The Multi-Faceted Approach to a Complex Disorder: Effective Treatment of Eating Disorders

By Magnolia Creek Staff

Eating disorders, like many other mental illnesses and maladaptive coping responses, are usually caused by a complexity of factors, which means that they are also best treated with a multidisciplinary approach that addresses the various facets of what contributes to the development and maintenance of an eating disorder for each individual. We know that things like neurochemistry, brain structure, genetics, cognitive processing patterns, digestive functioning, social influences, trauma histories, and environmental factors all impact our propensity of developing an eating disorder (see What Caused My Eating Disorder). So this also means we need an intervention that addresses multiple of those contributing factors simultaneously to effectively respond to the control our eating disorders have acquired over us.

Prior to engagement in process-focused therapy or medication initiation, bodies need healthy amounts of nutrition to restore functioning. You see, when our bodies are starving, they utilize the little energy they have to maintain the most essential organs in our body that focus on helping us stay alive: our hearts and our brain stems. This means that other bodily functions start getting ignored because our body is not getting enough nourishment to sustain all of our bodily functions simultaneously. If bodies are not adequately nourished, our ability to problem solve, think critically, and regulate emotions are greatly compromised which makes psychotherapy ineffective. This is why when you limit your food intake, you may notice you start to have a challenging time coming up with words during conversation. Similarly, the effectiveness of medications in assisting in emotion regulation is severely diminished if not completely obliterated if a body is malnourished as in order for anti-depressants, anti-anxiety medications, and mood stabilizers to be effective, they need protein and fat to bind to. If stores of protein and fat are not available or provided, medications intended to assist with emotion regulation will be useless.

Once a body has received healthy nourishment, various forms of psychotherapies and medications have been proven to be effective. Cognitive Behavioral Therapy (CBT) is one of the premier evidence-based therapies in assisting with the recovery of eating disorders. There is also a specific subcategory of CBT called CBT-E that is targeted towards eating disorders. Effectiveness of CBT-E is still being studied but preliminary studies are even more promising than general CBT in reduction of presence of eating disorder symptomology. The premise behind CBT is that our thoughts, emotions, and behaviors all affect each other. Since we have the most control over our thoughts, if we can analyze our thoughts and beliefs by examining evidence that exists to prove the likelihood of accuracy or inaccuracy of our thoughts, we are able to challenge any cognitive distortions that may exist and reframe our thoughts to make them more accurate. This process directly impacts our emotions, our behaviors, and our thoughts in the future which reduces our emotional distress and need to engage in maladaptive coping skills.

Another therapy that has been proven to be effective in the treatment of eating disorders, particularly for those who struggle with Bulimia Nervosa, Binge Eating Disorder, chronic suicidality, and/or co-occurring personality disorders, is Dialectical Behavioral Therapy (DBT). Similar to CBT, DBT is a cognitive focused therapy that examines problematic beliefs and thought processes. DBT is especially useful for those that could benefit from practical skill development to assist themselves with emotion regulation, distress tolerance, relationship effectiveness, and mindfulness.

Since we know that there is a high correlation between traumatic experiences and the development of eating disorders, trauma-specific therapies have also been proven to be effective in processing the experiences that contribute to the development or exacerbation of our need to numb, change what we are feeling, or control our surroundings. Eye Movement Desensitization and Reprocessing (EMDR) is a therapy that uses bilateral stimulation through tapping, eye movement, or bilateral sounds to assist brains with processing experiences that have caused distress. EMDR has been proven effective in treating PTSD, depression, anxiety, and substance use. There are also multiple studies that show promising results with eating disorders, particularly in the reduction of body dysmorphia and overall emotional distress that contribute to felt need to engage in eating disordered behaviors. Because we know eating disorders are a symptom of underlying distress (often trauma), addressing the experiences that created the distress alleviates our feelings of overwhelm and our brain’s need for relief.

Another therapy that we utilize at Magnolia Creek Treatment Center for Eating Disorders is Somatic Experiencing (SE). SE was initially created for the treatment of trauma symptoms; however, research suggests it may be helpful in treating a variety of disorders that create emotional distress. The premise behind SE is that our body gets dysregulated and holds distress in a variety of physical manifestations when we experience threatening events whether that be from car accidents, lack of care from parents, unwanted sexual experiences, consistent chaotic or unpredictable environments, etc. If we can learn to recognize and allow our bodies to process through the dysregulation and survival responses they experience, symptomology and distress dissipate as well.

Family Therapy has also been proven to be effective in the treatment of eating disorders. We know that family may look different for each individual, so at Magnolia Creek, we define family as whoever you identify as a part of your support system. Many people in our support systems want to be able to support us, but they do not understand what may be most helpful for us. When we are able to teach them about our disorders, practice communication skills, develop healthy boundaries, and enhance our support systems, we know that our chances of recovery increase. We all need people to support us through our journeys. Engaging in healthy relationships and practicing articulating our needs furthers our ability to succeed in recovery.

Support through Medical Nutrition Therapy (MNT) is also crucial in maintaining overall health. MNT offers you the opportunity to collaborate with a registered dietitian on a regular basis to develop an individualized meal plan that is specifically designed to offer your body the nutrition it needs to function most effectively. Understanding the functions of our bodies, the purposes of different foods, and the ways healthy nutrition may assist us physically and emotionally helps us understand the importance and effects of our overall nutrition. 

While focusing on a variety of psychotherapy and nutrition therapy approaches, psychiatric medications also may be beneficial in assisting with emotion regulation and mood stabilization. Following weight restoration, research has found that Selective Serotonin Reuptake Inhibitors (SSRI’s) have been helpful in addressing symptoms of depression in individuals with eating disorders. Various anti-anxiety and mood stabilization medications have also been proven effective in reducing symptoms of anxiety and promoting overall mood stability. Please note that medication is not necessary for every person due to differences in each individual’s neurochemistry and neurobiology. Consulting a psychiatrist or a psychiatric nurse practitioner is always recommended to determine if medication has the potential to assist you with emotion regulation and determine what medication may be the best fit for you.

At Magnolia Creek Treatment Center for Eating Disorders, we believe that the contributing factors to the development of each individual’s eating disorder are complex, so we are committed to taking a multidisciplinary approach to help address each person holistically through a combination of therapies, medications, experiential activities, and nutrition counseling. We know that recovery from an eating disorder can be daunting, but being surrounded by a team of people to walk with you through your journey and address various contributing factors makes it possible. We would be honored to walk with you through your journey. For further information on Magnolia Creek’s residential and partial hospitalization programs, please call our Admissions office at 205-409-4220 or complete our contact form.  

References:

psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/eatingdisorders.pdf

sovcal.com/treatment/emdr-shows-promise-in-treating-eating-disorders/