Where services are provided
Eating disorder treatment takes place along a continuum of care. Inpatient hospitalization focuses on medical stabilization and the safe introduction of nutrition. Residential treatment may be in a home-like setting or hospital-based with from 5 to 20 beds. It involves medical stabilization as the number one priority. Hospital outpatient facilities focus on therapeutic counseling. RDNS work in all levels of care and may be in private practice or employed by the institution or organization to provide services.
Typical populations served
Eating disorders affect a wide range of demographics including race, gender, socioeconomic status, sexual orientation, and age. While many people wrongly believe eating disorders only affect affluent, Caucasian young women, RDNs must work to dispel this myth and be prepared to work with a varied population.
Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder, and Other Specified Eating and Feeding Disorders (OSFEDD) are the most common disorders treated. Becoming familiar with the new DSM-5 criteria will be immensely helpful for the RDN working in the field. Many patients will present with a variety of symptoms and subclinical presentations should be taken seriously. Visit www.dsm5.org.
In addition to the eating disorder, co-morbid mental health and medical diagnoses are quite common. Typical mental health diagnoses include anxiety, depression, bipolar, obsessive compulsive disorder, post traumatic stress disorder, and borderline personality disorder. Common medical problems include functional gastrointestinal disorders (i.e. IBS), thyroid disturbances, osteopenia/osteoporosis, dental complications, PCOS, food allergies/intolerances, and diabetes.
Typical work and involvement with other professionals
Typical activities will vary based on the level of care. In inpatient hospitalization the RDN works collaboratively with the treatment team to assess the patient and develop an appropriate and safe nutrition care plan. This may include tube feeding.
Residential treatment involves the RDN working collaboratively with the other members of the treatment team to support patients in decreasing/eliminating eating disorder behaviors while increasing exposure to feared or avoided foods. The RDN is responsible for repairing nutrient deficiencies and optimizing intake for psychological and physiological well-being. The RDN will help the patient develop cooking skills and facilitate outings to the grocery, restaurants, etc. Counseling with the patient is often minimal at this level of care but can be catered to the psychological capability of the client. At this phase, the RDN will begin offering psychoeducation related to nutrition, metabolism, weight, exercise, and body image.
In the hospital outpatient setting the RDN will work with the patient’s outpatient team. The RDN’s responsibilities are the same as listed for residential treatment. Additionally, the RDN will begin providing more counseling to help the client separate eating and emotion.
In addition to the responsibilities listed above, the RDN may be responsible for documentation, development of kitchen protocol and systems, staff trainings, and group presentations to staff and patients.
As mentioned above, a complete and communicative treatment team is the gold standard of care. Members of the treatment team include the Primary Care Physician and other ancillary medical professionals as needed- i.e. gastroenterologist, endocrinologist, as well as Psychiatrist or Psychopharmacologist. Also included are Mental Health Providers (PhD, PsyD, LICSW, etc. and the client, client’s family and/or personal support network. Additional therapeutic resources include group support, equine therapy, yoga therapy, art therapy, and express arts therapy.