Can we predict success in eating disorders treatment?

Our posts on motivation and readiness for change in eating disorders recovery seems to have touched a nerve, so why not keep the conversation going? Going through my files, I came across notes from an interesting eating disorders conference session that took place not too long ago. It was delivered by several of the most esteemed medical people in the field, Drs. Craig Johnson and Ovidio Bermudez of the Laureate Eating Disorders Program in Tulsa, Okla., along with social worker and mother of a former teen anorexic Robbie Munn. The title of their presentation was “Will That Boat Float?: Predictors of Success in Intensive Treatment.”

 

The doctors didn’t offer foolproof ways to predict whose treatment will succeed and whose won’t. Instead, they offered advice and hints on the kinds of things to keep in mind when your own loved one is in need of intensive treatment. Here are a few key points from the presentation:

 

· Why entering treatment can be so hard: Resistance to change is natural, it is a human adaptation for survival. Yet treatment means change.

· When it comes to adolescents, action needs to be taken swiftly and decisively. The longer an eating disorder continues untreated, the more entrenched and difficult to solve it becomes.

· In cases where an eating disorder endangers health, most people wait too long to go to the hospital.

· Change requires both the ability and the willingness to change.

· The more ready the patient is to change, the greater the chances of success.

· Once in treatment, don’t expect steady upward progress. Improvements in behavior will be followed by relapses. Aim for an overall upward trajectory and don’t be discouraged by inevitable backsliding.

· The malnutrition of a severe disorder can “hijack a patient’s ability to think clearly.” In some cases, an accompanying mental illness can be a barrier to treatment.

· A key factor to success is the ability to effectively treat these “co-morbid” or accompanying disorders, such as anxiety or depression, obsessive-compulsive behavior, drug and alcohol use, post-traumatic stress disorder or personality disorders. Once these conditions are under control the patient is better able to focus on recovery from the eating disorder.

 

Of course you are probably wondering,”but how do I get my child/friend/loved one to agree to entering treatment?” Drs. Johnson and Bermudez discussed Motivational Interviewing as an important technique to help patients arrive at the holy grail of “readiness to change.” For more on MI, please see our posts:  I am motivated to use Motivational Interviewing and Motivation: the first step to recovering from an eating disorder. They also discussed the “stages of readiness to change,” which Marcia and I will address in future posts. Stay tuned!

 

Nancy

Marcia Herrin and Nancy Matsumoto are co-authors of The Parent's Guide to Eating Disorders: Supporting Self-Esteem, Healthy Eating & Positive Body Image at Home (www.childhoodeatingdisorders.com).

Comments

[Anonymous]

Some reading that suggests patient motivation is not necessarily crucial to begin treatment. (Not to say that alliance/movitation might not be important to continued treatment and recovery, just that loved ones don't necessarily have to wait for the patient to "want to get better" to insist on treatment.)

http://www.hopkinsmedicine.org/psychiatry/about_us/publications/newsletter/archive/08_winter/compassion.html

http://ajp.psychiatryonline.org/cgi/reprint/164/1/108

[Nancy Matsumoto]

Thank you for sharing this great article, and one that makes sense to me. Marcia and I have great respect for Dr. Guarda and the work she is doing at Johns Hopkins.

Parents and loved ones, please read the above linked article and think about whether you need to act now instead of waiting for that elusive "readiness for change" moment to occur. Dr. Guarda is right; for many patients, it's not going to happen unless you somehow get your child/loved one in treatment.

"Coercion" is a strong word, but by putting the word "compassionate" in front of it, we get the idea. When the stakes are as high as they are for sufferers of serious eating disorder, using compassionate coercion might be the most responsible, moral and loving thing you can do.