The need for effective IOP eating disorder treatment has never been higher. Diagnoses such as anorexia, bulimia and binge eating disorder remain some of the hardest conditions to treat. They also have some of the worst mortality rates in mental health. For years, The Dorm’s integrative eating disorder treatment approach has helped providers get to the root cause of clients’ complex cases and supported countless young people on a path to sustained recovery and independence.
We spoke with two Dorm experts, Alyssa Goldenberg, LMSW and Ali Malik, RDN to learn about how this works in practice through one client’s case example and inspiring breakthrough.
Client Case: “Jesse”*
- “Jesse” identified as a non-binary individual in their early 20s when they were admitted to The Dorm. They had a clinical history of anorexia, bulimia, laxative use and binge eating disorder as well as trauma and a burgeoning substance use disorder.
- With problematic behaviors beginning in grade school, Jesse had received residential ED treatment and worked with several registered dietitians and therapists over the years but without sustained success.
The IOP Eating Disorder Treatment Plan
Alyssa Goldenberg, LMSW (she/her)
Senior Therapist at The Dorm
- Eating disorders (ED) are multifaceted and often linked to trauma. As part of our integrative approach, our treatment plan was created to help Jesse examine the linkage between their identity, gender identity and ED behaviors while supporting trauma and substance use work.
- Jesse started at Tier 2 (20 hours/week). In addition to 1:1 therapy twice a week and 1:1 coaching twice a week, their clinical plan included groups that not only engaged in ED/nutrition but also other areas like identity processing and exploration, trauma and substance use/sobriety. Some examples included: Body Image Group, Food and Mood, psycho-educational Nutrition groups, Meal Groups, Meal Planning and Cooking Group, all paired with 1:1 nutritional counseling with one of our full-time registered dietitians.
- For identity processing, Jesse was also scheduled to participate in the TGNB (transgender non-binary) group, and delved into other important clinical areas in our Seeking Safety group for trauma work and engaged in Substance/Use Sobriety work in Relapse Prevention and Urge Surfing groups. DBT skills group was also recommended as part of the comprehensive treatment plan.
Ali Malik, RDN (she/her)
Senior Dietitian at The Dorm
- The client had previous knowledge of following meal plans from traditional eating disorder treatment. Their eating habits were in a place stable enough to do trauma therapy and other groups immediately.
- In addition to all that Alyssa mentioned, the clinical team supported Jesse with grocery shopping trips and had them engage in 1:1 yoga to better build the mind/body and movement connection and support with stress management.
- Altogether, Jesse’s history of ED treatment and variety of diagnosis made them a good fit for The Dorm’s model as all facets of their case could be approached synergistically by an interdisciplinary team.
Breakthrough
- AG: While at The Dorm, Jesse realized that their substance abuse history was both interconnected and also stemming from their eating disorder. When they had an urge to engage in ED behavior, they would turn to substances. They were symptom swapping. Finally, the entire care team was able to treat “at the source,” and see the interconnectedness of symptomatology.
- AM: This realization was a turning point; the client began to view their eating disorder as a top priority. They were more committed to ED treatment and, in turn, open to discuss past traumas that contributed to their maladaptive patterns. Jesse began to surrender versus white knuckle their way through ED recovery and spoke of “divorcing their disorder.”
- AG: Jesse was able to move towards becoming more self assured and see themselves beyond the lens of their eating disorder. They stepped away from it as with an abusive relationship. They gained a sense of confidence in themselves and in their relationships. Their ED no longer needed to “speak for them.”
Recovery through IOP Eating Disorder Treatment
At admission Jesse only ate about one meal a day and consumed excessive amounts of caffeine to make it through. At discharge they were eating every few hours, started to diversify their diet adding fruits and vegetables to support gut health, and reduced their overall caffeine intake. They went on to move into their own apartment, got a part-time job and went back to school.
- AM: I’m so proud! Jesse feels better and therefore has more confidence to go about daily activities. Their microbiome is healing, and they’re excited to incorporate more fruits and veggies into their diet. Finally, they’re in a place of self acceptance and that is a freeing place to be.
- AG: Jesse’s new eating patterns allow them to be present, nourish themselves adequately, increase the amounts of foods in their repertoire and try new foods. These are major wins in eating disorder recovery, signaling less rigidity and more openness! Additionally, Jesse gained independence by moving into their own apartment and handling new activities of daily living (ADLs). They were able to clean, grocery shop, shower, and take medications independently. Now, they are able to focus and be responsible and reliable for part-time work and school. These big wins demonstrate Jesse’s new financial responsibility and independence.
I would recommend that Jesse continues to watch out for high stress situations, life transitions, increased school work, relationship stress (including relationships with family, friends, and romantic partners), urges, body image thoughts, and excessive rumination. They should also continue to work with a therapist biweekly and eventually weekly. Lastly, they should continue to see a dietitian every other week until their nutrition plan becomes second nature.
*Names have been changed to preserve confidentiality.
Our Locations:
You Might Also Like:
Do you or a loved one need help with mental health?
The Dorm is here.
7 Signs of Disordered Eating (and How to Seek Help)
Gender and Eating Disorders – How Affirming Care Makes a Difference
