Sierra Center for Wellness offers a Family Outpatient Program that actively engages families in the treatment of anorexia, bulimia nervosa binge eating disorder and ARFID. The intent of the program is to provide families the information and experiences they need to effectively participate in their loved one’s recovery. In addition, this program allows patients and their families the opportunity to receive effective treatment while maintaining normal day-to-day activities such as school and work.
The program is tailored to the specific needs of the patient and his or her family. Each patient and family receives one 4 hour session of intensive treatment and education followed by individual therapy, family therapy, and continued education and support for 6-12 months. The purpose of the initial intensive treatment and education is to prepare patients and their families for long term recovery and to create their specific path to recovery. Patients and families will receive the information and tools they need to create an environment of recovery that originates within the home. The family and the family relationships are seen as tools to help the patient recover from his or her eating disorder. Only one family participates in the intensive treatment and education session which allows families to get the specific information and education they need to help their child achieve full recovery. The classes and experiential activities are conducted by Dr. Tony Paulson who has over three decades of experience treating patients with eating disorders.
Frequently Asked Questions
This program views the family as the primary resource to help their loved one recover from an eating disorder. We provide the information and tools families need to help facilitate lasting recovery. In addition, all services are provided by clinicians with extensive experience in the treatment of eating disorders.
Each patient and family receives one day of intensive treatment and education followed by continued individual therapy, family therapy, education, and support for 6-12 months. The initial one day of intensive treatment and education occurs on a Saturday from 9am to 1pm. Subsequent treatment will be scheduled to minimize the impact on school and work obligations.
This program views the family as the primary resource to help their loved one recover from an eating disorder. We provide the information and tools families need to help facilitate lasting recovery. In addition, all services are provided by clinicians with extensive experience in the treatment of eating disorders.
Your insurance will pay for most of the program. Prior to beginning, families will receive an estimate of the cost of treatment. We try to make treatment accessible to all. With that said we offer payment plans for any costs that are not covered by your insurance.
The first step is an assessment. Once the assessment is complete a treatment plan will be recommended to the family and the initial one day of intensive treatment and education will be scheduled if appropriate. If other types of treatment are warranted, the clinician will assist the family in securing the level of care most appropriate.
An Evidence-Based Approach to Treatment
Eating disorders typically have been treated in inpatient and residential treatment facilities that require patients to live away from their families. This separation is often disruptive and distressing to patients and their families. Treatment in residential and inpatient facilities is usually successful in restoring the patient’s weight. Unfortunately, the rate of relapse once they leave and return home is high. This often leads to multiple treatment episodes.
Researchers have found that for some patients suffering from Anorexia family participation in treatment contributes to better outcomes (1), (2), (3). Thus, the treatment for anorexia and other eating disorders have become more inclusive of families.
Family Based Treatment for Anorexia and Bulimia
Family based treatment (FBT) is a treatment option for children and adolescents with a diagnosed eating disorder and who are living at home with their family (Eating Disorders Victoria, 2014). It is currently the leading treatment for adolescents with eating disorders and is
often used as the first approach when treating any eating disorder (Rienecke & Le Grange, 2022). FBT is an evidence-based treatment, meaning that it has been tested and judged to see if it would be affective and appropriate for a given population. It was developed by Christopher Dare and Ivan Eisler, two family therapists, in the late 1970s and early 1980s in London, England(Loeb and Le Grange, 2009). This team was based at the Institute of Psychiatry and the Maudsley Hospital in London and can also be known as the “Maudsley Approach” or “Maudsley Method” (Loeb and Le Grange, 2009). The treatment was not brought over to the United States until 1994 where it was introduced as Stanford University by Daniel Le Grange (Loeb and Le Grange, 2009).
FBT emphasizes using parents as the main recourse to bring about recovery in their child by encouraging them to have power over mealtime (Loeb and Le Grange, 2009). FBT is most notably used with children and adolescents who have anorexia nervosa (AN) (Rienecke & Le Grange, 2022). AN is an eating disorder that is classified as a psychiatric disease that involved patients restricting their food intake in many ways which involve nutritional deficiencies (Moore, 2023). While a lot of research on FBT has been done with AN patients, it has been found to be helpful in treatment for bulimia nervosa (BN) patients as well (Rienecke & Le Grange, 2022). BN is also a psychiatric disorder classified by binge eating and inappropriate compensatory behavior that can lead to potential critical complications in relation to control weight loss and nutritional deficiencies (Jain and Yilanli, 2023). Both disorders show disturbances in attitudes and perceptions in regard to weight and shape (Berrettini, 2004).
Regardless of the disorder, FBT consist of three phases that can then be shaped for the specific disorder (Rienecke & Le Grange, 2022). The first phase is parents are given the responsibility for bringing weight restoration (returning to a healthier body weight) in AN and eliminating binge eating/purging while establishing regular eating habits for those with BN (Rienecke & Le Grange, 2022). For this phase, parents are asked to make all eating-related decisions for their child while also limiting their physical activity until the eating disorder behaviors are no longer influencing the child (Rienecke & Le Grange, 2022). When transitioning to phase 2, responsibility of eating gradually gets shifted back to the child or adolescent, this is in terms of whatever the family views as being appropriate food responsibility for their age (Rienecke & Le Grange, 2022). Lastly, phase 3 involves a review of the adolescent and an assessment of there they are in their development once the eating disorder has receded (Rienecke & Le Grange, 2022). This phase can only occur when they therapist and parent become convinced that the eating and weight disturbances and other behavioral issues are no longer the focus of conversation (Rienecke & Le Grange, 2022). FBT has been found to have a success rate of 86%, meaning that patients have seen successful recovery once out of the program (Loeb and Le Grange, 2009).
Types of Eating Disorders
Anorexia Nervosa is characterized by weight loss caused by inadequate caloric intake and/or excessive exercise. Many people suffering from anorexia believe they cannot be thin enough and continue to see themselves as “fat” even though they may be extremely malnourished. The following symptoms and behaviors are common in people suffering from anorexia:
1. Weight loss
2. Preoccupation with food, calories, dieting and body image
3. Refusal to eat certain foods
4. Wearing loose, bulky cloths to hide weight loss
5. Avoiding mealtimes or eating in front of others
6. Making comments about body image
Because people with anorexia become expert at hiding it, the disease may become severe before it comes to the attention of others. Because of this, getting appropriate treatment is often delayed. What we know about recovery from anorexia is the sooner in the progression of the illness people get the right type of treatment the more likely they are to fully recover.
Bulimia Nervosa is characterized by episodes of bingeing followed by purging, fasting, or exercising excessively to compensate for overeating. People suffering from bulimia are typically normal weight but as with people suffering from anorexia have intense fears of gaining weight and distorted body image. The following symptoms and behaviors are common in people suffering from bulimia:
1. Evidence of binge eating
2. Dieting without weight loss
3. Hoarding or hiding foods
4. Avoiding eating in front of others
5. Using the restroom after eating
6. Evidence of purging
Binge Eating Disorder is characterized by episodes of overeating and feelings of loss of control about eating. The following symptoms and behaviors are common in people suffering from binge eating disorder:
1. Evidence of binge eating
2. Attempts to hide binge eating behaviors
3. Guilt and shame associated with binge eating
4. Hoarding or hiding foods
5. Depression
Recognizing the signs and symptoms of eating disorders is the first step toward getting help and recovering. Getting the right type of treatment and having support from others are keys to recovery. Unfortunately, eating disorders have the highest mortality of all of the psychological disorders as nearly 1 out of 10 people suffering from eating disorders do not survive their illness. Fortunately, eating disorders are treatable, and with the right type of treatment and support most can find relief from their eating disorders and get their lives back on track.
How to approach someone you are concerned may be suffering from and eating disorder
People suffering from eating disorders often use their eating disorder behaviors to manage feelings of depression and anxiety. In other words, they feel less depressed and anxious because of their eating disorders. They are often ambivalent about getting treatment because they fear without their eating disorders their symptoms of depression and anxiety will worsen. Because of this people suffering from eating disorders hide their behaviors and deny a problem when approached by others. They can become defensive and angry when concerns about their eating are brought to them. Don’t let their response to your concerns deter you from making sure they get the right type of help they need. Here are some tips in approaching someone you are concerned may be suffering from an eating disorder:
1. Educate yourself about the signs and symptoms of eating disorders
2. Research different treatment options (see treatment options below)
3. Approach your loved one directly about your concerns
4. Provide your loved one written material about eating disorders, the health risks associatedd with them, and treatment options
4. Be persistent about your loved one getting help
Levels of Care
Outpatient Treatment
Typically outpatient treatment involves individual and family psychotherapy. In addition, many patients also receive nutrition counseling and all patients should be medically managed by their Primary Care Physician. The psychotherapist coordinates the patients treatment and insures all the providers communicate with one another about the patient’s treatment. Outpatient care is appropriate for most patients if they are medically stable and are making progress in treatment. Progress in treatment should be measured by reduction and elimination of eating disorder behavior and improved insight about the psychological issues that might be driving eating disorder behaviors. The benefit of outpatient treatment is that patients are able to receive treatment with minimal interruption in their day-to-day lives. In other words they receive treatment while continuing work, school, and remaining with their families.
Partial Hospitalization
Partial hospitalization program are typically 8-11 hours per day 5-7 days per week. Patients attend treatment during the day but return home in the evenings. This level of care is appropriate for those patients who need more consistent supervision throughout the day to prevent eating disorder behaviors. Patients at this level of care take a leave from work or school in order to attend treatment.
Inpatient Residential Treatment
At this level of care patients stay at the treatment facility 24 hours per day, 7 days per week. This level of care is appropriate for those patients who need this level of supervision to prevent eating disorder behaviors or require daily medical monitoring.
Reference:
American Psychological Association. (2017). What is Cognitive Behavioral Therapy? [Internet]
https://www.apa.org/ptsd-guide…
Berrettini, W. (2004). The Genetics of Eating Disorders. Psychiatry (Edgmont), 1(3), 18-25.
https://www.ncbi.nlm.nih.gov/p…
Jain, A. & Yilanli, M. (2023, July 31). Bulimia Nervosa. National Library of Medicine [Internet].
https://www.ncbi.nlm.nih.gov/b…
Loeb, K. L. & Le Grange, D. (2009). Family-Based Treatment for Adolescent Eating Disorders:
Current Status, New Applications and Future Directions. International Journal of Child
and Adolescent Health, 2(2), 243.
https://www.ncbi.nlm.nih.gov/p…
Moore, C. A. (2023, August 28). Anorexia nervosa. StatPearls [Internet].
https://www.ncbi.nlm.nih.gov/books/NBK459148/#:~:text=Anorexia%20nervosa%20is%
20a%20psychiatric,and%20have%20distorted%20body%20images.
Rienecke, R.D. & Le Grange, D. (2022). The five tenets of family-based treatment for adolescent
eating disorders. J Eat Disord 10, 60. https://doi.org/10.1186/s40337…
Russell, H., Aouad, P., Le, A. et al. (2023). Psychotherapies for eating disorders: findings from a
rapid review. J Eat Disord 11, 175. https://doi.org/10.1186/s40337…
This is a very helpful video that explains the Family Based Treatment Approach
Helpful Books
It Was Never About The Food
Contained in It Was Never about the Food are the stories of four individuals who developed and struggled with an eating disorder and then overcame it. Sprinkled throughout their words are clinical explanations for what is happening as their stories unfold. The reader will be able to see both the personal experiences and the clinical explanations of how an eating disorder can develop, how harmful it can be, and what the road to recovery might look like. It Was Never about the Foodis written for eating-disordered patients, their loved ones, and clinicians to provide a better understanding of what it is like to struggle with disordered eating and how to move on
Why She Feels Fat
Dr Tony Paulson and Dr Johanna Marie McShane authored Why She Feels Fat: Understanding Your Loved One’s Eating Disorder and How You Can Help. Sprinkled with over 100 quotes from revcovering individuals, Why She Feels Fat explores eating disorders from the inside out to convey the emotional experience and perspectives of those who have them. Decoding the deeper meaning of the statement “I feel fat” is at the heart of this simple and straightforward book that also includes basic information, such as signs, symptoms, medical complications, causes, approaches to treatment and states of recovery.
Reviews
“In Why She Feels Fat, McShane and Paulson give parents the all-important perspective of their suffering child-this book explains the incomprehensible. When read an open mind and heart, it brings to friends and family alike much needed understanding and guidance.” – Doris Smeltzer, MA, author, Andrea’s Voice: Silenced by Bulimia
“Like never before, this book takes the reader into the mind of someone with an eating disorder and explains the unexplainable. Combining personal insight from the sufferers with clinical expertise, the authors provide step-by-step guidance form maneuvering the long and winding path from illness to full recovery. Why She Feels Fat is an essential resource fro all families and friends.” -Jenni Schaefer, author, Life Without ED
“With a plethora of books on eating disorders these days, few are dedicated to the loved ones of those suffering from these illnesses. Why She Feels Fat is a welcomed addition to the field… From understanding medical issues to grasping why a person with anorexia says she feels fat, this book will help guide those lost in the quagmire that dealing with someone else’s eating disorder inevitably brings.” – Carolyn Costin, director, Monte Nido Treatment Center, author, The Eating Disorder Sourcebook
“Why She Feels Fat provides an inside view of the intense struggle and emotions behind an eating disorder…we look forward to adding Why She Feels Fatto our patient library.” -Martha Levine, MD & Richard Levine, MD, Eating Disorder Program Penn State Milton S. Hershey Medical Center
For more information please visit www.gurze.com