Ten years of treating eating disorders: what have we learned? A personal perspective on the application of 12-step and wellness programs.
Conventional therapy for eating disorders has focused on behavioral approaches, medical models, and combinations of both, with lesser emphasis on psychological and wellness models. Because eating disorders are often difficult to treat and the individuals who have them often exhibit significant comorbidities, the long-term success rate (3-5 years or more)-defined as recovery and abstinence from the disorder behaviors-is in the 40% to 50% range, at best. Moreover, if one examines randomized controlled trials (RCTs) that test the efficacy of the most commonly used behavioral approaches in a historical manner, as is described in this article, by assigning RCTs to 2 different time periods for the treatment of bulimia nervosa (BN), it is found that no progress has been made in the success rate of treating this disorder. Many reasons exist for this lack of progress, including comorbidities, failure of patient-therapist relationships to be dynamic, failure to appreciate that BN and binge eating disorder have addiction components that might require 12-step or multimodal approaches, and an absence of treating the whole person, which requires using a wellness model and elements such as body awareness exercises, yoga, and spirituality. Based on a review of the literature and my personal experience over the last 10 years, it is suggested that best practices for treating these disorders should include wellness and 12-step models that focus less on self-centeredness, highlighting the strengths of the person and helping individuals to find their true spirituality, which can be used as a focal point for all treatment. Conventional approaches can still be useful in treating eating disorders, but clinicians and psychiatrists should cease seeing eating disorders as "diseases" that should be treated by pharmacodynamics and consider that these are conditions that have taken many years to develop and that have many background psychological factors, often reaching back to childhood.
McAleavey
Kristen
K
Longwood University, Farmville, Virginia, USA.
D001521:Behavior Therapy; D015897:Comorbidity; D001068:Feeding and Eating Disorders / Q000523:psychology / Q000628:therapy*; D005260:Female; D006694:Holistic Health; D006801:Humans; D008297:Male; D029181:Spirituality