Overview of Treatment

“ We understand that many people and families who seek treatment for an eating disorder have fears or reservations about treatment. When possible, we try to “meet patients (and families) where they’re at.” We believe our program is unique in our ability to provide evidence-based treatment with warmth, compassion, and a sense of humor. ”

The UC San Diego Eating Disorders Center for Treatment and Research provides inpatient, day treatment/partial-hospitalization (PHP), and intensive outpatient (IOP) levels of care for children, adolescents, and adults struggling with food, weight, eating disorders, and related symptoms and behaviors. As a non-profit, university-based program, we are committed to providing state-of-the-art treatments based on research and new understandings of eating disorders to help people recover, prevent future relapses, and build a life worth living.

Philosophy and Clinical Orientation

Thomas Insel: Toward a new understanding of mental illness

Through our multi-decade research at UC San Diego and with collaborators around the globe, we believe that mental health disorders are brain disorders. We take a medical model and treat symptoms and behaviors using evidence-based treatments. We’ve found that genetic vulnerabilities to anxiety, emotional sensitivity, and obsessive/perfectionistic personality traits, predispose individuals to develop eating disorder behaviors. These temperament traits can be modified through new coping strategies, to allow these traits to become assets rather than liabilities. Through both our research and our work with thousands of people suffering from eating disorder symptoms, we strongly believe that people do NOT choose to have eating disorders, they do NOT choose to suffer, and families do NOT cause eating disorders but rather are the critical factor in successful recovery and relapse prevention.

Assessment

Every family/individual receives a complimentary 2-hour clinical assessment with an Admissions Clinician that can be done in person in our offices (preferred), or via phone/video-conferencing. After the initial assessment, the Admissions Clinician will communicate with you about any relevant diagnoses, treatment recommendations, and, if needed, referrals based on your insurance, symptom level, geographic location, and readiness for treatment. The comprehensive evaluation is the first step in creating your individualized treatment plan.

Our Admissions Clinicians are masters-level, senior clinicians who specialize in eating disorders and related symptoms. They understand that it is an incredibly courageous and difficult decision to initiate treatment. Our Admissions Clinicians meet each individual where they are at, assisting them as they navigate academic, work, family, insurance, housing, and other obligations/needs in order to engage in treatment. They understand that ambivalence is normal—people both want to start treatment AND change can be very scary. Contact an Admissions Clinician today to learn more about our treatment programs and how we may be a good fit for you and your family.

Target Behaviors

We understand that every individual is unique and no one fits perfectly into diagnostic labels. Individual treatment plans target specific behaviors or emotions that people wish to change in order to reduce their suffering and build a life worth living.

Behavior/Emotion Description
Restricting/Dieting Whether intentional or accidental, individuals are consuming less calories than they expend. This sometimes results in weight loss, or, particularly in young children, may be a failure to grow/gain weight.
Bingeing Feeling out-of-control while eating more than you intend to and more than your body needs in one sitting; followed by feelings of shame and guilt.
Purging Attempting to get rid of calories you’ve eaten by vomiting, using laxatives, and other means; some people also use purging as a means to regulate their emotions.
Excessive Exercise Exercising more than is healthy for your body, and/or to an extent that gets in the way of your living you life, coupled with a sense of obligation/urge to exercise.
Anxiety Feelings of worry, nervousness, unease about things that may or may not happen in the future. Often accompanied by body sensations such a stomach aches, fast beating heart, and racing thoughts.
Depression Lack of pleasure in things you once enjoyed; feelings of guilt, worthlessness, hopelessness; difficulties with sleep and appetite.
Emotion Dysregulation Experiencing emotions more intensely, and for a greater duration of time, that is desirable and/or effective.
Substance Use Using substances as a coping skill and/or in a way that interferes with building a life worth living.
Trauma An experience you found deeply distressing or disturbing that gets in the way of you building a life worth living and/or results in you using ineffective coping skills (e.g., restricting, binging, purging).
Self-harm Intentionally harming your body through cutting, burning, purging, etc. in order to find relief from your suffering.
Suicidal Thoughts/Actions Thoughts and/or actions about ending your life to find relief from your suffering.
These behaviors can be a part of a number of different diagnosis. Some of the diagnoses that we work with include:

Anorexia Nervosa (AN)

Avoidant Restrictive Food Intake Disorder (ARFID)

Binge Eating Disorder (BED)

Bipolar Disorder

Borderline Personality Disorder (BPD)

Bulimia Nervosa (BN)

Eating Disorder Not Otherwise Specified (EDNOS) / Other Specified Eating or Feeding Disorder (OSFED)

Generalized Anxiety Disorder (GAD)

Major Depressive Disorder (MDD)

Obsessive Compulsive Disorder (OCD)

Post-traumatic Stress Disorder (PTSD)

Substance Use Disorder (SUD)

Treatment Team

Each individual/family is assigned a personalized treatment team. All of our clinicians are full-time employees, ensuring that you have access to each of your team members at all times.

Team Member Service Provided
Psychiatrist A medical doctor meets with everyone for symptom assessment, medication consultation, and medication management. Parents are invited to attend all sessions. Sessions may be daily at the inpatient level, weekly while in Day Treatment, and monthly while in Intensive Outpatient (IOP). Frequency can be increased based on patient need.
Nurse Available at all times for medical needs; monitors weight and vitals 2-5x/week and assists with medication management.
Individual Therapist Meets at least once per week for evidence-based individual therapy utilizing DBT (see below).
Family Therapist Meets at least once per week for evidence-based Maudsley/Family Based Therapy for children, adolescents, and young adults. Adults can choose to have family therapy with parents, spouses/partners, children, friends—whoever is “family” to that patient and can assist in recovery.
Dietician Meets at least once per week for meal and snack planning. For children and adolescents, these sessions are attended by the parents and meet at the frequency requested by parents. Parents choose how much involvement they’d like their children to have in these sessions. Adult patients meet with their dietician weekly, and the dieticians and dietary staff also eat all meals and snacks with the patients. Weekend and evening support from the dietary team is also available through text/mobile support.

Therapeutic Foundation

Family Based Therapy (FBT), also called the Maudsley Model, and Dialectical Behavior Therapy (DBT) make up the foundation of our Pediatric and Adolescent Programs.

Family Based Therapy/Maudsley takes the approach that families are an integral part of treatment. As clinicians and researchers, we are experts in eating disorders, and you are the expert on your child. By training parents in eating disorders, parents are able to take the lead in feeding their children, returning them to their hobbies, sports, and interests, and preventing future relapses. FBT is the gold-standard in eating disorder treatment and is the ONLY evidence-based treatment for pediatric and adolescent eating disorders. Other programs offer “family days” or “family involvement”—do not mistake that for true FBT that treats parents as members of the treatment team who are uniquely positioned to lead their children to recovery. We do NOT offer a residential level of care (link) because residential treatment centers (RTC’s) separate parents from their children and thus are unable to provide FBT/Maudsley—the only evidence-based treatment for pediatric and adolescent eating disorders.

Dialectical Behavior Therapy (DBT)

Dialectical Behavior Therapy (DBT) is the foundation of our Adult Programs.

The term "dialectical" means a synthesis or integration of opposites. The primary dialectic within DBT is between the seemingly opposite strategies of acceptance and change. For example, DBT therapists accept clients as they are while also acknowledging that they need to change in order to reach their goals. Our therapists take a non-judgmental therapeutic approach that balances acceptance with teaching skills for managing dysregulated emotions that can trigger eating disorder symptoms. This is an excellent video explaining DBT.

What is Dialectical behavior therapy for adolescents (DBT)?

While many programs report that they offer a weekly DBT group, to our knowledge, we are the ONLY eating disorder program that has a true Full DBT Program, the kind that has the most rigorous research backing it up and consisting of four components:
1 DBT skills training group is focused on enhancing clients' capabilities by teaching them behavioral skills. The group is run like a class where the group leader teaches the skills and assigns homework for clients to practice using the skills in their everyday lives. We offer multiple DBT skills groups per week and the skills are woven throughout all aspects of treatment. In our Pediatric and Adolescent Clinics, we also offer a weekly Family DBT Skills Group where parents and siblings learn the skills alongside the patient so that the skills can be modeled at home and everyone is speaking the same language of recovery.
2 DBT individual therapy is focused on enhancing client motivation and helping clients to apply the skills to specific challenges and events in their lives. 
3 DBT phone coaching is focused on providing clients with in-the-moment coaching on how to use skills to effectively cope with difficult situations that arise in their everyday lives. Clients can call their individual therapist 7 days per week to receive coaching at the times when they need help the most. For example, clients may be working on their skills during our therapeutic meals in clinic—but find it harder to use skills while at a restaurant with family. They can call their therapist and receive skills coaching to help them use their skills outside of clinic. 
4 DBT therapist consultation team is intended to be therapy for the therapists and to support DBT providers in their work with people who often have severe, complex, difficult-to-treat disorders. The consultation team is designed to help therapists stay motivated and competent so they can provide the best treatment possible. Teams meet 1-2 times per week and are composed of individual therapists and group leaders who share responsibility for each client's care. 

Treatment Components

Individual Therapy

Often DBT individual therapy (as described above) unless client and therapist decide together to use a different evidence based treatment such as Cognitive Processing Therapy (CPT) for trauma or CBT for eating disorders.

Family Therapy

Weekly family therapy utilizing FBT/Maudsley (see above)

4 hours per week of Family Meals where parents eat with their children, therapist, and dietician to increase the effectiveness of meals outside of program

3 hours of Multi-family skills group per week (parents with their children)

3+ hours of Parent skills groups per week (Parent Management Training, Parent Support Groups)

Group Therapy

All of our groups are lead by 2 or more therapists. Our therapists all have masters or doctoral degrees, specialize in eating disorders, and receive a minimum of 4 hours of support and training per week for ongoing skill development and peer support. We have minimal staff turnover with the average clinician having worked with us for over 4 years. Our groups all utilize evidence-based therapies and are constantly evaluated for effectiveness. Your Admissions Clinician and Program Manager can tell you more about the specific groups listed below.

DBT Skills Groups, DBT Skills in Action, DBT Family Skills Group

Cognitive Behavioral Therapy (CBT)

Cognitive Processing Therapy (CPT) for Trauma

Mindfulness group

Relationships Group

Life Outside of Your Eating Disorder (LOUD) group

Goals group

Smart Recovery and AA

Seeking Safety

DBT for Substance Use

Art Therapy

Yoga

Therapeutic Meals

Our professional commercial kitchen produces all of our meals using fresh ingredients, and tailored to each individual’s meal plan. Patients can receive up to 100% of their nutrition while in program (3 meals and 2 snacks), slowly reducing to 30% of their daily nutrition (1 meal and 1 snack) as they are having increased success with meals outside of program. Dieticians and therapists attend all meals providing individual support as needed during meal time.

Dietary Support

In addition to formal weekly sessions, evening/weekend phone support, and consultation to parents, our dietary support offers several weekly groups to increase client’s efficacy around meals both inside and outside of program.


Restaurant outings

Cooking class

Grocery outings

Snack selection

Meal planning

Bringing meals from home **

** Once people step-down to IOP, they can practice bringing in meals that they may bring to school or work.

Psychiatric/Medical Support

Ongoing medical monitoring including labs, vitals, and weight checks, weekly psychiatric sessions, medication management, and drug/alcohol screens as necessary.