Eating Disorder Pro

One Size Fits All

By Dr. J. Renae Norton

Book Jacket Text

Eating Disorders are on the rise. They also have higher mortality rates than all other psychological disorders. A significant part of the problem is that treatment is more likely to fail than to succeed. This is due to the fact that a “One Size Fits All” approach to the treatment of eating disorders (ED’s) has emerged that is driven by sexist interpretations of the disorders, stigmatization, lack of information about subtle but critical differences between different diagnostic categories, a gender bias that negatively impacts males and females and efforts at driving down the cost of care, especially inpatient care, at the expense of the population being served. There are many groups that have been disenfranchised due to the impact of a One Size Fits All approach to the treatment of eating disorders: older women, men, those with more severe disorders and the obese.

A One Size Fits All approach perpetuates the stigma associated with ED’s, which puts the victims at more risk. In my experience, this is an extraordinarily diverse population, of exceptionally bright and potentially talented individuals, whose presentation varies even within diagnostic categories, let alone between them, such that no two individuals present exactly alike. What I hope the reader finds within this book, is the right information, delivered in a way that is useful in terms of moving the victims of these terrible disorders towards recovery, instead of inadvertently hastening their demise.

 

Exerpts From Chapter One

The Problem: One Size Does Not Fit All!

Introduction

"According to a comprehensive study reported in the International Journal of Eating Disorders regarding inpatient care, 27.5% of residential patients had a good outcome, 25.3% an intermediate outcome, 39.6% had a poor outcome, and 7.7% were deceased on follow-up.  If you add the last two categories, poor outcome and very poor outcome, 47.3% of those studied were still very sick or deceased 12 years post-inpatient treatment. Only 27.5% had a good outcome according to this research! "

...

"As far as skill development, Dialectical Behavioral Therapy (DBT) has been shown to be effective with impulse control disorders and addictions..."

...

"In this chapter, I will focus upon the essential problem, i.e. that most of the treatment today for ED’s over-generalizes, or uses what I am euphemistically calling a One Size Fits All approach."

What Does One Size Fits All Look Like in Practice?

"A good example of a One Size Fits All (OSFA) approach is represented by the fact that inpatient treatment is the treatment dujure for the individual whose symptoms are severe, despite its general lack of effectiveness."

Mismanaged Care

...

Profitability and OSFA With Residential Treatment

"Over the years, I have heard horror story after horror story from individuals suffering from Bulimia, who were put on a meal plan in a residential program of 3500 calories per day, and then restricted from exercising, and their frantic efforts at finding ways to beat the system and purge. (Too often they succeeded and purged the entire time they were inpatient.) "

...

"The majority of the patients that I have treated who were in this situation, simply grit their teeth, gain the weight, and vow to lose it when they are released. This becomes an interesting object lesson for the parents, significant other, and/or referring therapist in that it sends a clear message; “Force me into treatment, and/or to gain weight and instead of getting better, I’ll get worse as soon as I get out, so don’t do it again!” For the family member, it is devastating to get a loved one back only to lose them again. "

OSFA and Family Therapy

"While outpatient treatment for the very ill individual suffering from Anorexia takes much longer, anywhere from 18 months to 5 years, recovery outcomes on follow-up are much better, depending upon the treatment modalities employed. According to the research on efficacy, the most effective treatment (or that which has the best long-term remission rate) is one that includes family therapy."

OFSA in the Treatment of Obesity

"I see many obese patients whose physicians have never mentioned nutrition or exercise in relation to their obesity."

 

Int J Eat Disord. 1997 Dec;22(4):361-84.