Treatment of eating disorders has historically been conceived as rather monolithic or as a bit “one size fits all.” Until recently, little attention has been paid to variables such as the age at which the illness developed or the duration of the illness. Fortunately, clinicians are beginning to recognize the impact of these variables on the course of the disorder and on treatment.
Briefer-term eating disorders, have been studied and written about to some degree, and a specific treatment model exists. Longer-term eating disorders need similar attention.
Longer-term eating disorders benefit from treatment modalities tailored specifically to the complexities unique to those types of illnesses. These include a deep and wide-ranging dependence upon the symptoms/behaviors of the disorder; the sufferer’s belief that he/she “is” the illness as opposed to a person who "suffers from" the illness; an entrenched world view based on the eating disorder that leads to profound difficulty envisioning life without the disorder and an inability to believe in the possibility of surviving without the “assistance” of the illness; diminished experience in relationships other than with the illness, and the sufferer's consequent fear of incompetence in his/her ability to cultivate and maintain fulfilling connections.
In addition to psychological issues, medical and nutritional matters need to be considered within the context of the longer-standing nature of the illness. Serious physiological consequences can occur in any eating disorder; however longer-term eating disorders carry with them particular risks, not the least of which is higher mortality.
Treatment for longer-term eating disorders must navigate all these complexities, balancing attempts to reduce/resolve symptoms with the reality that the sufferer is intensely attached to and dependent upon those very symptoms.
In keeping with this, longer-term eating disorders need and deserve their own treatment models.
From a psychological standpoint, some approaches to treating eating disorders view the sufferer as engaged in a “war” with his or her disorder, the objective being to “win” the war by “conquering” (destroying) the disorder. Adversarial stances can provoke unintended consequences, particularly in longer-term illnesses: escalation of symptoms, intrapsychic disconnection and antipathy, antagonistic relationships between clients and clinicians.
Specifically designed for longer-term eating disorders, The Mediation Model holds that the sufferer and his or her disorder are not enemies. The goal of treatment is not to “kill off” the eating disorder, but to understand and then resolve what have seemed inexorable “conflicts between the sufferer and the illness.” As resolution of these “conflicts” occurs, symptoms of the eating disorder diminish.
Treatment of longer-term eating disorders brings myriad challenges. It also offers innumerable rewards for the sufferer and his or her family, and for clinicians. Treating these illnesses should be considered a specialty in its own right, with specific training for clinicians who wish to work with these types of sufferers. Longer-term eating disorders have often been considered “recalcitrant” or “treatment resistant” or “too chronic to treat,” or worse yet, “hopeless.”
This shouldn’t and needn’t be the case if we improve and expand our understanding of this subsection of eating disorders, and if we advance our ability to address these illnesses.
Dr. Johanna Marie McShane has been working in the field of eating disorders treatment for twenty-two years. After beginning her career as a therapist in an inpatient/residential eating disorders program, she went into private practice in 1994, working with adolescents and adults who suffer from all types of eating disorders. She has a passion for helping sufferers, their families and other loved ones understand these illnesses, as well as for guiding them through the process of recovery.
Johanna Marie McShane, PhD, CEDS
Certified Eating Disorder Specialist