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What is Comprehensive Eating Disorder Care?

Written by: Jaclynn Cosan, PsyD
Team Leader, The Renfrew Center of Pittsburgh

Comprehensive eating disorder care focuses on caring for the person, not just the eating disorder. Here’s a quick breakdown of everything it includes.

Comprehensive eating disorder care involves treating the whole person. You are more than your eating disorder, so thorough care must acknowledge your identity, your individualized goals, and your unique life circumstances.

Comprehensive eating disorder care starts with a biopsychosocial assessment, building understanding for how eating concerns developed in your life context (e.g., culture, family, experiences).

After admitting to The Renfrew Center, you will immediately participate in a psychiatric evaluation, nutrition assessment, medical evaluation, and goal-setting session with your therapist. Assessment continues throughout treatment, and you will consider various questions such as: Is this working? Is my quality of life improving? Have my goals been met or changed?

Treatment includes an ongoing process of measuring progress towards your goals while addressing barriers to change.

Nutrition Therapy

Eating disorder recovery includes more than starting a meal plan. Nutrition rehabilitation is important, but it is only the tip of the iceberg of comprehensive care. If your brain is nourished, then you are better able to actively engage in therapy and utilize emotion tolerance skills. Therefore, nutrition therapy is often an important initial focus.

Meanwhile, therapy is instrumental in building alternative strategies to manage difficult emotions. The Renfrew Center’s Unified Treatment Model for Eating Disorders® (UT Model) helps individuals understand the ways their emotional avoidance maintains the eating disorder cycle and learn the skills needed to increase distress tolerance, cognitive flexibility and more adaptive behaviors. This model is transdiagnostic, meaning it can be used to effectively treat a variety of mental health concerns and diagnoses.

Specialized Programming

Renfrew has broadened its specialized programming to better serve patients from diverse backgrounds and across different phases of life. Renfrew patients and alumni have access to ongoing BIPOC support groups to process the impact of racism and marginalization on mental health and eating disorder recovery.

The Sexuality and Gender Equality (SAGE) group offers a space for LGBTQIA+ patients to seek specialized support across Renfrew locations. There are groups specifically for college students and some sites offer a Thirty Something and Beyond group (TSAB) to explore unique midlife challenges in treatment and recovery. Some locations also offer faith-based programming for those who would like to participate.

Treatment Tracks

The Renfrew Center’s Trauma Track utilizes tools from Cognitive Processing Therapy and the UT Model to approach patients’ experiences of trauma and how those experiences may be showing up in the clients’ lives today.

Combining cognitive processing (e.g., writing an impact statement and identifying stuck points) with emotion tolerance skills from the UT (e.g., anchoring, re-appraisals, exposures) allows patients to begin to process and heal from trauma which may be maintaining or exacerbating the eating disorder.

In Renfrew’s Substance Use Track, patients explore the ways substance use may have functioned as a maladaptive coping strategy and identify the ways substance use and eating disorder symptoms may interact.

Identifying Support

We also know that sustainable change often involves including supports in treatment. Does your environment support ongoing change and recovery? Does your support system need education and tools to assist you in navigating difficult emotions? In Multi-Family Group (MFG), your family and friends explore recovery-oriented topics and learn tools to support the changes you are making throughout treatment.

Family therapy with your individual therapist can also help address any barriers to change. When one person changes in a family system, ideally the whole unit adjusts to support and sustain that change. Community and connection are vital in supporting long-term recovery. Treatment often includes recognizing where you experience a sense of community and identifying relationships that help you feel accepted, valued and energized (also known as growth-fostering relationships).

As you consider stepping down to a lower level of care, comprehensive care involves connecting you with an outpatient team. Here is a checklist to consider while building a support team:

  • A therapist who can meet with you consistently and honors your identity and values
  • A nutritionist who is knowledgeable in eating disorder recovery
  • A medication prescriber whom you trust and can share your concerns
  • Someone who can support you with any faith-based or spiritual needs
  • Identifying where you experience a sense of community and actively working to stay connected with this community
  • Identifying supports within your family or family of choice
  • Engaging with alumni events to offer and receive support from others with similar lived experiences

Conclusion

Although we conceptualize eating disorders as disorders of emotion regulation (emotion avoidance and emotion-driven behaviors in the face of intense, distressing emotions), your experience of an eating disorder is unique to you. What emotions feel intolerable? What thoughts do you feel stuck on? What function is the eating disorder serving in your life? What challenges do you face in your environment (e.g., access to resources, experiences of weight/racial/gender/sexuality bias)?

Working with a multidisciplinary team allows for exploration of your experiences, identifying goals that feel important to you and offering you thoughtful care. Everyone’s treatment team and supports look different. Access to resources, both geographically and financially, vary. Utilizing support opportunities such as Renfrew Alumni events, Multi-Family Group and other online services may increase access to care.

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