Eating Disorders Diagnosis and Treatment with Dr. David Garner

Bob M: Good evening everyone. I'm Bob McMillan, the moderator for tonight's eating disorders conference. Our topic tonight is Eating Disorders Diagnosis and Treatment. Our guest, Dr. David Garner, designed the test. He is the Director of the Toledo Center for Eating Disorders and a well-known researcher and treatment expert in the U.S. Dr. Garner is also one of the founding members of the Academy of Eating Disorders. Good evening Dr. Garner and welcome back to. Can you please start by telling us a bit more about your expertise in the area of eating disorders and then we'll move on from there?

Dr. Garner: Hello. I have had about 20 years of experience in research as well as clinical practice in the area of eating disorders.

Bob M: What does a clinician like yourself do to determine whether a person actually has an "eating disorder" or whether they have some disordered eating behaviors that aren't all that significant?

Dr. Garner: The key way to determine if someone has an eating disorder is by a careful clinical interview with questions directed at the main symptom areas.

Bob M: As you can imagine, several hundred people have already taken the Eating Attitudes Test on our site and they report back that the test indicated they have a significant area of concern. Is that all it takes?

Dr. Garner: The Eating Attitudes Test (EAT test) does not give a diagnosis, but it does provide valuable information on the levels of eating concerns typical of an eating disorder.

Bob M: For those just coming into the conference room: Our topic tonight is Eating Disorders diagnosis and treatment. Our guest is Dr. David Garner, Director of the Toledo Center for Eating Disorders. Dr. Garner is a highly respected professional in his field and has been involved in research as well as treatment of all eating disorders--anorexia, bulimia, compulsive overeating. There are many people who are self-diagnosed with an eating disorder. How important is it to get a professional evaluation?

Dr. Garner: A professional evaluation is essential, particularly a professional who has experience in the diagnosis and treatment of eating disorders.

Bob M: Dr. Garner can only be with us for about an hour tonight...so if you have a question or comment for him about any eating disorders related topic, please submit it now. I know the Toledo Center for Eating Disorders is an out-patient eating disorders treatment center. One question I always get is: what is the big difference, treatment wise, between in and out-patient. And how do you know which one to pick?

Dr. Garner: Inpatient provides complete structure and 24 hour supervision. Intensive Out-patient is about 35 hours a week at our center. There are advantages and disadvantages to both. I think that you want to pick the type of eating disorders treatment that is sufficient to get control over symptoms, but not more than you need. The advantages of an intensive outpatient program, IOP, is that it is less expensive and it provides practice every day with living in the real (non-hospital) world. In an IOP, you have 7 hours of treatment, but you also have time outside of the clinic setting to address the "out of hospital" world.

Bob M: The Toledo Center for Eating Disorders sponsors us. We asked them to sponsor the site because many of you, our visitors, asked for professional treatment, but wanted a great place to go at a more affordable cost. The Toledo Center for Eating Disorders is just that. They are located in Toledo, Ohio. If you go there, they can hook you up with some affordable housing during your stay. Here are some audience questions, Dr. Garner:

LOSTnSIDE: For someone who is an abuse survivor, is it at all possible to gain control of an eating disorder without having to bring up the misery of your past? Is it true that you can't fix one without the working on the other?

Dr. Garner: I have seen abuse survivors whose recovery is dependent on dealing with the abuse and others who really do not require delving into this issue. It may be important in its own right, but not essential to recovery from the Eating Disorder. This is a great question and the answer is that both approaches are sometimes best.

mleland: What are the strengths of the Toledo Center for Eating Disorders? (I've been to Laureate)

Dr. Garner: Laureate is an excellent program. We are smaller and provide a somewhat different orientation to treatment. The Toledo Center for Eating Disorders has a broad cognitive behavioral orientation as well as a strong family therapy component. We also emphasize nutritional counseling and a strong focus on group psychotherapy. And we don't use a "cookie cutter" approach of "one treatment fits all."

shade123: I have a daughter who is anorexic. How do I get her to consent to help? She is 36 and is severely underweight right now, in a lot of emotional trauma.

Dr. Garner: The best that you can do is to tell her that it is your view that she should absolutely seek treatment. However, she is an adult and she has to make the decision. Sometimes it is useful to think of how you would convince someone to seek treatment if they suffered from another disorder like alcoholism. Sometimes it helps in thinking through what you might do.

Bob M: We have nearly 100 people in the room right now. I'm going to set a one question per person limit.

chrissyj: Could you please give a little overview of an average out-patient day for a purging and restricting bulimic?

Dr. Garner: The average day consists of a review of the evening before, preparation of lunch with staff, group treatment, possibly a brief individual meeting to identify important issues, another group with a different theme, snack, dinner and perhaps some movement therapy- yes a lot of structured eating and a lot of therapy.

ack: What if you are not physically "sick" enough for inpatient eating disorder treatment, but feel that you are emotionally "sick" enough.

Dr. Garner: I think that your opinion is very important and that you may need more structured treatment. Again, this is an example of where perhaps Intensive Outpatient Treatment could be helpful. It is more than outpatient and not as expensive and structured as inpatient. The important question is: what are the details of "feeling sick". This needs to be discussed with someone who has expertise in evaluating and treating eating disorders patients.

Bob M: By the way, with everyone asking treatment questions, how long does it take, on average, to recover from bulimia and anorexia? And is one easier to recover from vs. the other?

Dr. Garner: It takes about 20 weeks on average to do well with Bulimia Nervosa. The treatment for Anorexia Nervosa is longer and sometimes can last as long as 1-2 years.

Bob M: If you haven't taken the Eating Attitudes Test on our site yet, please do. It will give you a good starting point in evaluating yourself. The 20 weeks figure, is that in intensive treatment to make significant inroads towards recovery?

Dr. Garner: Actually, for bulimia nervosa, treatment usually can be conducted on a strictly outpatient basis. It is only very resistant cases that need to be seen in intensive outpatient treatment and inpatient is rarely needed unless the person is underweight. Our IOP is usually 6 to 12 weeks and is usually best for those who have to gain weight as part of treatment.

UgliestFattest: My therapist says that I am "painfully thin," but I just do not see it. How can I train myself to see what others see to me? I think I could stand to lose at least 20 pounds?

Dr. Garner: Unfortunately, recovery does not occur by you "seeing yourself more normally". The so-called body image disturbance that your therapist is talking about is "corrected" after you have managed to gain the confidence to gain weight.

Renie: My mom had anorexia when she was a teenager. Is it hereditary? Can I still have an eating disorder if I eat and don't throw up?

Dr. Garner: There is some evidence of genetic influence, but this does not say anything about what is needed for recovery and should not cause you to feel hopeless. Many disorders have a biological contribution, but the treatment is psychological. You can definitely have an Eating Disorder, like anorexia nervosa or compulsive overeating, and not vomit.

Anitram: Dr., I hate my body and want to be 95 lbs. I am 5 ft tall, and a college athlete. I took the EAT test (Eating Attitude Test) and scored a 52. I often think about purging, but never actually did it the way it is normally done. I have only done it a couple of times. What do you think about all this?

Dr. Garner: A score of 52 is very high. That combined with what you have said makes me very concerned. I think that you should consult an experienced professional. 

Shy: How does a person with anorexia know when they are bad enough to be considered for an outpatient program?

Dr. Garner: The best way to begin is with a in-person or a phone consultation. If you have anorexia nervosa, then you should !!! be considered for an outpatient program. Perhaps an intensive OP program. The complications for Anorexia are significant. The recent evidence on osteoporosis is really of concern and this disease continues to take its toll all of the time you are underweight. Thus, treatment should not be delayed.

Bob M: I didn't know that. Is there research now available that says an eating disorder can lead to osteoporosis?

Dr. Garner: Very convincing evidence. Bone mass decreases with weight loss and once you have lost bone, it does not come back.

Bob M: Let's say you are not desperately ill. Are there any physical symptoms that would clue you in that you need help immediately?

Dr. Garner: If you lose your period, it may not be evident to others that you have a problem, but it may cause osteoporosis and long term complications associated with this disorder.

twinkle: 5 months to recover!! What is the percentage that stay recovered??

Dr. Garner: "stay recovered" is not completely clear since people should be followed for years. However, 70% of people do very well after a course of treatment. Of those who completely follow the treatment advice, most recover.

bean2: How can I prevent a relapse. I feel like I am on the verge of one but I feel like I need to lose like 40 pounds. Any suggestions?

Dr. Garner: bean2: The wish to lose 40 pounds is a "give away". These types of thoughts may indicate a problem. You should speak to someone (an experienced professional) about this. It is like an alcoholic trying to prevent a relapse by going to a bar.

Bob M: One thing we've learned from the various eating disorders conferences is: trying to recover from an eating disorder on your own, without any professional treatment and support is very difficult, next to impossible.

Dr. Garner: That is correct. You need an experienced guide (a professional) on order to have the best chance to recover.

jack: Is having your significant other involved in recovery/treatment of your eating disorder imperative?

Dr. Garner: Yes, having your significant other is very important. Maybe not essential, but a good idea.

Bob M: One last question. We hear about intensive treatment programs that last 2-3 weeks. Do you think that is effective, or can be effective, when it comes to true recovery or is that a waste of money?

Dr. Garner: Personally, I would like to see the research that says 2-3 weeks can have an effect. This sounds more like something that is being dictated by insurance companies rather than by informed professionals. Where have you heard about this type of treatment for an eating disorder (2-3 weeks)?

Bob M: Several people have come to our site and said they went to a treatment program for less than a month, came out, tried hard on their own, and relapsed. And yes, some of them couldn't stay because of insurance problems, but for others, the program only ran 2-3 weeks.

Dr. Garner: I am not surprised. It is terrible when insurance determines treatment rather than the needs of the person with an ED. Are there really programs that actually run for 2-3 weeks. Where is the research on this type of treatment?

Bob M: We appreciate you coming tonight Dr. Garner. I know you have to go now. And thanks everyone in the audience for coming and participating. Have a pleasant evening.

Dr. Garner: Thank you very much for having me as a guest at your eating disorders conference. I want to wish all of your participants the best in their efforts at overcoming their eating disorder.

Bob M: Good Night everyone.