From Identification to Treatment: Four Steps to Effectively Intervene with Your Child's Eating Disorder

Let's discuss four steps to effectively intervene with your child's eating disorder: identify the problem, talk to your loved one, reach out to their primary care physician, and plan for treatment.

1. Know the warning signs and symptoms.

Of course, a dramatic change in weight – either up or down – will be one of the more obvious signs that an individual’s eating has shifted (and may or may not indicate an eating disorder).  But someone can be suffering from disordered eating without much change in weight.  So here are some other signs/symptoms to look out for:

• Rituals or strange eating behaviors (e.g. cutting food into tiny pieces, measuring food, sticking to a few “safe foods,” hoarding food)
• Excessive or unusual use of condiments and beverages (e.g. an excessive amount of spices – like salt - on food, abusing beverages such as diet soda or coffee [in an attempt to feel more full], odd food combinations)
• Isolation - particularly around eating
• Decrease in interest and engagement in pursuits the individual previously enjoyed
• Significant and relatively sudden increased interest in reading about food, recipes, baking

It is important to remember that it is not your fault if you have missed these warning signs. Be compassionate with yourself and avoid placing blame. Remember, parents do not cause eating disorders though they are invaluable to the recovery and treatment process.

2. Learn how to talk to a loved one about an eating disorder.

When thoughts and feelings are communicated effectively, support from friends and family may motivate an individual to seek treatment. Here are some helpful tips:

• Set a private time and place to speak
• Use “I” Statements
• Feeling anxious? Rehearse what you want to say
• Avoid ‘simplistic solutions’ e.g. Just stop, Just eat.” This isn’t’ helpful and can leave your loved one feeling misunderstood
• Encourage them to seek professional help as getting timely and effective treatment will drastically increase their chances for recovery
• Stick to the facts (e.g. “I have seen you run to the bathroom at mealtimes, it makes me worried that you may be making yourself throw up.”)

3. Involve primary care.

Prior to initiating treatment, we must first evaluate if there are any medical complications due to weight loss/weight gain, malnutrition or purging. The medical evaluation is important for other reasons as well:

• It may help open a dialogue with your child on prospective treatment from the perspective of physical health.
• An evaluation with an MD will help you to identify if your child needs a treatment that will incorporate management of medical complications (like a hospital setting).
• Your primary care provider(s) may be able to connect you to helpful local resources.

4. Plan for treatment, including asking the right questions and navigating the costs.

If you have begun to explore the world of eating disorder treatment, you have likely identified that insurance coverage is limited and treatment can be expensive. Evidence-based interventions such as CBT-E are ideal— short term, cost-effective and highly successful (learn more about our treatment outcomes using evidence-based, time-limited treatments here).

According to the research, the leading treatment for bulimia and binge eating (CBT-E) is 20-weeks in duration. For anorexia, this treatment applies over the course of 40-weeks. Don’t hesitate to ask the important questions when researching your treatment provider since non-evidence-based interventions may be unnecessarily lengthy (open-ended) = wasted time and significant financial burden.

Here are seven critical questions for a prospective provider:

1. Does this treatment provider adhere to evidence-based treatments, specifically designed for eating disorders?  More specifically, you can ask if they use CBT-E, DBT or Family Based Treatment for Children/Adolescents?   These are the gold standard, proven treatments.
2. Is this provider experienced in such treatments (i.e. fully trained and practicing for some time)?
3. Where did the provider receive specialized training? 
   • For DBT, you look for Behavioral Tech Intensive training and ideally, 2-plus years of practice in the model.  The DBT therapist should be an active member of a weekly DBT Consultation Team.
   • For CBT-E, ideally the clinician completed the Fairburn therapist training and has been supervised using the manual for at least a year. 
   • For the treatment of children and adolescents with eating disorders, the provider should be certified in Family-Based Treatment.
4. Can the provider speak to his/her outcomes or results? 
5. Does he/she actually track how patients are responding to treatment provided?  What tool does he/she use? 
6. What is the typical length of treatment? 
7. Is the expectation of length of treatment outlined from the onset?  You should be able to get a basic sense.  Consider carefully if the length of treatment is open-ended.

If you have additional questions about diagnosis or the evidence-based practices utilized at Columbus Park, please feel free to contact us!