Professionals who use the FBT approach to treat adolescents with eating disorders can utilize this stance in the first session.  Experts in eating disorders identify the life-threatening symptoms and express alarm and compassion at the same time. Both sides of the coin are needed to orchestrate an intense scene.  This is referred to as a therapeutic bind.
 
The goal of this technique is to engage the family. Each family comes to the initial session with a unique level of confidence, anxiousness and understanding of illness. During the assessment the therapeutic bind can either propel paralyzed parents into action or ground overly anxious parents to get them focused on their role in weight restoration.  RDNs use this therapeutic window to move parents into action with acceptance and commitment to the role of feeding.  
 
This happens when professionals use the facts (collect these on the EDGE tool prior to the meeting) and their expertise in eating disorders to communicate.  RDNs are uniquely qualified to make the connection with the physical symptoms of the body and educate how malnutrition has caused a series of physical problems. The “Food Is Medicine” message can be heard more clearly when parents have experienced this intense scene.

One example of this is when I had a young lady in my office with her mom. She was clearly in need of hospitalization.  I educated the parent on the facts with a tone of urgency and alarm. I expressed my concerns over her daughter’s heart rate and rate of weight loss and risk of refeeding syndrome.  We talked about the need for a medical visit the next day and prepared the Mom to consider how she could ask her employer for Family Medical Leave Act (FMLA). Direct, urgent, honest and caring words helped the mother who was in tears know what to expect. Today her daughter is a doing well in high school. Without the FBT approach she still may be fighting a chronic eating disorder.

​Learn more about how to blend urgency with compassion. If you treat adolescent with Eating disorders  learn how to blend FBT informed treatment and sign up for coaching with Melanie Jacob, RDN today. Save your spot for the fall webinar series here.

FOUR: Paradigm Shift is long over due in Eating Disorder Treatment
 
I love to read scientific articles and attend conferences like ICED to learn about the latest research in the eating disorders field. This article by Stuart Murray spoke to the need to look beyond weight as an indicator for recovery. We should never assume that weight-based recovery is a proxy for broader cognitive recovery. This is not supported by evidence. This has been a motivation for me in my clinical work in the development of the Eating Disorder Global Evaluation (EDGE). I strongly recommend the use of symptom assessment in both the physiological and behavioral realms. The EDGE is not yet validated and should be used along with the EDEQ.  
​The EDGE instrument allows clinicians within 5 minutes to identify symptoms. I recommend that it is used this at baseline and every three months during treatment.  The beauty of the form is that noting frequency can score symptoms: daily, weekly or in the last month. These scores typically reduces with nutritional restoration and time in treatment.  Often residual behavioral symptoms are targeted during phase 2 and 3. Since anorexia nervosa is ego syntonic and our clients could be very young; providers can utilize dual or parent-report observations of symptoms. 
 
Why use the EDGE instrument in your practice?