Treating Co-Occurring Conditions in Eating Disorders
Understanding and addressing the complex interplay between eating disorders and co-occurring mental health conditions is essential for promoting effective, sustained recovery. Eliot Community Human Services remains committed to providing comprehensive, person-centered care that meets the diverse needs of those we serve. This Eating Disorders Awareness Week, “The Time is Now” to prioritize integrated, compassionate care for individuals navigating the challenges of EDs and co-occurring mental and behavioral health conditions. Eliot clinician Sarajane Mullins, LMHC, NCC has been working with eating disorders for more than a decade.
What attracted you to working at Eliot’s Community Behavioral Health Centers (CBHC)?
When I first considered working at Eliot’s CBHC, the biggest attraction was the chance to continue working with an integrated care team. In settings focused on eating disorder treatment, we often refer to the standard of care as a “trifecta.” That trifecta is a combination of psychotherapy, nutrition, and medical interventions. I always thought that if I delved deeper into community mental health, I’d have to give up that experience. So, I was pleasantly surprised that Eliot’s CBHC has a team-based model.
What has been your biggest takeaway from this year’s eating disorder awareness week?
Every year, I look forward to what stats NEDA has captured and how they choose to present the data. This year, it’s the statistics around co-occurring disorders that caught my attention. First, I read that 94% of those diagnosed with Binge Eating Disorder reported other lifetime mental health symptoms. Then, I stumbled upon a journal article citing that more than 70% of people with an eating disorder also have another co-occurring disorder. It was a jaw dropping moment for me. I read that and thought that if this research is representative of reality, Eliot’s CBHC program is right on time with their approach to transdiagnostic treatment.
What is transdiagnostic treatment?
If you’re looking for a clinical definition, transdiagnostic implies co-occurring mental health conditions can be treated concurrently and that one treatment can provide relief to more than one co-occurring condition. Google probably has a better definition. Clinical jargon aside, I’m more of a visual person. I’ve been envisioning transdiagnostic treatment as focused on the roots of a tree. Those roots lead to a trunk, which I see as the center of someone’s being, the person. And from that trunk can stem branches where we might see twigs of anxiety, depression, a substance use disorder, or an eating disorder. These branches and twigs are interconnected. We can treat any one branch, and the symptoms and distress in that one area might resolve. But often, any relief is isolated to that one branch or that one twig and the relief can be temporary. When we focus on providing treatment at the roots, we nourish the whole tree. We develop a deeper understanding of how the root system works. We get to know this person and the roots of their values. Transdiagnostic treatment is at the roots. And the roots need to be strong, grounded, and interconnected for recovery.
Has transdiagnostic treatment been a theme in eating disorder treatment?
Yes and no. Many experienced eating disorder professionals will advocate for at least some stabilization before approaching other co-occurring issues. It’s not uncommon to hear eating disorder professionals say things like, “The person has to be sober first” or “We have to treat their eating disorder and make sure they are nutritionally stable before we consider a trauma treatment.” And, these professionals are not wrong. It’s a well thought out, compassionate plan that makes sense in many instances and has saved many lives. At the same time, the most popular treatments in eating disorder treatment programs are CBT and DBT, when neither of those treatments were originally designed to treat eating disorders. They are treatments that are flexible and functional for treating a wide variety of diagnoses such as depression, anxiety, substance use, and so much more. So, there’s some acknowledgement of the possibility of transdiagnostic treatment in the eating disorder community, even if it hasn’t been on the forefront of everyone’s mind. When I read that we still have more than 70% of folks living with another co-occurring mental health condition, it really makes me pause. I think the time is now to be extra curious about what a transdiagnostic approach might offer. This could be especially important for individuals who haven’t had success in treatment or those who experience repetitive relapse. I begin to wonder more about treatment at the roots.
Any thoughts or goals you have for next year’s eating disorders awareness week?
Honestly, my hope would be that we can nudge that 70% statistic in future years. For my own journey working with humans who bravely battle co-occurring mental health conditions, I want to hold myself accountable this year to be extra curious. The time is now to really deepen my roots of understanding. The time is now to consider what it takes to get from root to recovery.