Globalization, once thought to only affect trade, economy, and international politics is now affecting cultures, perceptions, and attitudes on vital matters. One of the emerging challenges is the worldwide growth in the number of eating disorders. According to Bordo (2011), culture is what teaches individuals what to believe, perceive, and accept as normal. Through norms, cultures dictate what is acceptable and what is not. For instance, before globalization was entrenched into everyday life, there were virtually no recorded cases of eating disorders in countries like China, Fiji, South Korea, and other parts of Africa. Through globalization, an individual’s insecurities about their bodies became marketable commodities to be imported and exported (Bordo, 2011). The outcome has been a growing medical challenge whose solution requires not clinical inpatient treatment but outpatient therapy.
Types and Etiology of Eating Disorders
Eating disorders are a serious concern as they have high morbidity and mortality rates. As psychiatric illnesses with associated DSM-5 criteria, eating disorders manifest as anorexia, bulimia, avoidant/restrictive food intake disorder, and binge eating disorder, among others (Okumus & Deveci, 2019). However, the severity and prevalence of eating disorders depends on the specific disorder. For instance, the prevalence rates for anorexia, bulimia, and binge eating disorder in the US is 0.8%, 0.3%, and 0.85%, respectively (Davis & Attia, 2019). While it used to be that eating disorders only affected white Caucasian women, Bordo (2011) documents cases where the psychiatric illness has crossed racial and gender lines. For instance, teenage boys will start to worry that they are not manly enough once they hit puberty.
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Therefore, it is essential to understand the root cause for the growing number of eating disorders worldwide. Though Davis & Attia (2019) state that the etiology and development of eating disorders has not been established, Bordo (2011) attributes the problem to cultural changes. Through culture and modern media, individuals, especially young people, are increasingly being indoctrinated into the cult of modern perfection, where they both learn what is beautiful and to feel ashamed if they lack it. Unfortunately, the pictures about the perfect body has driven countless people to seek it, and in the process, develop eating disorders. For instance, there were not recorded cases of eating disorders in the Fiji Islands in 1995. However, three years after the introduction of the first TV station, 11% of the girls were reported to partake in activities that were signs of an eating disorder (Bordo, 2011). In other words, culture, not genetics or any other biochemical or physiological condition and predisposition, is the main reason for the emerging eating disorder pandemic. Therefore, clinical inpatient and pharmacological treatments are not the answer.
Outpatient Treatment Interventions for Eating Disorders
In recent years, psychotherapy, especially Enhanced Cognitive Behavioral Therapy (CBT-E) has emerged as the most effective and popular treatment intervention for eating disorders in the outpatient setting. CBT-E is one of the many psychosocial interventions for eating disorder that is backed by evidence from numerous studies (Okumus & Deveci, 2019). Madden et al. (2015) and Okumus & Deveci (2019) document different evidence-based studies with extended follow-up periods to establish the difference between the effectiveness of inpatient and outpatient treatments on patient outcomes. Their reviews not only indicate that outpatient treatment interventions are better in improving long-term patient outcomes, but also that there are different outpatient psychotherapies developed for specific eating disorders. For instance, cognitive behavioral therapy has proven to be highly effective in treating anorexia, bulimia, and binge eating disorder (Okumus & Deveci, 2019). Furthermore, Family-based treatment (FBT) has proven to be highly effective in treating adolescents diagnosed with anorexia (Madden et al., 2015). Even then, the search is not over as advancements in the outpatient treatment of eating disorders are increasing.
Group therapies have emerged in the last three to four decades as an alternative to traditional outpatient interventions. For instance, group therapies using cognitive behavioral therapy have been established to being as effective in treating bulimia as other psychotherapies like family and behavioral interventions (Okumus & Deveci, 2019). Group therapies also have several advantages. First, group therapies cost lower. Secondly, they are modelled like Lewin’s three stage change management model. In the first stage, patients are treated with behavioral therapies to regain control. In the second stage, the negative beliefs, attitudes, perceptions, and values regarding their bodies are addressed using cognitive therapy. This stage is essential as it removes the brainwashing and self-destructive behaviors and belief systems instilled by popular culture, media, and social media. To sustain patient outcomes, the last stage maintains the changes as the new status quo. As a result, the patients are less likely to be influenced by destructive cultural and social system with subsequent exposure. In other words, outpatient interventions like groups therapies address culture (directly or indirectly) as the root cause of the eating disorders.
Why Outpatient Interventions Should be the Main Treatment Method for Eating Disorders
Compared to clinical inpatient treatment, outpatient interventions employ numerous approaches to treat different eating disorders. Some of the interventions, such as BT-E, were designed to specifically treat eating disorders. As a result, patients can be treated with the most appropriate and preferred psychotherapy. Secondly, outpatient treatment alternatives are cheaper compared to clinical inpatient interventions. As a result, all patients can afford to pay for the treatments regardless of their socioeconomic status. After all, the Affordable Care Act (ACA) guarantees that they will have medical coverage.
Lastly, outpatient interventions do not separate the patients from existing social support systems. As a result, patients can gain more support from their families and friends. Furthermore, there is no need to interrupt work or put careers on hold to attend therapy. The same cannot be said of clinical inpatient treatments.
When Outpatient Interventions Fail
Unfortunately, outpatient clinical treatments are not effective in all cases. For instance, severe cases of eating disorders are accompanied by medical and psychiatric complications like kidney damage (common with bulimia cases) and suicidality cannot be effectively managed in a pure outpatient setting. As a result, an intensive outpatient program for eating disorders is highly recommended before considering clinical inpatient treatment.
It should firstly be noted that when considering treatment for an eating disorder, five standards of care should be considered. They are ranked as outpatient care, intensive outpatient treatment, partial hospitalization, inpatient treatment, and inpatient hospitalization. Therefore, when the symptoms of an eating disorder appear, it is recommended to seek outpatient care as the first option. As the case deteriorates, other levels of care will be considered. However, the affordability and availability of evidence-based approaches to the outpatient treatment of eating disorders means that most emerging cases will be effectively treated. For instance, if the patient is enrolled in a group therapy, their prognosis becomes increasingly positive.
Secondly, eating disorders are a problem whose solution requires that individuals with eating disorders be accepted, supported, and helped to recover and maintain positive health. It is everyone’s responsibility to provide any amount of support to their social groups, especially when one of the members starts to show signs of an eating disorder.
Conclusion
In summary, there has been a growing medical challenge whose solution requires not clinical inpatient treatment but outpatient therapy. Culture, not genetics or any other biochemical or physiological condition and predisposition, is the main reason for the emerging eating disorder pandemic. Fortunately, outpatient therapy is the first level of care that is specifically designed to counter the effects of the negative culture behind the eating disorder pandemic. However, it should be noted that while outpatient therapy is recommended as the first response to tackling, more severe cases should be treated with higher levels of care. Such can happen when the patient failed to seek treatment upon the first emergence of the signs and symptoms.
References
Bordo, S. (2011). The globalization of eating disorders. The New World Reader: Thinking and Writing about the Global Community , 17-21.
Davis, L. E., & Attia, E. (2019). Recent advances in therapies for eating disorders. F1000Research , 8 . https://doi.org/10.12688/f1000research.19847.1.
Madden, S., Miskovic-Wheatley, J., Wallis, A., Kohn, M., Lock, J., Le Grange, D., Jo, B., Clarke, S., Rhodes, P., Hay, P., & Touyz, S. (2015). A randomized controlled trial of in-patient treatment for anorexia nervosa in medically unstable adolescents. Psychological medicine , 45 (2), 415–427. https://doi.org/10.1017/S0033291714001573
Okumuş, F. E. E., & Deveci, E. (2019). Group Psychotherapies in Eating Disorders. Psikiyatride Guncel Yaklasimlar , 11 (3), 338-350.
