What is Outpatient Treatment for Eating Disorders

Eating Disorders> Treatment

1. The most important things in a nutshell

Eating disorders are curable, but the recovery process is long and the risk of becoming chronic is high. The best chance of recovery is when those affected seek help at an early stage. The therapy options range from outpatient psychotherapy, (day) clinics, self-help groups, self-help manuals to therapeutic residential groups. The treatment to consider depends on the person's symptoms and situation.

2. Outpatient psychotherapy

The goals of psychotherapy are on the one hand to reduce the symptoms of eating disorders (e.g. normalization of eating behavior and weight), on the other hand to treat the underlying or parallel psychological problems (e.g. self-esteem problems, social isolation, depression).

Psychotherapy is based on the disease phase and the individual possibilities of the patient and his life situation. The therapeutic work can help to reflect on situations and thoughts or to clarify one's feelings. In the long term, it can help to track down the causes and triggers of the eating disorder and to cope with the sustaining factors.

Outpatient psychotherapy is particularly recommended for bulimia and binge eating disorders, provided that there are no medical or social reasons that make a previous inpatient stay necessary. Since anorexia often poses a high physical risk, inpatient therapy is often required first, which is then followed by outpatient psychotherapy. Whether outpatient therapy is sufficient should always be decided individually in consultation with the doctor and / or psychotherapist.

The health insurance company pays for certain psychotherapeutic treatments. Details on reimbursement of costs, search for a therapist, application for therapy and duration under psychotherapy.

3. Partial inpatient and inpatient treatment

(Partly) inpatient therapy should be carried out if the eating disorder is associated with a high level of physical danger, if outpatient therapy is not sufficient or if the psychological or social situation of the person concerned requires it. Several inpatient stays are often necessary (so-called interval treatment).

3.1. Inpatient treatment

In the case of inpatient therapy in a clinic, the affected person is looked after by a multi-professional team consisting of psychotherapists, nurses, social pedagogues, nutritionists as well as physiotherapists and occupational therapists. The inpatient treatment program is often comprehensive and consists of individual and group therapy, movement, art or music therapy and (therapeutic) accompaniment while eating. In addition, the patients can be medically monitored. The protected environment of a clinic, the support from the treatment team and fellow patients make it possible for many sufferers to face their fears and work intensively on their problems.

3.2. Partial inpatient treatment

After inpatient therapy, the transition from a clinic to everyday life is often very difficult and not infrequently leads to relapses. Partial inpatient therapy in a day clinic can make sense here. In a day clinic, the person affected receives similarly intensive support during the day as in a clinic, but returns to their familiar surroundings in the evenings and on weekends. So he can gradually approach everyday life.

Partial inpatient therapy can also be completed without a previous stay in a clinic, e.g. if the patient does not want to be completely torn out of his familiar environment. However, day clinics cannot be reached from every place of residence, so that day-care treatment is not always possible.

4. Therapeutic residential group

Adolescents and young adults usually have the opportunity to move into a therapeutic residential group after inpatient treatment, if they are overwhelmed by the return to the familiar, mostly problematic environment or if they do not receive enough support at home. Such a residential group can also be helpful for people with chronic eating disorders and pronounced social isolation.

In the living group, those affected can slowly take steps into a healthy life and gain a foothold in everyday life in a supportive environment and in cooperation with a therapeutic team (consisting of psychotherapists, social pedagogues and nutritionists). The offers range from 24-hour care with accompanied meals to freer models in which those affected only receive assistance from time to time. Individual living with outpatient care is also possible. Here the patient lives in his own apartment and is visited at home by social workers who support him in everyday life.

A list of therapeutic residential groups for people with eating disorders in Germany can be downloaded from www.dick-und-duenn-ev.de/index.php?id=115.

5. Drug treatment

Pure drug treatment does not lead to recovery in eating disorders. In any case, psychotherapy is the treatment of choice. Medicines can accompany this.

For patients with bulimia, an antidepressant can be prescribed to accompany psychotherapy, because depression often occurs in connection with eating disorders. But there are also proven positive effects on the symptoms of bulimia. Currently, only the active ingredient fluoxetine is approved for the treatment of bulimic patients over 18 years of age in Germany.

Doctors sometimes prescribe low-dose neuroleptics when there is a pronounced urge to move and compulsive circles of thought in anorexic people.

In any case, drug treatment should be discussed thoroughly with a qualified psychiatrist, who can then coordinate it individually.

6. Self help

For many of those affected, the step to therapy is very big. The feeling of shame and fear of opening up often prevent them from seeking professional help. Here self-help can be a first step in dealing with one's problems. The exchange with other affected persons can also have a relieving effect and open up new paths.

6.1. Support groups

Eating disorder counseling centers often offer support groups. Those affected meet there about once a week and exchange ideas about topics related to their illness. Usually a social worker is present to lead the group. The exchange can help those affected feel understood and realize that they are not alone with their problem. Alternative coping strategies can be tried out together, the group can provide emotional support and those affected can benefit from the experiences and tips of other affected persons.

6.1.1. Virtual support groups

There are also self-help groups on the Internet. Self-help forums offer a platform for anonymous exchange with other patients.

But there are also dubious websites on which those with disordered eating do not exchange ideas with the aim of recovery, but rather to reinforce sick behaviors. Those affected should definitely refrain from such sides!

We recommend forums which are supervised by moderators and which no allow detailed information on weight, height and precise eating habits. This enables a meaningful, supportive exchange among people with eating disorders.

6.2. Self-help programs

Studies have shown that working with a self-help program that is carried out according to a special manual and is based on elements of cognitive behavioral therapy can be particularly helpful for patients with bulimia and binge eating disorder.

The following books, among others, offer scientifically based manuals for guided self-help:

  • Christopher G. Fairburn (author), Susanne Bonn (translator): Stopping binge eating: A self-help program against binge eating. ISBN 978-3456853345
  • Ulrike Schmidt, Janet Treasure, June Alexander: Conquering Bulimia: A Self-Help Program. ISBN 978-3407864093
  • Tanja Legenbauer, Silja Vocks: Manual of cognitive behavioral therapy for anorexia and bulimia. ISBN 978-3642203848

There are also self-help programs on the Internet that are supported therapeutically (so-called guided self-help). Those affected receive feedback from a professional helper at regular intervals. Such guided self-help for patients with bulimia is available, for example, at www.anad.de/essstoerungen/salut-bulimie-selbsthilfe-programm.

7. Related links

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Eating Disorders> Forms and Causes

Eating disorders> loved ones

Eating Disorders> Financial Aid

Eating Disorders> Addresses