essential. The person with an eating disorder should be seen by a medical professional regularly to monitor for physical symptoms. Any medical symptoms that can’t be managed at home will require inpatient treatment.
Other than medical complications, residential treatment is also recommended if suicidal thoughts are present, if the person is not gaining weight according to their treatment plan, or if they are continuing to engage in harmful behaviors such as purging or self-harm without signs of improvement.
Source: Anorexia nervosa: Outpatient treatment and medical management by Stein Frostad and Mette Bentz, World Journal of Psychiatry, 2022
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