eJournal

I have just returned from a big eating disorders conference and plan to write a few entries about what I found most interesting at the conference.

The conference started with an excellent presentation by Dr. James Lock of Stanford University on family involvement with outpatient eating disorders treatment.

Dr. Lock presented a lot of technical research findings, but I'd like to summarize some of them for you…

• It is very important to try to begin treatment for an eating disorder as soon as possible.  Preferably, even before you have a full-fledged eating disorder (when the young person is only showing some symptoms of an eating disorder).  When caught early, treatment is more successful and doesn't usually take as long.

• Outpatient vs. Inpatient (or Residential) treatment:  I was particularly interested in this research finding.  Aside from life-threatening issues that require inpatient treatment, in general, people do just as well with outpatient treatment as with inpatient or residential treatment.  This is very important because of the vast cost differences between inpatient/residential and outpatient treatment. 

As someone who works with eating disorders day in and day out, I'm always excited when I come across academic research findings that mirror what I see in my daily practice.  The first of these seems kind of obvious in a way - the earlier one starts treatment, the better.  I think this is certainly true, but often can be quite tricky.  Eating disorders often start gradually.  There might be only a little bit of restricting of food intake.  Or perhaps a little compulsive exercise.  Or just an increase in negative body image attitudes.  This is the probably the ideal time to seek treatment.  However, many people in this phase of not-yet-quite eating disorder don't see the problems in their behavior.  It's still a good idea to seek out treatment.  We can think of this as preventive treatment.  Sometimes in this phase a careful, not too forceful intervention can correct a trajectory headed toward a full-blown eating disorder.  My own experience has been that when that kind of behavior has been present for only a few months, it can almost always be reversed.  After several years, it's much more difficult (Dr. Lock's findings highlighted this as well, i.e., it is never too late to seek treatment, though earlier is better).

Again, as a practicing therapist over the last 25+ years, I have seen that the vast majority of people with eating disorders can be effectively treated on an outpatient basis.  Outpatient treatment can be slower at first, though research presented by Dr. Lock suggests that by the time you are 6-12 months away from the start of treatment, outpatient treatment provides results just as good as treatment beginning with a stay in an inpatient or residential treatment center.  Ultimately, anyone recovering from an eating disorder has to learn how to manage both their eating behaviors and the psychological parts of an eating disorder in their own environment.  Their own family, school, place of work, relationships, etc.  There are a lot of excellent residential eating disorders treatment centers around the country.  In general, they do an outstanding job.  I know they try to prepare people for their return home.  But that is a very difficult job to do well in a structured and controlled environment (when home environments just cannot be as structured or controlled).  I think it should be considered largely a matter of personal preference.  Some people really prefer the sort of radical change to their situation that a treatment center provides.  In cases where that is what someone prefers, it is probably a good idea to do just that.   However, the important thing to know is that it is not a question of one form of treatment being more effective than the other.

I hope this has been informative and helpful to some of you.  As always, please feel free to click on the "Contact" link on the left to send me a message, ask a question, etc.

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