Treating Patients with Eating Disorders: It Takes a Village
The treatment of eating disorders is one of healthcare’s most complex therapeutic pathways. Helping patients achieve recovery requires a sustained, collaborative, and multidisciplinary approach, tailored to the unique needs of the individual and family. And that’s just the start. Elisha Contner Wilkins, MS, LMFT, CEDS, executive director of Veritas Collaborative’s Richmond, Virginia, facility, shares her perspective on what it takes to achieve optimal outcomes for patients with eating disorders.
You are a fierce proponent of a multidisciplinary approach to treating eating disorders. Why is this so important?
Eating disorders are a biologically based mental disorder, and they have one of the highest mortality rates of any psychiatric illness. By the time patients get to us, we’ve got to pull apart the medical, nutritional, and psychological issues affecting the individual, and different experts are necessary to address them. That’s why each of our patients has a primary team that includes a family medicine physician, a dietitian, a psychiatric provider, and a therapist.
What is each care provider’s role?
The physician focuses on the patient’s medical issues, bringing in specialists, if needed. The dietitian focuses on meal consumption, ensuring the patient has appropriate energy to be successful in treatment. The therapist works to understand the underlying psychological issues that triggered the patient’s eating disorder in the first place, and what factors maintain those issues—since what starts an eating disorder isn’t always what maintains it. Everyone has a unique role, with some overlap—it really does take a village.
This care team must work together very closely…
Absolutely. Collaboration is key. In fact, we think it’s so important we made it part of our name. You can’t treat someone with an eating disorder in isolation; it’s a disservice to do so. You must bring providers with different skills together. You simply can’t effectively help patients achieve a full recovery unless you have that multidisciplinary expertise. Our teams meet formally and informally several times each week. Because if you’re going to effect change, all of an individual’s providers must be on the same page.
What about the provider who cared for the patient before you, or referred to patient to you?
Given the long trajectory of recovery that many patients have, it’s vital to understand the patient’s history so that we’re not starting all over again, and previous providers possess valuable information. At some point, the patient may go back to that provider, so it’s also important to keep them informed of the patient’s progress, and bridge that next level of care. We’re in this together, to get our patients to the point of full recovery. So we’re committed to maintaining a lifelong conversation with other providers, who we consider an integral part of our team.
What is a patient’s usual course of treatment?
There is no “one size fits all” when it comes to treating eating disorders, and recovery is rarely a linear process. Treatment can take anywhere from 1 ½ to six years, and many patients move through various levels of care during that time. For example, some patients require inpatient, acute residential, or partial hospitalization care, while intensive outpatient treatment is appropriate for others. Or someone might do well with outpatient treatment for a long time, but then a life transition triggers an old behavior and inpatient care is needed. Our aim is to provide patients with the right level of care at the right time.
How is the family involved in the treatment of eating disorders?
Family involvement is a critical part of treatment, particularly for adolescents. In fact, I attended a conference early in my career and heard a woman whose daughter was in treatment say that if parents aren’t involved, you probably chose the wrong treatment facility. She was so right. There may be some situations when the patient must separate from the family system for a while, but reintegration is the ultimate aim. Because home is where they’re going to deal with real-life “stuff” and establish a new normal. They can’t do it in a vacuum, so we use a family-based therapy (FBT) model that teaches adolescents to use their family as a resource, and gives parents to tools to serve in that role.
What’s the single most important message you want patients and families to know about treatment for eating disorders?
First and foremost, I want them to know that recovery is possible. I’ve been doing this work for close to 20 years, and the field continues to advance. With an experienced, multidisciplinary team committed to the highest standard of evidence-based care, people with eating disorders can feel hopeful and learn the skills necessary for long-term recovery. I repeat: recovery is possible.
Elisha Contner Wilkins, Executive Director, Veritas Collaborative, Richmond VA Clinic, is a Licensed Marriage and Family Therapist and Certified Eating Disorders Specialist – Supervisor. She has approximately 20 years of experience working with children, adolescents, adults and families. After receiving her Bachelor’s degree in Psychology from Rollins College, she went on to achieve a Master’s degree in Marriage and Family Therapy from Stetson University. Outside of her clinical and administrative responsibilities, she has extensive experience educating parents, families, school personnel, and other professionals on eating disorders. She also enjoys providing supervision and training to educate, train, and nurture the next generation of eating disorder professionals. She has presented at local and national conferences and is the President of the Richmond IAEDP Chapter.