Training & Competency in the Treatment of Eating Disorders

Becoming an expert in the treatment of eating disorders takes time. Scroll through any Psychology Today professional listing, and chances are you find a number of clinicians who seem to “specialize” in almost every disorder listed in the DSM-5. While I believe that everyone should be trained initially as a generalist, with exposure to as many therapeutic modalities and clinical populations as possible, it is also important as social workers to make sure that you are practicing within your scope of expertise and knowledge. As a Faculty and Supervisor, I often remind my students, that experience does not always equal expertise. Someone can attend a training on a treatment modality or specific diagnosis, and while that imparts some knowledge and experience, it does not make one an expert. Most complex mental health issues are best treated by a clinician who has specific knowledge, expertise, and practice treating them, and eating disorders in particular are a cluster of syndromes that necessitate specific and advanced training in order to be providing standard of care. Consider this, if you needed an operation, would you choose the surgeon who has operated on cases like yours a handful of times, or the surgeon who has spent the better part of their career understanding, treating, and operating on conditions like yours and is up to date on the most recent protocols? 

As eating disorders affect a person on all dimensions of functioning (cognitive, emotional, behavioral, physiologic, relational/interpersonal), it is imperative that clinicians are well-versed in these disorders which have the highest mortality rate of any other mental illness in the DSM-5. 

How does one gain knowledge and competence in the treatment of eating disorders? I recommend a tripartite model of training that involves the clinician immersing themselves in didactic learning, supervised clinical practice, and personal therapy. 

In order to offer your patients the best care, it is important that you are educated in all of the fundamental aspects of eating disorders. Didactic learning should include: 

  • Introduction to eating disorders
    • The genetics & neurobiology of eating disorders
    • DSM-5 & ICD-11 diagnostic criteria
    • Trans-diagnostic understanding of eating disorders
    • Understanding the necessity and rationale for a “Team Approach”
    • Treatment Modalities for Eating Disorders        
      • “Gold-Standard”/Standard of Care EBP (CBT-E, DBT, IPT, ACT, ERP)
      • Psychodynamic Approaches to Care & Treatment
      • Levels of Care – outpatient (individual, IOP, PHP), residential, inpatient
      • Medical Aspects of Eating Disorders
        • Review of systems
        • Medical consequences of eating disorders
        • Lab values & basic interpretation of them
        • Nutritional Aspects of Eating Disorders
          • Understanding “normal” eating
          • Approaches to nutritional treatment (structured eating, exchange system, intuitive eating)
          • Effects of food and related ED behaviors on physiological and emotional functioning (restrictive behaviors, bingeing, purging, overexercise)
          • Effects of processed food on hunger/satiety signals
          • Effects of disordered eating behaviors on the gut microbiome 

Additional learning areas include understanding social justice movements such as Fat Activism, Body Positivity and Health At Every Size. 

Supervised clinical practice should be done with a clinical supervisor who has training and expertise in the treatment of eating disorders. Together your supervisor can help you begin to think critically about each case, determining which therapeutic modality to utilize for each patient based upon depth understanding of the person and current symptoms and functioning. Eating disorders can be quite challenging to treat, evoking a range of countertransference feelings in the clinician; as such, it is especially important to seek supervision and consultation as a means to provide the best care for your patients and also provide you with your own support system when faced with overwhelming or scary moments in the treatment process. 

Lastly, I recommend beginning or continuing with your own personal therapy, as working with this population often brings to the surface one’s own thoughts and feelings about food and body image. Personal therapy allows you a private space to reflect on all thoughts and experiences that come to mind about treating eating disorders. 

Treating eating disorders without appropriate training and competency violates both the code of social work and creates a potentially dangerous situation for the patient, where, unlike most other mental illnesses, there can be acute risk of medical consequences and long-term harm if appropriate treatment is not initiated

How can you get educated and supervised? 

There are many options to receive specialized training in the treatment of eating disorders. 

International professional membership organizations, such as the Academy for Eating Disorders (AED), and the International Association of Eating Disorders Professionals (IAEDP), offer webinars, case conferences, and symposiums; additionally, IAEDP offers a structured course of learning including supervision in order to become an IAEDP certified eating disorder specialist (CEDS). 

Lewis & Clark College offers an eating disorder certificate after completing a series of eight courses. Northern Illinois University offers a certificate in Eating Disorders and Obesity. The University College London offers an MSc degree in Eating Disorders and Clinical Nutrition as well as abbreviated versions of this degree resulting in a certificate. The Center for the Study of Anorexia and Bulimia (CSAB) offers a two year post-graduate training program in the treatment of eating disorders. 

Additional training and supervisory options are available, though not all offer the same scope of training as the above options. For more information about education and training opportunities in the treatment of eating disorders and any other inquiries, please contact the author at: [email protected] If you found this article helpful and have requests for future eating disorder topics or ABCSW sponsored eating disorder training please let us know! 

(Disclosures: The author has professional relationships with AED as co-chair of the special interest committee on Psychodynamic & Integrated Psychotherapies; IAEDP as a certified eating disorder specialist and supervisor; and with CSAB as a faculty, supervisor, and executive committee member).

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