3 Advanced Treatment Approaches for Severe, Chronic, and Resistant Eating Disorders

Severe and enduring eating disorders are sadly not uncommon. Eating disorders, in general, are complex mental health conditions that affect millions of people worldwide. For many, however, the journey to recovery can be particularly challenging and prolonged. 

Tragically, some individuals find themselves in and out of treatment, experiencing minimal benefits from treatment and frequent relapse of symptoms. 

Chronic or resistant eating disorders that don’t respond well to traditional treatments, require specialized and often multi-faceted approaches. Highly specialized providers can offer advanced treatment strategies and innovative therapies that offer hope and support for those struggling with more persistent forms of their conditions.

Understanding Chronic and Resistant Eating Disorders

Chronic eating disorders are characterized by their long duration and the tendency to persist despite ongoing treatment efforts. These disorders often manifest through entrenched behaviors related to eating, such as restrictive eating, bingeing, or purging, that become deeply ingrained over time. 

This long-term persistence can lead to severe physical and psychological consequences, including a wide range of health problems, limited social and professional engagement, and chronic emotional distress. 

When we refer to resistant eating disorders, we’re talking about conditions that do not respond well to standard treatment approaches. These disorders are often marked by particularly severe or atypical symptoms, which can complicate traditional therapeutic methods. 

The resistance to conventional treatments may be due to a variety of factors, including the intensity of the disorder or co-occurring mental health issues such as depression, anxiety, or substance abuse. This resistance requires treatment strategies to be adapted or intensified, potentially incorporating innovative approaches and a more holistic view that addresses both the eating disorder and underlying mental health conditions.

3 Advanced Approaches for Chronic and Resistant Eating Disorders

Recovery from chronic or resistant eating disorders is a journey that requires perseverance, flexibility, and a willingness to explore multiple treatment avenues. It’s essential to work with a team of professionals who understand the complexity of these conditions and can provide a comprehensive and compassionate approach.

Fortunately, there are several treatments that show promise for treating complex, severe, and enduring eating conditions. Let’s talk about a few of them.

1.) Dialectical Behavior Therapy for Eating Disorders

People with eating disorders commonly experience additional challenges like substance abuse, chronic emotion dysregulation, suicidality or self-harm behaviors. These individuals may not respond reliably to first-line treatments for eating disorders like Cognitive Behavioral Therapy (CBT) or Interpersonal Psychotherapy (IPT). When patients with additional complexity, engage in more standard care, there’s potential for struggle, inadequate progress and treatment drop out. 

Dialectical Behavior Therapy (DBT) has emerged as a highly effective approach for treating eating disorders, particularly in cases where traditional treatments may be insufficient. Originally developed to address emotion dysregulation, self-injurious behaviors, and suicidality, DBT provides a robust framework for managing the complex emotional and behavioral issues that often accompany eating disorders. 

DBT focuses on four core skill sets: mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness. These skills help individuals navigate intense emotions and challenging situations, which are crucial for those struggling with eating disorders where emotional instability often drives disordered eating behaviors.

For eating disorders, DBT is adapted to address specific challenges related to food and body image. The therapy integrates cognitive-behavioral strategies with mindfulness and acceptance techniques to help patients develop a more positive relationships with food and their bodies. 

In DBT, patients learn to manage and regulate their emotions effectively, which can reduce the reliance on disordered eating for coping. In teens, therapy also involves working closely with parents or caregivers, teaching them how to support their child in practicing these skills and managing crisis situations.

This comprehensive approach not only targets the eating disorder symptoms but also addresses the underlying emotional difficulties, making it a powerful tool for fostering long-term recovery and improving overall quality of life.

2.) Specialist Supportive Clinical Management: Hope for Severe and Enduring Adult Anorexia

Specialist Supportive Clinical Management (SSCM) represents a promising approach in the treatment of anorexia nervosa (AN), particularly for adults with chronic, enduring cases. SSCM is designed around the central principle of aligning with the client's evolving goals and supporting them through fluctuating levels of willingness and resistance. 

SSCM is an outpatient treatment that blends elements of clinical management with supportive psychotherapy. This approach fills a gap left by traditional interventions that fall short for certain patients, especially those who have experienced multiple treatments with little relief.

SSCM incorporates educating the patient about their condition, offering responsive and attuned support, allowing for self-determination and building a therapeutic relationship to foster treatment adherence. Throughout treatment, the provider ensures that the patient remains medically stable while remaining responsive to the patient’s needs. Although weight restoration is an important aspect of the treatment, the primary focus is on enhancing the patient’s quality of life. 

This approach helps to address eating, food, and overall health in a way that feels less threatening to the patient. Physical status is monitored through regular weigh-ins and blood tests, complemented by nutritional education and advice.

3.) FBT/DBT: An Integrated Model for Adolescent Eating Disorders

For a subset of adolescent patients, standard first-line treatments for eating disorders may not be sufficient on their own, particularly when these individuals present with additional challenges such as severe emotion dysregulation, suicidal or self-injurious behaviors, or other complicating factors alongside their eating disorders. 

In such cases, adaptations to traditional treatment approaches may be necessary to effectively address the full spectrum of the patient’s condition. 

FBT involves a critical role for parents or caregivers, who are tasked with managing and supervising their teen’s nourishment. In FBT, eating and weight stabilization are driven by parents until the child demonstrates an ability to resume responsibility for their own nourishment. 

Stand-alone DBT does not specifically address the role of parents in managing food and nourishment, which is essential when a teen’s eating disorder impairs their ability to reliably feed themselves. But with an FBT/DBT integration, DBT can take parent engagement to the next level by teaching them regulation, communication, mindfulness, and distress tolerance skills and involving them in the process of helping their child practice these skills in real-time. 

This is particularly important when there are significant emotional and behavioral challenges that could otherwise undermine parent feeding. We can see how integrating these two approaches creates more attuned and comprehensive support for parents as central in their child’s recovery.

Feedback on this integration has been promising, with a 2015 study supporting its efficacy for adolescent bulimia nervosa, though more robust controlled trials are needed. Given the rising incidence of eating disorders and suicide rates among young people, integrating these two evidence-based treatments holds significant potential for addressing the multifaceted nature of these severe cases effectively.

What We Say: Patients Can’t “Fail” Treatment

Sometimes the full responsibility for unsuccessful treatment is placed on the patient, suggesting that they are to blame for not overcoming their eating disorder. The reality is that people rarely fail treatment; rather, treatment fails the individual. 

When therapies aren’t tailored to fit an individual’s unique needs or lack integration of cutting-edge practices, patients may not see the results they’re hoping for. Furthermore, gaps in access to specialized care and continuity of support can leave individuals without the comprehensive help they need to tackle their complex challenges effectively.

Blaming individuals for treatment failure also overlooks significant systemic issues within healthcare. Many face obstacles such as inadequate access to skilled professionals, financial barriers, and insufficient insurance coverage, which can impede their journey to recovery. Instead of focusing on personal failings, it’s crucial to address these systemic flaws and improve how care is designed and delivered. 

By refining treatment approaches and ensuring better support, we can better meet the needs of those struggling with eating disorders and help them achieve the recovery they deserve.
As we continue to refine and expand these advanced treatments, there is an increasing opportunity to improve outcomes and support individuals in overcoming even the most severe and persistent eating disorders.

If you or someone you know is struggling with a chronic or resistant eating disorder, reach out to Columbus Park. Our team of seasoned therapists are skilled and experienced in nuanced treatment for even the most complex eating disorders.

Remember, recovery is always possible.