Science has come a long way over the last few decades and, in the process, has produced effective interventions for eating disorders. While there is still much we don’t know, we have learned a lot about how and why eating disorders evolve and how to treat them effectively.
Don’t Look Back
The most current, first-line eating disorder treatments are relatively short-term (20-40 weeks), structured and completely focused on what is happening today. So when people present for treatment and ask “what caused my eating disorder?” I tend to respond by explaining why it doesn’t actually matter; the more important question is “what’s keeping your eating disorder going now?”
Think about cancer: Once a diagnosis is confirmed, there are immediate interventions like surgery, chemotherapy, and radiation, implemented even though it’s unclear what caused the cancer in the first place. Treatment is prompt and aggressive because we know that the longer the cancer festers, the worse it gets, the more it spreads and unfortunately, the more lethal it becomes.
Well, the same can be said for eating disorders. An article in the November 2015 issue of The International Journal of Eating Disorders highlights factors that predict good treatment outcomes both at end of treatment and follow up:
- “Greater symptom change early during treatment… [is] the most robust predictor of outcome…”
This confirms what we see in practice: Patients who implement behavioral changes early in treatment (in the first 6-8 weeks) tend to do better over all. A rapid response to treatment increases feelings of efficacy, boosts confidence and over all increases optimism about recovery. Significant early change simply does not happen in longer-term, non-behaviorally oriented treatments where the focus is on exploring, processing and increasing insight over time.
- Early, focused intervention leads to better outcome.
Yes, addressing behaviors before they have habituated is a potent predictor of a good result; hence the importance of using a treatment that encourages change (over “processing”) from the start. Treatments that are change-oriented and that incorporate manageable behavioral exposures early on, will guide the patient forward right from the start of treatment.
The Bottom Line About Short-Term Treatment
So if you want to address disordered eating — restricted eating, bingeing, or purging — without a doubt, it’s best not to get too caught up in the past. Consider a present-focused, change-oriented treatment like CBT-E (Enhanced Cognitive Behavioral Therapy), the leading evidence-based treatment for bulimia, binge eating disorder and anorexia.
 Vall E, Wade T. Predictors of Treatment Outcome in Individuals with Eating Disorders: A Systematic Review and Meta-Analysis. International Journal of Eating Disorders 2015; 48: 946-971.