Early recognition and intervention are essential in enhancing the likelihood of recovery from an eating disorder (ED). It is very common for ED patients to hide and/or deny the symptoms of the disorder and to live a dissociated, secret inner eating disordered life that is filled with tremendous emotional pain and dysregulation with very little of this suffering apparent on the outside. Any suspicion of a disturbance in a loved one’s experience of her body, of weight, food, and eating, should be addressed immediately. Families themselves often must struggle with their own denial about recognizing the severity of the psychological trouble of the afflicted family member. The speed of recovery is enhanced by the family’s capacity to recognize and take seriously the illness and its root causes.

When an eating disorder is not medically threatening, multi-disciplinary outpatient treatment is the first recommended course of action. Ideally, ED outpatients will work with a core triad of providers: an individual psychotherapist, a nutritionist, and a primary care physician. It is very important that each of these practitioners have specific expertise in the treatment of eating disorders; signs and symptoms of EDs can be hidden, secretive, complex, and not always intuitive to a general practitioner of nutrition, psychology, or medicine. It is also very important that the clinicians agree to collaborate in the provision of care for an individual patient. Therapeutic modalities that may be used in addition to the above triad include a family therapist (with the patient), a parent guidance therapist (without the patient), and a psychiatrist.

Psychopharmacological treatment may be a useful adjunct to the total treatment package (in particular, the SSRI, or selective-serotonin reuptake inhibitor category of anti-depressants has documented efficacy), but it should always be used in combination with psychotherapy. Finally, when outpatient therapy results in insufficient progress, ED patients should be referred to a higher level of care (evening, day, residential, or inpatient treatment).

About the author: Licensed psychologist Dr. Abigail McNally maintains a private practice in Harvard Square (Cambridge, MA) where she conducts psychoanalysis, psychodynamic therapy, DBT-informed psychotherapy, and integrative therapy. In addition to a general focus on anxiety and depression, Dr. McNally maintains particular expertise in the treatment of eating disorders, personality disorders, and trauma. She is the former Assistant Director of the Laurel Hill Inn Residential Eating Disorder Treatment Center as well as the former Director of Post-Doctoral Training at Two Brattle Center.