Being serious mental health disorders that can have severe mental and physical health consequences, eating disorders often require extensive psychiatric treatment. This extends beyond the role of therapy; although psychologists and recovery coaches are essential parts of treatment, psychiatric intervention is common in eating disorder treatment. Treatment is also not limited to the stereotype of an eating disorder patient. Eating disorders can take their toll on people of all ages, genders, ethnicities, and cultural backgrounds.
Sometimes, people are not aware of the difference between a psychiatrist and a psychologist or therapist. Although psychologists and therapists require extensive training and field work to earn their title and practice, they cannot write prescriptions and don’t attend medical school. Physiatrists, however, do attend medical school, specializing in both psychology and the medical aspects of how the brain works. For illnesses such as anorexia nervosa or bulimia nervosa, therapy is absolutely key to recovery – but they often require a psychiatrist’s input as well.
Psychiatrists Are Part of a Care Team
Effective treatment for eating disorders like anorexia nervosa, bulimia nervosa, and binge eating disorder normally goes beyond talk therapy and requires medical and psychiatric care as well as extensive nutritional education and quality-f-life enhancements. At a residential treatment center, individuals with various forms of eating disorders work with a team of health professionals that may include medical doctors, registered dieticians, nutritionists, and crucially, psychiatrists.
Although many people feel some trepidation about the idea of undergoing psychiatric treatment, it’s a key part of most recovery journeys. Here we’ll explore some of the ways psychiatrists form an integral part of the recovery team – what they can do, what they can’t, and how they help to provide the best outcomes for their patients.
The Role of a Psychiatry in Residential Treatment for Eating Disorders
Psychiatric care plays an important role in the eating disorder treatment process for people with eating disorders as well as the many cases in which there is a co-occurring psychiatric disorder such as OCD. This is the main way psychiatrists assist the recovery process – although they may perform therapy, psychiatrists are more capable than psychologists of treating psychiatric disorders that go beyond a therapeutic approach. Eating disorders presenting without another form of psychiatric disorder – according to some studies, 55 to 97 percent of all people with eating disorders also have at least one comorbid psychiatric illness.
As with the general population, depression is likely the most common co-occurring disorder, although various forms of anxiety disorders are also common. Less frequent, but also occurring at a higher percentage than the general public, are various forms of anxiety disorders such as social anxiety, panic attacks, and PTSD. The latter is particularly important to eating disorder treatment; a 2012 study highlighted a clear link between PTSD and disordered eating behaviors. In many cases, disordered eating behaviors act as an equally disordered coping mechanism for the negative emotions brought on by trauma. Psychiatrists are well-qualified to treat the symptoms of PTSD and corresponding behaviors through a combination of therapy and sometimes medication. Borderline personality disorder and OCD are also thought to occur at higher rates among people with eating disorders.
It would be remiss to discuss eating disorders and their comorbid psychiatric presentations without bringing up suicide, suicidal ideation, and self-harm. Suicide is one of the leading causes of death among people with eating disorders, especially anorexia nervosa, and self-harm is also quite frequent among this group. Many studies have indicated that the rate of these presentations is much higher in people that suffer from an eating disorder than in other groups. These are considered psychiatric emergencies – the patient must be stabilized and free from imminent suicide attempts before engaging in therapeutic or nutritional treatment.
Psychiatrists’ Role at an Eating Disorder Treatment Center
Once medically and psychologically stabilized (untreated eating disorders can cause physical and psychiatric crises like malnutrition and psychotic breaks), and a residential program is completed, day treatment is often a good fit. These clients don’t usually need daily medical monitoring, and benefit from applying their new life and coping skills in a real-world environment.
Before reaching that point, residential care is often the best eating disorder treatment option for psychiatrically unstable clients. For example, the individual in question may be expressing suicidal ideation or suffering from type II diabetes as the result of sudden weight fluctuations. These potential complications make both medical and psychiatric care an invaluable aspect of comprehensive eating disorder treatment.
A psychiatrist specializing in eating disorders understands the intricacies of disordered eating behaviors and how they affect brain function. Their expertise in other mental health issues is also key because many psychiatric symptoms are common in people with an eating disorder diagnosis. For example, many teens with eating disorders also experience co-occurring conditions like acute anxiety, OCD, clinical depression, and substance abuse. In such cases of a dual diagnosis, psychiatric treatment must be understood and addressed appropriately.
The Role of Psychiatric Medications in Eating Disorder Treatment
Most treatment experts prefer to engage in talk therapy and cognitive retraining before even considering the use of mediation. This is with good reason; the FDA has not approved any medications specifically designed for treating eating disorders. Per the Mayo Clinic, this is one of the major hurdles to the treatment of eating disorders like anorexia nervosa. However, given the frequency of comorbid psychiatric presentations, it’s not uncommon for prescriptions to be made to counteract them. Most of these medications are antidepressants or SSRI medications that help to relieve the symptoms of anxiety, depression, obsessive-compulsive disorder, and PTSD. Anti-psychotics and benzodiazepines are also used in psychiatric emergencies. Although primary care physicians are technically able to prescribe these drugs, most will refer to an eating disorder specialist psychiatrist rather than make the call themselves.
Access to this level of care is one of the greatest benefits of the residential psychiatric care process. In fact, many clients are referred to eating disorder centers that offer inpatient psychiatric treatment because they have been diagnosed with co-occurring conditions like panic disorder, major depressive disorder, and substance abuse. Most residential programs will have at minimum weekly visits with a psychiatrist, and 24-hour access for emergencies, and most schedule appointments more frequently. Although most psychiatrists do not specialize exclusively in eating disorders, they are all capable of making a referral to an expert or a recognized treatment facility.
How Does Psychiatric Care Help with Eating Disorder Recovery?
Comprehensive psychiatric treatment allows clients to both address the psychiatric aspects of their eating disorder and any co-occurring psychiatric illnesses. For example, when an individual is experiencing clinical depression that makes it difficult to engage in group therapy or maintain motivation for getting better, inpatient psychiatric care is necessary to stabilize their depressive symptoms before they can enjoy the full benefits of eating disorder treatment. Having a psychiatrist on the treatment team also provides the therapists and nutritionists with a slightly different, specialized perspective that encourages a comprehensive care plan.