The Transdiagnostic Treatment of Eating Disorders
When I first developed my eating disorder, I had anorexia. That anorexia later morphed into anorexia atheletica… then into exercise bulimia, over to BED, and finally, I settled on EDNOS (Eating Disorder Not Otherwise Specified, or, what I like to call a cop-out diagnosis, much like slapping “idiopathic” before a condition and calling it a day).
Despite my weight remaining steadfastly below where it should be, each treatment team’s method varied wildly from the last, based on whatever diagnosis I’d been given at the time:
Anorexic? “Just try to finish this Boost.”
Anorexia athletica? “Eat this meal, AND a Boost shake.”
BED? “Eat LESS food, then be vigilant about eating too much.”
EDNOS? “Follow this strict meal plan, and don’t eat anything else.”
It was CRAZY 🤡 TOWN. Looking back, I’m flabbergasted that a group of “professionals” charging $2,000+/day out of pocket maintained hardly a base-level knowledge about the disease they were treating. That is, until I found something out that confirmed everything I’d suspected:
Did you know, that unless you were treated with the Maudsley Method…
Your treatment wasn’t even evidence-based.
That’s right, the Maudsley Method is the only evidence-based treatment program out there. Meaning:
There are clinical trials testing the method against a control group, and;
Those results were able to be duplicated.
What this means is: every treatment center implementing any method other than Maudlsey* literally pulled that program out of their buttocks, and served it to you on a silver platter. It’s no wonder two of the treatment centers I visited went out of business!
Does this mean that every treatment center offering non-evidence-based programs is out to get you and your hard-earned cash? No. Then again, I’m a staunch misanthrope who wouldn’t be the least surprised to hear that all these social workers and dietitians developed over-inflated egos despite their paltry success rates, slipshod programs, and anything but humble relapse and mortality rates. Am I salty? Obviously. But am I wrong? I guess that’s up to you to decide. Regardless, there’s one big reason why treatment centers remain ineffectual, and that’s the DSM.
The Diagnostic and Statistical Manual of Mental Disorders (DSM) is a clinical diagnosis tool used by health care professionals to submit claims to health insurance providers for coverage. It’s eating disorder classifications were created by a panel, in which 83% of its members had ties to the pharmaceutical industry.
In updating the DSM, these panel members ignored advice from independent researchers to merge the five distinct classifications of eating disorders into one, all-encompassing transdiagnostic approach. This would’ve more accurately reflected the current clinical, genetic, and neurological evidence that eating disorders aren’t distinct diagnoses, but rather a part of the same neurobiological spectrum.
In fact, proband, twin, and genotyping studies all confirm that each of the different eating disorder diagnoses are actually just variations of the same underlying genetic predisposition. Despite this, health care workers and patients are both forced to continue using the DSM as a way to receive coverage for what is otherwise exorbitantly priced.
This is why I, like so many others, had so much trouble with eating disorder treatment. If I’d been properly diagnosed from the start, I would have had access to the appropriate treatment method. Because, regardless of whether I was bingeing, purging, over-exercising, or starving, it’s all the same condition. To settle the debate:
An eating disorder is an inherited neurobiological condition activated by an energy deficit.
And as such, instead of analyzing my feelings and giving me contradictory advice on how to control my food intake even more, I would’ve been given what I believe was owed me: proper treatment.
Despite it being a genetic condition, eating disorders are treatable mainly because your brain is capable of changing its own structure and habits. But this accomplishment is limited by whether a patient is utilizing a well-fed, and therefore well-functioning, brain. So, regardless of whether you are displaying symptoms of anorexia, bulimia, or binge eating disorder, the treatment is the same:
Eat more food, retrain your brain.
My hope is that the more awareness is brought to this issue, the sooner change will come. Until then, if you find yourself surrounded by a treatment team telling you to watch what you eat lest you overindulge (like I did), here’s my advice to you: run. Preferably in the direction of the nearest Maudsley Method treatment provider. 😉
You deserve proper diagnosis. And you deserve proper, evidence-based treatment.
Fighting for you,
Maria
P.S. Come check out my ebook for more info on how to get from weight-restored, to full remission!
*Being as the Maudsley Method is geared toward a younger population, I’d encourage anyone struggling with disordered eating as an adult to consult the Homeodynamic Recovery Method (or HDRM, formerly called MinnieMaud), which is essentially the Maudsley Method adapted to more mature patients no longer living at home with their families. Or, read my ebook, which outlines the HDRM using actionable steps to reaching remission.
