Unlike other conditions in the mental health field, eating disorder treatment involve more of a process of rehabilitation than the direct treatment of mental disorders such as depression, bipolar disorder, panic disorder, or schizophrenia. When deciding treatment for the majority of mental health disorders, the accepted standard of treatment is to find the most appropriate treatment in the least restrictive environment. In other words, if an individuals depression is mild to moderate and can be treated in an outpatient setting with once a week therapy, than that is the preferred treatment over something like inpatient hospitalization or a day program. Similar treatment planning takes place with an eating disorder as well, however, it is often better to conceptualize an eating disorder as more of a rehabilitation process requiring rewiring the brain, in a similar manner that takes place when a stoke victim requires rehabilitation to relearn how to talk, walk or hold a pencil.
Nearly every individual with an eating disorder has a history of “normal” eating without the tangles of obsessive thoughts, driving behaviors, demeaning self-talk, and overly critical self-judgement. However, with an eating disorder, the brain’s neural pathways for regulating eating behaviors and related cognitive perceptions around food, weight and body image begin to malfunction. As a result, the brain develops a new way of functioning with actual changes in physiology and anatomy leading to misinterpretations, cognitive distortions, and errant behaviors surrounding food, eating and self-perceptions. These changes further lead to alterations in mood and affect with consequences to relationships, academics, work and basic functioning. Similar to the rehabilitation required with stroke victims, recovery from an eating disorder requires the retraining old brain pathways that functioned well and the development of new pathways to enhance future functioning. The rehabilitative processes in both types of situations also requires practice and sustained repetition of the retrained behaviors for lasting effects. Treatment itself involve the rehabilitation of the brain.
With a more moderate to severe stroke, the rehabilitation process can take months and even years as rehabilitation requires the brain’s neurons to discover new connections, develop into an entire network (even for a simple task), and then, through sustained repetition, strengthen their connections and improve the chances of firing automatically and properly when called upon. To do this, individual’s with strokes must work with specialist in rehabilitation and can spend extended periods of time in a rehab facility. Simply giving one a set of instructions to take home and practice will rarely bring about any satisfactory results. Likewise, with an eating disorder, the more intensive a program path one pursues, the greater will be the results. By this conceptualization, it can appear to go against the customary concept of treatment the lowest level-of-care in the least restrictive environment, and in many’s opinion, properly so for the best standard of care. I often tell people who come in for treatment and have a moderate to severe eating disorder, that if money and time were of no issue, and they wanted to find their way to recovery in the shortest period of time, then they could consider a residential program from the start. Generally speaking, a years work of outpatient treatment can be accomplished in a month at the right residential treatment center because of the continuous focus on therapeutic rehabilitation. Still, very few have unlimited time and unlimited finances.
By conceptualizing eating disorder treatment as rehabilitation, it can also help patients and families have more realistic goals and expectations about treatment itself and what is involved in the process. With this model, it should also help when deciding on a treatment plan so that a patient can choose a path that is aggressive enough to build and strengthen new neural pathways and avoid a prolonged course of ineffective treatment and debilitating suffering. – Dr. Jeffrey DeSarbo