Managing ED

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Despite the differences between ED in terms of clinical characteristics and observable symptoms, there are some strategies that AOD workers can utilise to manage these disorders. The general principles of managing and treating ED should include the establishment of a trusting, collaborative, therapeutic relationship, taking care to avoid any potential power struggles [889]. The techniques outlined in Table 44 may help AOD workers to manage clients with ED symptoms.

Table 44: Dos and don’ts of managing a client with symptoms of eating disorders

DO:

  • Encourage and emphasise successes and positive steps (even just coming in for treatment).
  • Take everything they say seriously.
  • Approach the client in a calm, confident and receptive way.
  • Be direct and clear in your approach.
  • Use open-ended questions such as ‘So tell me about...?’ which require more than a ‘yes’ or ‘no’answer. This is often a good way to start a conversation.
  • Constantly monitor suicidal thoughts and talk about these thoughts openly and calmly.
  • Encourage the client to express his/her feelings.
  • Focus on feelings and relationships, not on weight and food.
  • Be available, supportive and empathetic.
  • Encourage participation in healthy, pleasurable and achievement-based activities (e.g., exercise, hobbies, or work).
  • Encourage, but do not force, healthy eating patterns.
  • Assist the client to set realistic goals.
  • Involve family or friends in management or treatment strategies.
  • Be patient in order to allow the client to feel comfortable to disclose information.
  • Explain the purpose of interventions.

DON'T:

  • Act shocked by what the client may reveal.
  • Be harsh, angry, or judgemental. Remain calm and patient.
  • Use statements that label, blame or shame the client.
  • Invalidate the client’s feelings.
  • Make comments (either positive or negative) about body weight, appearance or food – these will only reinforce their obsession.
  • Express any size prejudice, or reinforce the desire to be thin.
  • Engage in power struggles about eating.
  • Criticise his/her eating habits.
  • Trick or force the person to eat.
  • Get frustrated or impatient.

Adapted from NSW Department of Health [277], Clancy and Terry [296], and World Health OrganisationCollaborating Centre for Evidence in Mental Health Policy [879].