The specialist suggests a more comprehensive approach to treating people with eating disorders

Health services should teach eating disorder patients psychosocial skills to help more people recover and avoid relapse, according to an expert.

Anorexia, bulimia and other eating disorders affect millions of people, and eating disorder expert Bethany Crowley warns that eating disorders are often misunderstood. He suggests that a more holistic approach to treating people is needed, focusing on the whole person rather than just the disordered eating.

Quieting negative thoughts, learning to deal with emotional triggers and practicing self-compassion are among nine key skills outlined by the therapist in a new book.

An integrated approach to the treatment of eating disorders aims to demystify the complexities and nuances of disordered eating. The intention is also to help patients understand their thoughts, feelings and behaviours.

Warning signs

An estimated 30 million people are affected each year in the US by eating disorders such as anorexia, bulimia, and binge eating, and every 62 minutes someone dies as a direct result.

The relapse rate is high among those who seek treatment.

An integrated approach to the treatment of eating disorders includes real-life case histories to illustrate the struggles people face with disordered eating.

The author says that eating disorders are difficult to treat because everything is a metaphor, and one of the key skills for recovery is understanding the meanings behind food and eating. A bag of chips, he adds, can serve as a symbol of love and a substitute for a hug.

Sensitivity to rejection, obsessions and compensatory behavior, such as eating only after exercise, are among the many warning signs – or red flags – of a possible eating disorder, Crowley warns. Teaching patients to use their authentic “voice” is key to recovery, Crowley suggests, and to learning to silence negative thoughts.

She also says that people with eating disorders often struggle with everyday life and relationships, such as social situations, and another key skill is understanding attachment styles and needs to develop healthier relationships.

Other skills include people changing the “story” or “narrative” they’ve been repeating for years. Crowley says some people think of their eating disorder as their “best friend.” “What is needed,” he says, “is for them to learn to let go of their rigid thinking and the belief that they cannot change a negative situation, even when there are opportunities to do so.”

Evidence-based therapy

Crowley’s advice is based on multimodal therapy (MMT), an evidence-based treatment that explores biological, psychological and social aspects of why someone develops an eating disorder. MMT uses several therapeutic techniques at once, rather than just one, which may mean that underlying factors are overlooked.

Crowley, who has 20 years of experience treating eating disorders, says therapists need to better understand patients’ struggles from the time they enter treatment until they leave.

For patients, they are given a framework that they can use to cultivate the skills necessary for a positive recovery.

Psychoeducation is an essential part of my approach to treating eating disorders. Helping clients understand how their thoughts, behaviors, feelings, and perceptions are connected to their eating struggles and body dissatisfaction has been a cornerstone of the effectiveness of my approach.

For example, people with eating disorders often find it difficult to ask questions when things don’t make sense, which may be due to their anxiety or need for control. If they don’t ask questions, how can they expect to get better?

It’s our job to help them gain clarity around their issues so they can finally ask the right questions – and then better pursue and practice the skills needed for eating disorder recovery.”

Bethany Crowley, eating disorder specialist

An integrated approach to the treatment of eating disorders also advises that therapists use a physical and emotional energy scale to help patients recognize the body’s cues for rest. A lower number means the person is physically and emotionally tired and needs to act on it.

In addition, the book details how patients can identify their emotional triggers – their “window of tolerance” for emotional distress. The upper limit is hyperarousal such as arousal and the lower limit is hypoarousal such as feelings of hopelessness.