How Psychiatrists Help Turn Eating Disorder Treatment Into Recovery

Psychiatrists have unique roles in eating disorder treatment. Because of their specific training, psychiatrists can evaluate the status of your eating disorder from many angles. A psychiatrist may be an ideal candidate to lead your treatment team.

How Psychiatrists' Training Can Prepare Them for Eating Disorder Treatment

Eating disorders are unique in that they have behavioral, physical, and psychological symptoms. "Psychiatrists with eating disorders training are often the best trained to evaluate all of these components," says Joanna Steinglass, MD, a psychiatrist at the Eating Disorders Clinic at Columbia University Medical Center. "...It is common to need or benefit from a multi-discipline treatment team, and the psychiatrist is often the head of that team."

The blend of psychological and medical training that psychiatrists have can give them an integrated understanding of eating disorders that others may not have:

• Physical symptoms can be severe, at times demanding immediate care. Psychiatrists have four years of medical training in physiology and disease, plus internship experience as both hospital physicians and neurologists. They are well-positioned to grasp the impact of disordered eating on the body's functioning.
• Psychological symptoms are also prominent. Those with eating disorders often deal with intrusive thoughts, depression, significant anxiety, and many other psychological problems. A psychiatrist is also well-equipped here, with at least three years of training in psychopathology. Their study includes the use of both medications and psychotherapy.
• Behavioral symptoms often endanger eating disorder patients. Psychiatrists have training in behavioral psychology that helps them to understand how a person's actions influence overall health and also whether the actions are likely caused by other problems.

Given these qualifications, psychiatrists are likely to determine the appropriate level of care for you -- for example, as specified in the American Psychiatric Association's guidelines.

What Do Psychiatrists Do in Eating Disorder Treatment?

It's not hard to see how psychiatrists can be of huge benefit in evaluating new patients and determining treatment plans. So what happens when treatment starts? The role of the psychiatrist here depends significantly on the treatment setting and the structure of the treatment team.

In some clinical settings, psychotherapy is left to psychologists, counselors, or social workers. But there's still plenty to do, as psychiatrist Kevin Wandler, MD, executive medical director at Remuda Ranch, describes. "The psychiatrist’s role at Remuda Ranch is very specific," he says. "Because we do not do therapy per se, we are 'coaches' for our patients...Our coaching comes in as we support the patients when they resist ineffective behaviors and help them work through some of their feelings when they are unable to resist." 

Besides conducting psychiatric evaluations and prescribing medications, psychiatrists at Remuda watch for urges to behave in unhealthy ways, like overexercising, restricting food, and purging. These daily interactions with patients also include monitoring of body weight and body image, depression and anxiety, and other symptoms.

Psychiatrists Are Often Therapists, Too

In contrast, psychiatrists at the Columbia University Medical Center conduct psychotherapy themselves, in addition to their other duties. "Many eating disorders psychiatrists are well-trained in the psychotherapies that are known to be helpful in the treatment of eating disorders," notes Steinglass. These approaches include cognitive-behavioral therapy and interpersonal therapy.

It's helpful to know who will be performing each role on your treatment team so that you know where to take your questions. If these roles aren't clear to you, be sure to ask.

Psychiatrists Are Multi-Purpose Allies

Having a psychiatrist on your treatment team is undoubtedly to your benefit. Good treatment often involves - at the least - general medical and psychiatric care, nutritional support with a registered dietitian, and various forms of psychotherapy. With broad training and years spent working in various kinds of medicine, a psychiatrist is likely to be able to survey the entire landscape of your recovery and help you plot a healthy course through it.