Interventions for Eating Disorders

When most people think of interventions, they have an example in their minds from a television show, most often related to someone with a substance use disorder. Although interventions are used frequently to help convince persons with addictions to begin treatment, it is my belief (thanks to my experience tracking and staffing cases for a large eating disorder organization) that it is quite rare for people with eating disorders to have a formal intervention. This realization, then, begs the questions: Can an intervention be done for patients with eating disorders? And if so, why are they not used more frequently?
Below, I discuss some points to consider when answering these questions:
First, we must look at the difference in temperament and presentation of eating disorders versus substance use disorder.​​​​​

• As my mentor Craig Johnson used to say, “Eating disorders thrive in secrecy and isolation.” Oftentimes, families have no clue what their loved one is hiding behind closed doors. Plus, it’s difficult to recognize an eating disorder in a culture that glamorizes dieting and exercise. It can be confusing to know when behaviors have crossed the line into  being disordered.
• Temperaments of persons with eating disorders, across diagnoses, tend to be “harm avoidant,” meaning they follow the rules, pay attention to details, and generally know how to stay out of trouble. They often don’t have the legal troubles that frequently initiate the alarm bells of families who have loved ones with addictions.
• Individuals with eating disorders also struggle to believe that they are sick enough to warrant care. They are fearful of accepting treatment because they think they don’t look as sick as others. They can make very convincing arguments to professionals and families about why “it’s not that bad.” They often convince their loved ones that they can get things under control without outside help. 

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Persons with eating disorders and their families do not have the same access to support groups as addictions.

• One positive outcome from the COVID-19 pandemic is that it has opened the door for more virtual support groups for eating disordered patients and their families. Still, compared to the thousands of meetings available every single day to those with addiction struggles, the disparity in the number of support group offerings for eating disorders is chilling.
  Family members of individuals with eating disorders will often tell you that they don’t have anyone to talk to or that, when they do reach out, others just don’t understand their experiences. One of the beautiful things about support groups is the finding of common ground, including the discussion of topics like successful family involvement and interventions. Unfortunately, when there is limited access to support, these conversations are less likely to happen.

In the eating disorder community, many individuals are worried about interventions being too confrontational.

• Some intervention models use a “surprise” approach when meeting with the individual of concern. In general, due to the temperament of those with eating disorders (as explained above in 1b and 1c), this population doesn’t do well with surprises. They may shut down and become more stubborn or anxious. Persons with eating disorders also like to be thoughtful about details and planning and are less likely to begin a treatment plan without a thorough review. Additionally, families will tell you that the idea of an eating disorder intervention “scares them.”
• ​The ARISE® Comprehensive Care with Intervention model takes a different spin on intervention that is a nice fit for persons with eating disorders. The individual is invited to become part of the family network and part of the first meeting -- meaning there are no surprises or ambushes. The ARISE® facilitator collects family history and develops a recovery message with the family in order to reduce shame and blame and increase healing and health for the whole family over the course of the recovery journey. An intervention, if needed, is just one piece of the plan that can be implemented to help individuals stay engaged with treatment and ultimately reach their treatment goals. 

Eating disorder treatment programs may require specialized admission procedures.

• Persons with eating disorders may have very serious physical and medical complications that need careful vetting with an admissions team. Eating disorder programs must screen for things like appropriateness, travel considerations, and level of care needs, which means that they often cannot have the quick turn-around time of a substance abuse program. 
• In addition, programs may have wait lists that are several days or weeks long. This complication calls for an adjustment to the typical practice of packing your bags and going to treatment immediately following the intervention. The eating disorder interventionist needs to help the family manage the time between the person agreeing to treatment and the actual admissions date.

With mindfulness to the considerations above, I believe that persons struggling with eating disorders can benefit from intervention services. It is imperative for the family network to have support from others to help navigate the road to recovery while their loved one is in treatment and once they return home.  
If you are interested in learning more about eating disorder interventions, please visit my website (EatingDisorderIntervention.com) and reach out to me via my contact page. I offer free, 30-minute consultations to new clients.