4.1 Describe different approaches to the treatment of eating disorders

This guide will help you answer 4.1 Describe different approaches to the treatment of eating disorders.

Eating disorders are serious mental health conditions that impact a person’s relationship with food and their body. Examples include anorexia nervosa, bulimia nervosa, and binge eating disorder (BED). Approaches to treating eating disorders are varied and often depend on the individual’s diagnosis, severity of the condition, and personal circumstances. Support workers play a critical role in recognising symptoms and supporting individuals through treatment.

In this guide, we describe several common approaches used in treating eating disorders, providing a clear understanding of how each method works.

Psychological Therapies

Psychological therapies are a key approach to treating eating disorders. These therapies help individuals explore the thoughts, feelings, and behaviours causing their unhealthy eating patterns. Some examples include:

Cognitive Behavioural Therapy (CBT)

CBT is widely used for treating various eating disorders like bulimia, BED, and anorexia. It focuses on identifying negative or unhelpful thought patterns and changing them to improve behaviours relating to food and body image.

For example:

• A person with bulimia might believe they need to overeat and then vomit in order to control their weight.
• CBT aims to address this belief by replacing it with healthier and more balanced thoughts.

CBT is often structured and time-limited, with individuals attending weekly sessions. Individuals may also complete homework, such as keeping food diaries or practising alternative coping mechanisms.

Dialectical Behaviour Therapy (DBT)

DBT is another form of therapy used for individuals with eating disorders, especially those who use food to manage intense emotions. DBT teaches skills in four key areas:

• Emotion regulation (managing big feelings in healthy ways)
• Distress tolerance (coping during a crisis without harmful behaviours like binge eating)
• Interpersonal effectiveness (building and maintaining healthy relationships)
• Mindfulness (staying present and aware of current thoughts or urges)

DBT can be very effective for people with binge eating disorder who struggle to regulate their emotions.

Family-Based Therapy (FBT)

FBT is particularly effective for children and adolescents with eating disorders, especially anorexia nervosa. In this therapy, parents and family members are actively involved in the individual’s care.

Key components include:

• Helping parents take control of the individual’s eating habits until they regain a healthier weight or pattern.
• Gradually allowing the individual to regain control over food as their condition improves.
• Addressing family conflict or negative communication patterns that may contribute to the eating disorder.

FBT views the family as a valuable resource in recovery and is often short-term, running approximately for 20 weeks.

Nutritional Rehabilitation

Re-establishing healthy eating habits and restoring nutritional balance is central to treating eating disorders. Nutritional rehabilitation works alongside psychological therapies and may require collaboration with a dietitian or nutritionist.

Key elements include:

• Meal Planning: Professionals develop a tailored meal plan that ensures the individual receives the right balance of nutrients for their needs.
• Restoring a Healthy Weight: For individuals with anorexia, this involves gradual, supervised weight gain.
• Challenging Food Rules: Many individuals with eating disorders develop restrictive or irrational ‘rules’ about what they can and cannot eat. Nutritional rehabilitation aims to help people overcome these rigid behaviours.
• Addressing Physical Health Problems: Eating disorders often lead to medical complications, including weakened bones, poor heart health, or digestive problems. Nutritional approaches may target these conditions directly.

In some cases, individuals may require feeding through a nasogastric tube if they are very malnourished. This step is typically taken during hospitalisation.

Medical Treatment

Medical treatment may be needed to manage complications from eating disorders. These complications include electrolyte imbalances, gastrointestinal problems, or heart conditions. GPs and other healthcare professionals oversee this treatment.

Some patients may need medication to address co-occurring conditions, such as anxiety or depression. Common medications include:

• Antidepressants: Selective serotonin reuptake inhibitors (SSRIs) like fluoxetine are sometimes prescribed. These may help in cases of bulimia and binge eating disorder by reducing the frequency of binges and improving mood regulation.
• Anti-anxiety Medication: Some individuals might benefit from short-term anti-anxiety medication, but this is not a long-term solution.
• Medication for Weight Loss or Appetite: In the case of binge eating disorder, medication like lisdexamfetamine may reduce cravings.

It’s important that medical treatment only supports other therapeutic interventions, as medication alone cannot resolve eating disorders.

Inpatient and Residential Treatment

In severe cases, a person may require inpatient or residential care. This type of treatment is often recommended for individuals who are very underweight, have life-threatening physical complications, or have failed to respond to outpatient therapies.

In these settings, individuals receive round-the-clock multidisciplinary care, including:

• Supervised mealtimes and support to challenge disordered eating behaviours.
• Therapy sessions to address underlying psychological issues.
• Regular monitoring of physical health (e.g., weighing, checking nutrients in the blood).

Residential care is typically longer-term than inpatient hospital settings and focuses on rebuilding the individual’s independence after stabilisation.

Support Groups and Peer Support

Support groups and peer-led programmes can be helpful for people recovering from eating disorders. These groups allow individuals to share their experiences, listen to others, and feel less alone in their struggles.

Examples include:

• Eating Disorder Charities: Organisations like Beat (the UK’s main eating disorder charity) offer online and in-person support groups for those affected by eating disorders and their families.
• Peer Support: This involves community-based support by others who have lived experiences of an eating disorder. Sharing recovery stories can inspire hope and motivation.

Group settings reduce isolation and encourage shared learning, although they are not a replacement for professional treatment.

Self-help Approaches

Self-help interventions can be useful, especially in cases of binge eating disorder. This approach is often guided by structured resources, such as books, worksheets, or online programmes.

Key elements of self-help:

• Following evidence-based techniques, often based on principles of CBT.
• Setting personal goals, like reducing the number of binge episodes each week.
• Tracking progress and reflecting on triggers through a journal or app.

While self-help can work for milder conditions, individuals with moderate to severe eating disorders may need additional professional help.

Cultural and Religious Considerations

Cultural and religious values can shape how people perceive food and their relationship with their bodies. Treatment approaches often recognise these influences and adapt to meet individual needs sensitively.

Examples of culturally sensitive care:

• Facilitating therapies in the individual’s first language.
• Ensuring dietary plans align with religious dietary restrictions, such as providing halal or kosher options.

Support workers play a role in advocating for these adjustments, ensuring that treatment resonates with the individual.

Focusing on the Whole Person

Treating eating disorders is not just about food. It requires addressing an individual’s overall well-being, self-esteem, and social connections. In addition to therapies and medical care, individuals may receive support in areas like:

• Building Self-esteem: Activities or workshops to boost confidence and improve body image.
• Social Skills Training: Helping individuals rebuild relationships that have been impacted by their eating disorder.
• Developing Life Skills: For instance, teaching cooking or meal preparation skills in a safe and supportive environment.

By taking a comprehensive view of recovery, practitioners improve the individual’s long-term outcomes.

Role of a Support Worker

As a support worker, your role is vital. While you may not provide direct medical or therapeutic interventions, your responsibilities include:

• Observing and reporting signs and symptoms of eating disorders.
• Providing emotional support and encouragement.
• Supporting individuals in attending appointments or following treatment plans.
• Encouraging healthy behaviours while maintaining a non-judgmental stance.

You may also act as a bridge between the individual and other professionals, fostering consistent and compassionate care.

Eating disorders require a multi-disciplinary approach. Each strategy builds toward safety, growth, and recovery. By understanding different treatment methods, support workers can better help individuals make meaningful progress.