Eating disorders: better addressed at specialized centers

Residential schools are designed to provide therapy and education for students with a range of behavioral and emotional issues as well as learning, psychological and psychiatric disorders. In the past, many of these schools also addressed eating disorders, but treatment for this condition appears to be moving away from the residential school setting.

David J. Alperovitz, Psy.D., staff psychologist at the Klarman Eating Disorder Center at McLean Hospital, noted that several new centers focused on eating disorders have opened in recent years.

“Ten to 15 years ago, there were not as many,” he said, adding that because adolescents today deal with multiple, complex issues, residential facilities may not always be appropriately equipped to handle them. “You need a structured milieu for eating disorders or a lot of patients might fall through the cracks.”

At the Klarman Center, eating disorders are the primary diagnosis. “The program is highly structured. We monitor the patient’s medical and nutritional status,” said Alperovitz. A team of clinicians, including a nurse, psychiatrists, psychologists, counselors and nutritionists, utilizes dialectical behavior therapy, cognitive behavioral therapy and traditional dynamic and relational therapy for patients.

Many patients also present with co-occurring illnesses. In these cases, the patient is treated for both diagnoses concurrently, but each treatment plan is personalized. “In cases with acute anorexia there is often initial cognitive impairment. With individuals who are critically low weight, the first task is to help the brain begin to function better. Primarily this is done through nutritional re-feeding. They have to ‘come alive’ first. That initial cognitive impairment limits what we can do in the early stages,” Alperovitz said.

And since the Klarman Center is located within the walls of a psychiatric hospital, it has an advantage over stand alone facilities. “We have ready consultations with experts if we have a complicated psychiatric or medical question. There is good collaboration.”

Stuart Koman, Ph.D., president and CEO of Walden Behavioral Care headquartered in Waltham, Massachusetts, also cited the challenge of treating eating disorders “with any great success” in a residential school program.

While these schools may accept some students with food issues, those diagnosed with a serious eating disorder would not enter a general population facility, he added.

“There is a lot of secrecy involved. The kids know ways to avoid eating and it’s difficult to monitor them. Residential schools are not structured appropriately and this could become a problem for staff and other patients. It requires so much control of the environment in a particular way that it makes it difficult to run a generic program.”

Programs like Walden’s offer a highly specialized program where the environment is controlled to focus on eating issues and recovery from an eating disorder. There is a great deal of supervision and understanding by the specialized staff, Koman noted.

“In addition to general psychiatric and psychotherapy services, nutrition is a big part of the program,” he said. “We have an adolescent residential program with a full-time nutritionist and a nurse practitioner specifically trained to work with kids with eating disorders. Clinicians focus in this area. They are highly oriented toward recovery.”

Although not a school per se, Walden does offer an academic program, which is “essentially tutoring,” said Koman. Patients attend classes for up to three hours a day as part of treatment.

Family involvement is a key element of the program at Walden. “We do family meals and train the parents in how to help their child finish meals,” Koman said. “[Parents] get nutrition education and education in affect tolerance. They learn a language in which to talk with one another that doesn’t focus on food.”

Facilities whose exclusive emphasis is on eating disorders will most likely be the trend in the future, according to Koman. “It does make good sense to send a child to a specialized center that focuses exclusively on eating disorders,” he said.