When being treated for an eating disorder, it’s important that the approach used is evidence-based. This means it has undergone rigorous clinical trials to prove that it is an effective treatment.

In Australia, the federal government has approved a certain group of evidence-based treatments that are eligible for Medicare rebates if you are accessing an Eating Disorder Plan. We have outlined these treatment approaches below and indicated the ages and diagnosis that are generally suited to each approach. All listed treatments are designed to be undertaken with the guidance of qualified therapists such psychologists, psychiatrists and mental health social workers. These approaches are also used by clinicians in inpatient and outpatient programs in the public and private hospital system. 

When engaging any clinician for eating disorder treatment under Medicare, we encourage you to refer to this consumer checklist developed by the National Eating Disorder Collaboration.

Treatment for children and adolescents with an eating disorder who are living at home with at least one full-time parent or carer. The treatment approach can include whole family, Parent Based Therapy, parent only or separated therapy.

• FBT is an outpatient treatment that occurs with the support of a caregiver at home. This treatment model relies heavily on parent and family involvement in re-nourishing their child, using specific amounts of foods and scheduled mealtimes throughout the day.
• FBT centres around the idea that a young person needs to regain weight to restore normal thinking and functioning, and focuses strongly on weight restoration rather than the psychological aspects associated with the eating disorder.
• FBT does not imply that families are responsible for the development of the eating disorder, but acknowledges that every family has issues that are difficult to deal with, and that the family can work together to help overcome these issues.
• FBT is currently the most effective treatment for young people with restrictive eating disorders.

For more information see the EDV factsheet below.

Most suitable for: children, adolescents and young adults living at home with a diagnosis of anorexia nervosa. May also be suitable for young people diagnosed with bulimia nervosa.

• Individual psychotherapy for adolescents experiencing an eating disorder that focuses on proving coping strategies in order to change behaviours with support from family and experienced therapist.
• Recommended treatment for young people with eating disorders when family based treatment is not possible.
• A key text on this treatment is ‘Adolescent focused therapy for anorexia nervosa’.

Most suitable for: Adolescents with a diagnosis of anorexia nervosa who are unable to engage in FBT, or for who FBT has been ineffective. May also suit some young people following the completion of FBT to address the psychological aspect of the eating disorder.

Cognitive behavioural therapy (known as CBT) is a type of psychotherapy (talking therapy) used to help people identify links between their thoughts, feelings and behaviours in order to improve upon these issues.

• CBT was originally developed for treating depression in the 1950s, and a framework for treating eating disorders began in the 1970s.
• Cognitive behaviour therapy for eating disorders follows the original CBT manual, plus an additional framework that targets mood intolerance, perfectionism, low self-esteem, and interpersonal difficulties.
• CBT-ED is designed to treat all eating disorders with slight variations in CBT-AN, CBT-BN and CBT-BED to address the specific behaviours apparent in anorexia nervosa, bulimia nervosa and binge eating disorder.
• CBT for Eating Disorders is often time-limited, goal oriented, and requires homework for the individual outside of sessions.
• Treatment sessions are usually weekly and range from 20 – 40 sessions or more depending on the individual.

Other variations include Including Cognitive Behavioural Therapy for Anorexia Nervosa (CBT-AN) and Cognitive Behavioural Therapy for Bulimia Nervosa and Binge Eating Disorder (BED) (CBT-BN and CBT-BED).

Most suitable for: Adolescents and young people with a diagnosis of bulimia nervosa and binge eating disorder. Adults with a diagnosis of anorexia nervosa, atypical anorexia nervosa, bulimia nervosa, binge eating disorder and OSFED.

• Specialist supportive clinical management is an outpatient treatment for adults with all types of eating disorders but most commonly used for anorexia nervosa patients.
• The treatment combines clinical management (establishing normal eating and weight restoration) and supportive psychotherapy (to help respond to important life issues affecting the eating disorder).
• The treatment takes an individualised and flexible approach with the goal of not just improving symptoms but also enjoyment and quality of life.

Most suitable for: Adults with any eating disorder diagnosis

The Maudsley model of anorexia treatment in adults is a newer and more integrative treatment for adults with anorexia nervosa.

• This approach was developed by the Maudsley Hospital in London, the same place where Family Based Therapy was developed.
• The treatment consists of seven modules that are addressed on an individual basis depending on the needs of the patient. The focus is on factors that are known to influence the eating disorder – cognitive, emotional, relational and biological and then work on finding better ways of coping and overcoming difficulties.
• The treatment is very collaborative, involves families and close friends and can be undertaken on an outpatient basis alongside other study and work commitments.

Most suitable for: Adults with a diagnosis of anorexia nervosa

Interpersonal therapy is a form of psychotherapy based on exploring and addressing issues in relationships (family and peers).

• Often interpersonal difficulties (like social withdrawal and low self-esteem) work to maintain an eating disorder and dealing with these problems can greatly help with recovery.
• Outside of eating disorders, interpersonal therapy is often used in the treatment of clinical depression.
• The treatment follows a structured approach that aims to improve communication and address the personal issues that may be contributing to the eating disorder.
• Interpersonal therapy has been found to be effective in treating bulimia nervosa and binge eating disorder but it is not recommended as a treatment for anorexia nervosa.

Most suitable for: Adults with bulimia nervosa and binge eating disorder

• Dialectical behavioural therapy is a skills-based therapy designed to teach healthy coping strategies. When used to treat eating disorders, the therapy focuses on four major skills – mindfulness, interpersonal effectiveness, emotion regulation and distress tolerance.
• DBT for eating disorders is highly structured, and lasts for 20 sessions.
• The therapy includes psychotherapy (talking) sessions with a therapist, use of diary cards to self-monitor emotions and behaviours (around eating, food preoccupation and the urge to binge) and group skills sessions.

Most suitable for: Adults with bulimia nervosa and binge eating disorder. Not recommended for those with anorexia nervosa.

• Focal psychodynamic therapy is a type of counselling that concentrates on how a person’s life experiences (especially from childhood) influence their current thoughts, emotions, relationships and behaviours.
• The therapy in individualised depending on the needs of the patient, but generally works through several phases of up to 50 sessions – initially concentrating on self-esteem and body image, then strategies for emotional regulation and personal responsibility.

Most suitable for: Adults with all types of eating disorders, with particular evidence for effectiveness for anorexia nervosa.

References

The Medicare Benefits Schedule (MBS) Book and quick reference guide outlines the approved treatments and clinicians. You can find eating disorder information on pages 183-196 and outline of approved treatments on page 194.

Other references:

Fairburn, C. G., Cooper, Z., & Shafran, R. (2003). Cognitive behaviour therapy for eating disorders: A “transdiagnostic” theory and treatment. Behaviour Research and Therapy, 41, 509-528. 

Kass, A. E., Kolko, R. P., & Wilfley, D. E. (2013). Psychological treatments for eating disorders. Current opinion in psychiatry, 26(6), 549–555.  

Murphy, R., Straebler, S., Basden, S., Cooper, Z., & Fairburn, C. G. (2012). Interpersonal psychotherapy for eating disorders. Clinical psychology & psychotherapy, 19(2), 150–158.  

Schauenburg, Henning & Friederich, Hans-Christoph & Wild, Beate & Zipfel, Stephan & Herzog, Wolfgang. (2009). Focal psychodynamic psychotherapy of anorexia nervosa: A treatment manual. Psychotherapeut. 54. 270-280.