Eating Disorder Recovery
Most therapy for eating disorders focuses on psychological and medical treatments. Less widely known is the role of occupational therapy in eating disorder recovery. Occupational therapists, or OTs are found mostly in inpatient programs, although we’re increasingly being employed in outpatient, community and private services.
Eating Disorders
In Canada, approximately 1 million people meet the diagnostic criteria for an eating disorder, which has devastating consequences: eating disorders have the highest mortality rate (estimated between 10-15%) of all the mental illnesses1. There are currently 8 eating disorder diagnoses in The Diagnostic and Statistical Manual of Mental Disorders2:
Anorexia Nervosa: Restricting food intake that leads to significant weight loss. Individuals have an intense fear of gaining weight, their self-evaluation is unduly influenced by their weight/shape, and they lack recognizing the seriousness of their low weight. There are restricting and binge-eating/purging types.
Bulimia Nervosa: Binge eating (eating a large amount of food in a short period of time and lacking a sense of control) and inappropriate compensatory behaviours (self-induced vomiting, misuse of laxatives/diuretics/medications, fasting, or excessive exercise). Self-evaluation is unduly influenced by body shape and weight.
Binge-Eating Disorder: As with Bulimia, binge eating and feeling marked distress. This is not associated with compensatory behaviours.
Avoidant/Restrictive Food Intake Disorder (ARFID): A disturbance in feeding or eating (e.g. apparent disinterest in food, avoidance of sensory characteristics of food, or concern about aversive consequences of eating). This leads to failure to achieve expected weight gain in children, nutritional deficiency, and a marked interference with psychosocial functioning.
Pica: Persistently eating nonfood substances in a way that is inappropriate to the person’s developmental level and what is culturally/socially normative.
Rumination Disorder: Repeatedly regurgitating food (and then re-chewing, re-swallowing or spitting out) that is not attributed to an associated gastrointestinal or other medical condition.
Other Specified Feeding or Eating Disorder: Symptoms of an eating disorder that cause clinical distress or impairment of daily functioning but do not meet the criteria for a diagnosed eating disorder. Includes the reason why criteria are not met.
Unspecified Feeding or Eating Disorder: Same as above but doesn’t include the reason why criteria are not met.
Eating disorders impact on an individual’s daily life and occupations in a profound way3. Occupations that are usually health-promoting, such as eating and exercising, are instead used as a way to reinforce the illness4. This complicates recovery, as these essential behaviours need to be re-taught without an eating disorder mindset.
Occupational therapists work with clients around mealtimes, managing stress, regulating emotions and moods, increasing independent living skills, working on self-care, creating a health-promoting routine, trying new hobbies, body image improvement, and relapse prevention5.
More specifically, work is usually done around managing anxiety during food-related occupations: family meal planning; grocery shopping; before, during and after mealtimes; meal preparation and portioning; cooking; and eating in social situations. Occupational therapists can also liaise with schools and organizations that their clients are involved with to request accommodations or to assess the client while they take part in an activity.
These interventions don’t always happen in a clinic or hospital. Occupational therapists work in the community and often meet at their clients' homes or schools, workplaces, grocery stores, cafes, and restaurants. In other words, wherever the occupation takes place.
Most importantly, occupational therapists are trained to see their clients holistically and not focus solely on a diagnosis. This provides individualized interventions that are specific to each person and their family. Keeping the goal of recovery always at the forefront, occupational therapists offer treatment plans that fit with the interests and values of their clients.
Engaging in meaningful activities is of great importance to the eating disorder recovery process, as it allows individuals to explore their values and identity apart from their eating disorder. As they begin to build an occupational repertoire they find fulfilling, they are more able to let go of their preoccupations with weight and food.
Author bio
Lori Henry is an Occupational Therapist based in Vancouver and runs a private eating disorder service for children, youth and young adults. She has recovered from an eating disorder herself and is passionate about helping others through their recovery. www.LoriHenry.com
References
Canadian Eating Disorders Alliance (2019) The Canadian Eating Disorders Strategy: 2019 – 2029.
American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders (5th ed.).
Clark, M. & Nayar, S. (2012) Recovery from eating disorders: A role for occupational therapy. New Zealand Journal of Occupational Therapy, 5 (1), pp. 13–17.
Elliot, M. L. (2012) Figured world of eating disorders: Occupations of illness. Canadian Journal of Occupational Therapy, 79, pp. 15–22.
Lock, L. C., & Pèpin, G. (2011) Eating disorders. In C. Brown & V. C. Stoffel (Eds.), Occupational therapy in mental health: A vision for participation (pp. 123–142). F A Davis.
Bradford, R., Holliday, M., Schultz, A., and Moser, C. (2015) The Role of the Occupational Therapist in the Treatment of Children With Eating Disorders, Journal of Occupational Therapy, Schools, & Early Intervention, 8 (3), pp. 196–210.