Treatment Options

The Eating Disorder Foundation is not a treatment service, but we refer people to a variety of treatment centres and clinicians situated as close as possible to your local area. The Eating Disorder Foundation provide this information on the understanding that we do not endorse on treatment over another, nor one clinician over another. You may find the Consumer Guidelines for the Treatment of Anorexia Nervosa for the Royal Australian College of Psychiatrists (and co-authored by our CEO Amanda Jordan) a valuable aid in assessing the appropriateness of treatments. It will help you make an informed decision about treatment and assist you to know your rights as a consumer or carer.

The Eating Disorder Foundation supports evidence based practice and we recommend that you check that your practitioner belongs to an accredited professional body. We do not have an on-line database of health professionals, but you are welcome to all or email for information and referral.

Environments

No one environment can claim to be the best for everyone. Different people have different clinical needs and some clinicians and therapeutic communities might suit you better than others. Check it out carefully and know your options before you commit to some long term and possibly expensive and/or disruptive treatment. Remember that people with eating disorders often have serious (and hidden) health problems so it is essential to have some involvement with a medical doctor.

Inpatient

Inpatient clinics provide a structured and contained environment in which the person with an eating disorder has access to clinical support 24 hours per day. This involves structured programs and usually therapy as well. It is most effective when followed up with an outpatient program.

Outpatient

Most people in treatment attend either outpatient units, where they are seen by a team of health professionals from many different disciplines, or they may see a solo practitioner like a dietitian or a psychiatrist. People are encouraged to maintain everyday responsibilities, like attending school or going to work. Therapy and support is provided to enable that person to deal with the practical and emotional difficulties caused by their eating disorder, but they must ‘go it alone’ for much of the day.

Day Patient

People for whom outpatient treatment is inadequate may benefit from the increased structure provided by a day hospital program. These programs provide structured eating situations and active treatment interventions while allowing the individual to live at home, and in some cases, to continue to attend work or school.

Therapies

The most expensive programs are not necessarily the most successful, nor is the charge per session a true indication of a clinician’s competence or abilities. The reality is that there are few treatments in the public system which are free/low cost, and those that exist are mostly under great pressure with long waiting lists.

Costs in the private system can vary quite markedly. Psychiatrists fees are partly recoverable under Medicare for Australian residents, but mostly there is a gap payment to be made. Few psychiatrists bulk bill, but it may be worthy negotiating with your clinician if you have financial difficulties.

Allied health workers like psychologists, social workers and dietitians may attract a partial rebate from Medicare and private health insurance, but this is for a limited number and session and/or in special circumstances which you would need to discuss with your practitioner.

Individual Therapy

Cognitive Behavioural Therapy (CBT)

The central idea of CBT is that feelings and behaviours are created by thoughts. The basis of this style of therapy is if you are provided with accurate information and develop a trusting relationship with your therapist, you can begin to replace faulty or distorted thoughts with more positive and realistic ways of thinking and ultimately be able to change your behaviour.

In treating eating disorders the therapy aims to:

  • explore thoughts and beliefs which maintain the eating disorder
  • establish healthy eating habits
  • establish regular eating patterns
  • help you learn about food, eating and weigh and shape, and to eliminate some of the myths about food, eating and dieting
  • increase your awareness of potential triggers for relapse and helps you take preventative action
  • help you increase your self-esteem and decrease the importance of physical appearance you assessment of yourself.
Motivational Enhancement

This style of therapy is based principle that people with eating disorders are not always motivated to change. Even if you are motivated to “get better”, you may find it difficult, or be reluctant, to give up certain symptoms or behaviours of the eating disorder. The aim of Motivational therapy is to facilitate your readiness to change - to explore your reasons for holding onto the eating disorder and to encourage you to express your concerns about giving it up. It is then about discovering and exploring your own reasons to change.

The goal of motivation enhancement therapy is to support and promote people’s perception of their own capabilities - their ability to draw on their own resources and strengths to overcome obstacles and difficulties without relying on an eating disorder or eating disordered behaviour to cope.

Psychodynamic Approaches

Psychodynamic theory views disordered eating and weight control behaviours as a way of communicating or expressing underlying issues. The goal of a psychodynamic approach is to develop an understanding of the meaning of food and bodily control for people with eating disorders and to help them find alternatives to self-expression through eating disordered behaviour.

Developing a trusting relationship with the therapist is a key element of this style of therapy. Therapy involves looking at the way the beliefs and behaviours around food, eating, weight and the body, shape our self of sense of self. You, and your therapist, work together to form an alliance against the eating disorder. The aim is to slowly replace self-expression through an eating disorder with an experience of ‘aliveness’ - enhancing your capacity to experience the world in a more positive way.

Interpersonal

Interpersonal therapy aims to help people resolve troublesome interactions with significant others - such as unrealistic dependence on, idealization of, or hatred for a particular person. Eating disorders can sometimes result from, or be exacerbated by, such interpersonal difficulties. This style of therapy may also help people deal with difficulties such as impulsive behaviour, lack of control over anger and fluctuating moods.

Feminist

Feminist therapy assists women to examine eating disorder behaviour in the light of an extreme, but not surprising, response to a “pathological” social structure and the role and place of women in this society. Particular attention is paid to the disempowerment of women and the pressure to attain an unrealistically thin body. Issues of power are explored - and feminist approaches accept that issues of physical, emotional and sexual abuse may be relevant issues for women.

The aim of feminist therapy is empower women to take control of their lives in less self-destructive ways than through eating disorders and eating disordered behaviour.

Narrative

Narrative therapists are interested in joining with people to explore the stories they have about their lives and relationships, their effects, their meanings and the context in which they have been formed and authored. It centres people as the experts in their own lives and views problems as separate from people - that is the eating disorder is not part of person - but does have a profound influence on people lives. Narrative therapy assumes that people have many skills, competencies, beliefs, values, commitments and abilities that will assist them to reduce the influence of problems in their lives. The word ‘narrative’ refers to the emphasis that is placed upon the stories of people’s lives and the differences that can be made through particular tellings and retellings of these stories.

DBT (Dialectical Behaviour Therapy)

DBT focuses on the development of skills in the areas of emotion regulation, distress tolerance, interpersonal effectiveness and the practice of mindfulness. An emphasis is placed on the therapeutic relationship between the therapist and client - and targets some of the more self-destructive behaviours, beliefs and thoughts that people with eating disorders experience.

Family Therapy

Family therapy is based on the idea that changes within the family unit will result in a reduction of eating disordered behaviour. It does not necessarily imply that family factors where involved in the development of the eating disorder, but acknowledges that every family has issues that are difficult to deal with.

The aim of family therapy is to encourage the family, as a unit, to develop way to cope with issues that may be causing concern, including the eating disorder. They success of this style of treatment depends on the family being willing to participate and make changes to their behaviour. Family therapy can offer education about eating disorders and help families develop healthy ways to deal with the eating disorder.

Maudsley Family Based Therapy

The Maudsley model is an outpatient treatment that aims to bring about recovery in the home by supporting parents to take charge of re-feeding their children with anorexia. It’s effectiveness has been shown in younger adolescents with anorexia of shorter duration

This family-centred treatment progresses in three distinct phases. The first phase focuses on empowerment and eating. The family separates the patient from her/his illness and learns strategies to successfully battle the disease. For this method of re-feeding to succeed, the parents must establish an alliance and agree to enforce consistent food rules. In order for the patient not to feel her parents are the enemy, she is encouraged to turn to siblings for support.

The second phase of treatment starts when the patient complies with the parents’ food guidelines and makes steady weight gain . At this point, the parents help their child assume increased responsibility for eating. The third phase begins when the adolescent has regained and maintained 95% of her ideal weight without parental supervision. Individual therapy then begins and the patient can focus on issues and anxieties surrounding adolescence, a life phase that they have avoided by having an eating disorder. They can explore their identity and independence and learn to construct clearer family boundaries.

Group Therapy

The main purpose of group therapy is to provide a supportive and safe network of people who have similar issues. A therapy group usually has a closed membership and runs for a specified period. The aims and goals of the group will vary, depending on the approach taken. Some groups may have similar aims to cognitive behavioural therapy or interpersonal therapy. Although group therapy is not appropriate for every person, those for whom it is seem to benefit greatly from it.

Support Groups

Support groups differ from therapy groups in that they are intended to offer mutual support, encouragement and understanding. Support groups are usually open in attendance - people can attend regularly of drop in less frequently - and meet regularly. Support groups are usually run by people how have had experience with eating disorders, either personally, or a family member or friend. The Eating Disorder Foundation support groups are run by people with this experience, but we also encourage leaders to gain professional training and to undergo regular supervision. It is important that the group leaders feel secure in their recovery so they can act as genuine role models of recovery.

Guided Self-Help

Self-help texts are most commonly based on the cognitive behavioural approach and the techniques aim to provide strategies for improving eating patterns, reducing bingeing and purging patterns and strategies to deal with anxiety provoking and potentially triggering situations. Guided self help is more commonly used by people bulimia or binge eating disorder.

Drug Therapy

There is no magic pill or miracle cure that will ‘fix’ the eating disorder. Medication however, can be useful in treating other psychiatric problems such as depression and anxiety often associated with eating disorders. It is most effective when used in conjunction with ongoing therapy.

Medication can take several weeks to be effective, so results will not always be apparent immediately. Be patient, but do speak to your psychiatrist about any concerns you might have regarding the effectiveness of the medication. Some people will find that they only need to take medication for a few months while others may need to take medication for the rest of their lives.

Clinicians do have different views about the use of medication in the treatment of eating disorders. Some clinicians will use medication quite early on in the treatment, while others prefer to wait to see how other treatment progresses before prescribing medication. The type of medication used will also differ between doctors; some doctors may prescribe a number of different medications for you. If you are unclear about any aspect of your treatment - ask questions. You need to know why you are being prescribed medication, the expected benefit, and any side effects you might experience while taking it. If you are in any way concerned, or confused, about the use of medication in your treatment, raise it with your psychiatrist. You are entitled to ask for a second opinion if your concerns are not addressed.

Practitioners

GP

For most people, a GP is usually the first point of call for any medical treatment. GPs will all have a medical degree, but some may also have some further qualifications. In general, GPs assess symptoms, perform medical examinations and give advice and education on medical issues. Where a serious condition is suspected, GPs will often refer patients to specialist practitioners if further treatment is necessary. GPs can prescribe drug treatments such as anti-depressants.

Psychiatrist

Psychiatrists have a medical degree and additional qualifications in psychiatry. The will be registered with the Medical Board of Australia and also be a member of the Royal Australian and New Zealand College of Psychiatrists (RANZCP). Because they are medically trained, in addition to providing therapy, psychiatrists can prescribe medication, are able to monitor how well the medication is (or is not) working, and can assess and monitor physical symptoms. A referral to a psychiatrist can be obtained from a GP or from another medical practitioner.

Dietitian

A dietitian is qualified in nutrition and dietetics. They provide nutritional assessment, eating plans, and nutritional education. Dietitians are vital in the process of nutritional rehabilitation and the development of healthy eating patterns. They work with the person with the eating disorder to identify fears of food, and discuss the consequences of not eating well. They also work with the individual to recognize feelings of physical hunger and fullness and a healthy response to these.

Psychologist

Psychologists are graduates who provide counselling to individuals, couples or groups. Clinical psychologists are further trained in the assessment, diagnosis, and treatment of mental illness and psychological problems. Clinical psychologists, working with people with eating disorders, will often work collaboratively with other health professionals.

Social Worker

Social workers are graduates who provide counselling including individual, couple and/or family therapy. They may also facilitate self-help and support groups. They take into account: eg. living situations, relationships, financial resources, employment, health and education.

Counsellor

While many counsellors have completed specialist courses, they do not necessarily have a background in behavioural science. Registration with a professional body is not currently mandatory in Australia, but attempts are being made to establish professional standards.

Psychotherapist

This is a meaningless term in Australia as any one can put up a shingle and call themselves a psychotherapist. They range from highly skilled men and women with health science backgrounds and years of counselling experience, to health practitioners who have been deregistered by their relevant bodies and use the term psychotherapist to continue to earn a living. So buyer take care if your therapist belongs to no professional body.

For information about a program offering free outpatient treatment for people with longstanding anorexia, please click here.