Heavily referenced across EDI as HDRM builds upon FBT. FBT is for children and adolescents living with their guardians. One of its greatest strengths is the application of the Minnesota Starvation Experiment in confirming that many psychiatric symptoms persist unless and until refeeding is initiated. There are many variations on FBT attempting to expand its use and render it applicable in young adult spaces.

History of HDRM

NIH article: Family-based treatment of eating disorders in adolescents: current insights

Originally developed for those with borderline personality disorder, it is a treatment modality proven to be helpful for very sensitive people who wish to modulate their emotional distress. As refeeding is distressing to all with eating disorders, DBT has helpful techniques to apply during recovery and beyond.

Dialectical Behaviour Therapy: Shame, Guilt and Emotional Distress

Part Three UCSD EDC2014 Review

As with FBT, this treatment modality is most suited to children and adolescents living with, or very closely connected with, their guardians.

A backgrounder on temperament and its relevance in eating disorder treatment can be found in these entries:

Eating Disorder Personality

Part One UCSD EDC2014 Review

The following entries delve into the TBT in more detail.

NIH article: Temperament-Based Intervention: Re-examining Goodness of Fit

EDI review: Part Two UCSD EDC2014 Review

This treatment modality is most closely aligned to the framework that an eating disorder is an anxiety disorder, most specifically a phobia of sorts. As such, HDRM twins well with this approach.

Explained with references in the section: Recover Fast or Slow in Phases of Recovery Part Three

External Papers on the topic:

Rationale for the Application of Exposure Response Prevention to the Treatment of Anorexia Nervosa

Role of exposure with response prevention in cognitive–behavioral therapy for bulimia nervosa: Three-year follow-up results

An integrated review of fear and avoidance learning in anxiety disorders and application to eating disorders

Conceptualizing eating disorder psychopathology using an anxiety disorders framework: Evidence and implications for exposure-based clinical research

Had the opportunity to synthesize this treatment modality from two of the originators of the program: Drs. Stephen Wonderlich and Caroline Peterson

Part Four A UCSD EDC2014 Review

Part Four B UCSD EDC2014 Review

It is a treatment modality that integrates some motivational interviewing, CBT, DBT, etc. but at its core binges are identified as maladaptive behaviours which is problematic for use with HDRM. It is not the binge that is the issue, it is the restriction post binge and the cultural framework that fear of weight gain is as valid as fear of venomous snakes.

An approach for patients who feel they are struggling to make a commitment to change or who are really not sure of their treatment and recovery goals at all. It's more of a pre-treatment partnering with a trained therapist to help a patient uncover their own motivations and next steps.

External papers:

The use of motivational interviewing in eating disorders: a systematic review

Pretreatment motivation and therapy outcomes in eating disorders: A systematic review and meta-analysis

This is considered the gold standard of treatment for everything and the kitchen sink. The basic premise is to uncover faulty ways of thinking; address unhelpful behaviours that have been implemented due to those faulty thoughts; replacing maladaptive behaviours with adaptive ones.

Here is a helpful primer of what CBT is (external link):

What is Cognitive Behavioral Therapy?

A systematic review of evidence for psychological treatments in eating disorders: 2005–2012

This is a modality specifically designed for the transdiagnostic framing of eating disorders - meaning it does not depend upon the distinct DSM categories of eating disorders.

A description of the treatment can be found here (extxernal link):

Description of CBT-e

Sometimes also called multi-family therapy (MFT).

It is designed for adolescents and young adults still residing at home with their guardians.

There is an EDI review on this to be found here: Part Six UCSD EDC2014 Review

A systematic review and meta-analysis can be found here (external link):

Multi-family therapy for eating disorders across the lifespan: A systematic review and meta-analysis

ACT is designed to help patients move through distressing emotions. Accepting emotions rather than denying, avoiding and resisting so that the patient can move towards choosing different behaviours that are more adaptive moving forward.

External paper on ACT with eating disorders:

Acceptance and commitment therapy (ACT) for eating disorders: A systematic review of intervention studies and call to action

This is a treatment modality that includes psychotherapeutic, prescription and medical interventions on an individual basis.

There is a binary approach to all things illness: either you are actively recovering or you are actively deteriorating. There has been recent recognition in the practitioner communities that not actively recovering does not need to involve active deterioration.

While so far the evidence of the value of harm reduction in the eating disorder treatment space is sparse and underwhelming, there is more focus on its use for severe and enduring anorexia nervosa.

There is also evidence that later life efforts at recovery are common, suggesting that any effort to support health in the intervening years is well worth it.

Eternal paper:

Harm reduction in severe and long-standing Anorexia Nervosa – part of the journey but not the destination. A narrative review with lived experience.

Rather than classifying emotions in a binary of good and bad, the framing in this treatment approach is that emotions inform decisions and actions and are an essential way in which we understand ourselves and our motivations.

External paper on EFT with eating disorders:

Efficacy of emotion-focused therapy in the treatment of eating disorders: A systematic review

Bluntly, intuitive eating is a misnomer. True intuitive eating involves no conscious decision-making overrides.

Intuition is a subconscious activity.

The framework is ostensibly "weight inclusive" but still heavily rooted in healthism (health status is within your locus of control) and the faulty tenets that "obesity causes increased morbidity and mortality outcomes."

Nonetheless, this approach may be appealing to those who remain attached to the feeling that there is a hierarchy of food and good nutrition.

External paper on HAES intuitive eating

A Health at Every Size intervention improves intuitive eating and diet quality in Canadian women

There is of course no psychotropic drug designed to treat eating disorders.

While psychiatric drugs are placed in distinct classes: anxiolytics (anti-anxiety medications), anti-depressants, anti-psychotics and mood stabilizers, there is no evidence that these drugs target the conditions for which they have been assigned. They all knock down brain functions in broad ways and this is why they are all used in "off label" treatments – meaning a patient diagnosed with depression may be taking anti-psychotics to suppress the symptoms of depression.

Think of all psychotropic drugs as symptom suppressors. In fact, most drugs used to treat chronic illnesses are symptom suppressors and are not designed to treat the underlying cause. Examples of this symptom focus: insulin for diabetes, biologics for arthritis, triptan class of drugs for migraines.

As with any drug, psychotropic drugs have monographs that will itemize the side effects and risks along with the expected benefits. The decision to take any of these drugs should rest on whether the quality of life improvements are so foundational for you that they are worth the possible down stream negative impacts of drug side effects or even damage you might incur.