Eating disorders (ED) are complex bio-psycho-social illnesses that can have severe, sometimes life-threatening, effects on a person’s mental and physical health and wellbeing. Despite the severity and complexity of eating disorders, very little guidance exists around training standards and the level of skills and experience recommended for ED treatment providers.
Research shows that tertiary health education programs have provided only limited training in EDs, meaning graduates often enter the field of ED treatment with inadequate training and skills .
In fact, the National Agenda for Eating Disorders in Australia found that 97 percent of clinicians had received little or no training in EDs, leaving them without the knowledge or skills they need to treat ED patients with confidence .
The Australia and New Zealand Academy for Eating Disorders (ANZAED) recently gathered an expert group of ED clinicians and researchers to address this lack of treatment guidance . The group outlined training standards and defined the best clinical practices for mental health professionals and other ED treatment specialists.
These guidelines not only describe the knowledge and skills necessary to competently treat ED patients, but they can also be used to advise and guide ED training programs.
Best Practices of the Australia and New Zealand Academy for Eating Disorders
The following practices laid out by the ANZAED build upon the core competencies outlined by the National Eating Disorder Collaboration (NEDC), yet go beyond those earlier principles to define the practical skills, knowledge, and experience required to capably treat patients with an ED .
1) Early intervention is crucial – Research shows early detection and treatment of eating disorders greatly improves the speed of recovery, increases the probability of a full recovery, and reduces symptomatology. For example, one study found that when adolescents with anorexia nervosa receive family-based treatment within the first three years of the onset of their illness, their chances of recovery are much greater . Since early treatment is critical to preventing long-term complications and increasing chances of full recovery, eligibility for ED services and treatment should not be limited to only those persons that meet strict ED diagnostic criteria .
2) Co-ordination of services is essential to all service models – When patients transition between treatment settings (e.g., inpatient to outpatient or adolescent to adult services), care is often disrupted, resulting in a decline of health or relapse in recovery. Therefore, it is crucial to coordinate services, so any transitions made do not have adverse effects on the patient’s health or recovery progress .
3) Services must be evidence-based – While all treatments should follow evidence-based guidelines, if a deviation from the set model is deemed necessary (e.g., certain elements of therapy may temporarily cause distress to the patient and may need to be halted or the patient may require more frequent sessions), these deviations should be evaluated and supervised by experts .
4) Involvement of significant others in service provision is highly desirable – When possible, utilizing family and significant others (SO) during the treatment process is highly beneficial. Subsequently, it is important to educate and equip family/SO so they can feel confident to deal with an eating disorder while also attending to their own needs .
5) All patients require a personalized treatment approach – Each patient must be individually evaluated on a session by session basis to determine 1) what level of care they need and 2) if adequate progress is being made. In addition, ED services should always be culturally responsive, taking into consideration the patient’s sexuality, gender, body size, race, and age .
6) Education and/or psychoeducation is included in all treatment interventions – Given the level of misinformation surrounding eating disorders, weight, and “healthy eating,” it is crucial to educate the patient (as well as family/SO supporting the patient) during treatment sessions. Education and/or psychoeducation should give insight into evidence-based treatment approaches and teach about the importance of restoring nutritional health .
7) Multidisciplinary care is essential – Since eating disorders commonly co-occur with other serious illnesses (both physical and psychological), clinicians must:
- Make sure a medical practitioner is regularly monitoring and involved in the patient’s care
- Be linked with other treatment professionals (e.g., psychologists, social workers, occupational therapists, dietitians, etc.) to ensure the patient receives care for all co-occurring illnesses .
8) A skilled workforce is required – Research shows that clinician expertise in EDs results in better patient outcomes (i.e., faster recovery, lower rates of inpatient admission, lower costs of treatment, and greater patient satisfaction) compared to treatment by generalist services. This means ED-specific training and experience should be prioritized in treatment settings .
These eight principles laid out by ANZAED are intended to:
1) provide a foundation on which ED specialists can build a competent and effective practice in the ED treatment field, and
2) improve treatment outcomes and provide guidance to eating disorder service providers and training programs. When implemented, these practices will bring ED care closer to best practice, reduce the cost of care, and improve patient’s quality of life.
Resources: Heruc, G., Hurst, K., Casey, A. et al. ANZAED eating disorder treatment principles and general clinical practice and training standards. J Eat Disord 8, 63 (2020). https://doi.org/10.1186/s40337-020-00341-0  The Butterfly Foundation. National agenda for eating disorders 2017 to 2022: Establishing a baseline of evidence-based care for any Australian with or at risk of an eating disorder. Sydney: The Butterfly Foundation; 2018. Available from: https://www.nedc.com.au/research-and-resources/show/national-agenda-for-eating-disorders-establishing-a-baseline-of-evidence-based-care-for-any-australian-with-or-at-risk-of-an-eating-disorder.  Heruc, G., Hurst, K., Casey, A. et al. ANZAED eating disorder treatment principles and general clinical practice and training standards. J Eat Disord 8, 63 (2020). https://doi.org/10.1186/s40337-020-00341-0  ibid.  Lock, Agras, Bryson, & Kraemer, 2005; Loeb et al., 2007; Russell, George, Dare, & Eisler, 1987; Treasure & Russell, 2011.  Heruc, G., Hurst, K., Casey, A. et al. ANZAED eating disorder treatment principles and general clinical practice and training standards. J Eat Disord 8, 63 (2020). https://doi.org/10.1186/s40337-020-00341-0  ibid.  ibid.  ibid.  ibid.  ibid.  ibid.  ibid.
About the Author:
Sarah Musick is a freelance writer who specializes in eating disorder awareness and education. After battling with a 4-years long eating disorder, she made it her mission to help others find hope and healing in recovery.
Her work has been featured on numerous eating disorder blogs and websites. When she’s not writing, Sarah is off traveling the world with her husband.
The opinions and views of our guest contributors are shared to provide a broad perspective on eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer a discussion of various issues by different concerned individuals.
We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.
Published December 11, 2020, on EatingDisorderHope.com
Reviewed & Approved on December 11, 2020, by Jacquelyn Ekern MS, LPC