 
Eating Disorders Program
Treatment details & clinical protocols
Who we treat
The Eating Disorders Program treats women and men, 18 and older. The treatment team works with individuals who are experiencing difficulties and health issues due to moderate to severe eating disorders and other psychiatric disorders.
Although patients who come to Menninger frequently have the principle diagnoses of eating disorder at the time of admission, treatment includes addressing accompanying mental illness, such as mood, anxiety and personality disorders, substance abuse and mild to moderate obsessive-compulsive disorder. Many patients in the Eating Disorders Programs have multiple psychiatric diagnoses.
Treatment approach
The Eating Disorder Program is based on a bio-psycho-social (medical, emotional, social) model of care in which the needs of the whole person are assessed and addressed in treatment. This approach hypothesizes that patients come for treatment struggling with problems in several areas of their life, taking into account the patient's background, physical well-being, social and occupational functioning, interpersonal relationships and family environment.
Treatment targets several different areas in the patient's diagnosis, such as medical or inherited characteristics and emotional and social effects of the illness. While the patient is in treatment, the staff assesses significant life events that may affect a patient's functioning. The staff also looks at the family, occupational and cultural environments' effect on the patient in addition to the individual's strengths. Understanding the whole person and how each area of life influences the person is crucial to achieving a diagnostic understanding and the development of the patient's individualized treatment plan.
Treatment team
A multidisciplinary team approach enables Menninger to offer the bio-psycho-social model of treatment. The primary clinician, who is responsible for overseeing and coordinating the patient’s treatment, as well as addressing family and occupational issues, directs the team. Other members include the psychiatrist, activity therapists, dietitian, individual therapist and nursing staff. A substance abuse counselor also joins the team when patients have substance abuse/dependence issues. A utilization review manager is an additional part of the clinical team, ensuring that needed services are provided and allocated in an effective and financially feasible manner. Other specialists work with the treatment team when appropriate.
The most important member of the treatment team is the patient. Together, the patient and staff work as a team to plan treatment, assess treatment goals and set up relapse prevention and discharge strategies.
As each patient engages in treatment, the team assesses, reviews and revises the patient's treatment plan to ensure that it fits with his/her needs. As part of capturing the diagnostic understanding of an individual, one or two core issues that drive the patient's symptoms are focused upon as the primary goals of treatment. As these matters are addressed, other issues may be added into the treatment plan.
In addition, treatments and interventions ordered by the treatment team stress the importance of developing healthy relationships with family, peers and school or work, enhancing or learning core living skills, and consolidating a positive and realistic self-identity.
Upon admission
As part of the admission criteria, patients must be medically cleared and physically stable. This is determined with input by the patient's primary care clinician and the results of labs and an EKG that are conducted within 72 hours before admission. If lab work and/or EKG are abnormal, the patient can come to Houston to receive medical stabilization at a hospital at the Texas Medical Center before admission to Menninger. If the patient needs inpatient care after admission to a Menninger Eating Disorders Program, the patient can be transferred to a hospital at the Texas Medical Center and then return to Menninger following stabilization to continue treatment.
- Once admitted to the Eating Disorders Program, the patient receives the appropriate program handbook outlining her/his rights and responsibilities as a voluntary patient and the responsibilities of the treatment team.
- Within a few hours of admission, the patient receives an orientation to the program, and a nursing assessment is completed.
- Within the first 24 hours, the patient is seen by an internal medicine physician for an initial diagnostic physical and met by the primary clinician or psychiatrist for a psychiatric interview.
By the end of the patient's first week at The Menninger Clinic, the treatment team will complete the diagnostic assessments. These will include a psychosocial assessment with information obtained from the patient, as well as his/her family, review of past treatment records and observations by staff. When necessary, psychological testing will be obtained. Assessment findings are shared by team members in rounds with the patient and in team meetings in which the patient's diagnoses and clinical understanding are communicated along with an estimated length of stay to attain the patient's treatment goals.
Core treatment program
All patients participate in the following treatments.
Individual and group therapy: These therapies are central aspects of treatment and are provided by program staff. Sometimes the patient's individual work will be responsibility of the patient's primary clinician. At other times, a therapist outside of the core team will be involved. The patient's treatment team will determine this within the first week of admission.
Individual therapy provides the opportunity for in-depth understanding of the patient's issues and the adaptive function of her/his eating disorder. The approaches will vary according to the patient's needs and experiences and may include cognitive behavioral, insight-oriented or other therapy modalities. The style and focus of individual therapy is directly related to the prioritized goals of treatment.
Group therapy provides an opportunity for patients to share their issues and receive support while also providing the same to peers. Every patient's situation is unique, but also overlaps with problems of others. Group therapy provides a sense of commonality of problems and experiences and allows patient's to explore their issues in a safe and supportive environment with others in similar situations.
The eating disorder groups focus the attention on the adaptive function of eating disorders. Groups are led by staff who specialize in areas including eating disorders, depression, trauma, substance abuse and other psychiatric problems. The leaders include primary clinicians, addiction counselors, psychiatrists and nursing staff. Group methods range from psychoeducational and experiential groups to process and skills development groups. Examples of program groups follow.
Eating disorder family groups
Family dynamics affect members of the family and are impacted by the eating disorder. How the eating disorder adds to the dysfunction within the family is explored, and alternative behaviors are considered to create healthier dynamics.
Body image group
Individuals with eating disorders typically experience skewed and disturbing notions about their bodies. Concern about shape and size can lead to obsessive thinking and compulsive behaviors to correct perceived flaws. Helping individuals gain a more accepting and realistic experience of their bodies is an essential intervention to disrupt the pattern of eating disordered thinking and behavior.
Meal planning, nutrition & exercise education groups
The individual with an eating disorder has many misunderstandings about nutrition and exercise that lead to extreme methods of dieting or exercise and a great many fears about certain types of food. We challenge the myths and provide the facts in a persistent fashion to undermine the often entrenched and misguided beliefs of the individual with an eating disorder. The dietitian also works with the patient twice a week on meal planning.
Eating disorders & substance abuse group
Often eating disorders are only a part of a range of behaviors that are used to cope with life. It is important to educate individuals about the similarities between eating disorders and substance abuse, as well as the similar functions each may serve in an individual’s life.
Food & feelings group
How a person experiences their relationship with food is highly unique to that individual. This group is typically conducted after a mealtime (during sitting time). Individuals are asked to reflect on how they are experiencing food in their lives at the moment and in the past. Patients receive assistance in regaining a comfort range with the sensation of fullness or hunger with the goal of eventually returning to a more intuitive relationship with food as fuel.
Therapeutic meal preparation & restaurant outings
Patients with an eating disorder require time and experience with food that opens the door to returning to a more normalized and healthy relationship with food. These groups focus on food preparation and ordering from a menu to challenge the individual to try different foods and to desensitize the individual to highly vulnerable life situations involving food.
Eating disorder goals group
Each patient sets weekly goals involving triggers for eating disorder behavior and anxiety. The staff work with the patient on holistic health interventions, relapse prevention planning and other specific goals. Progression toward the goals is reviewed daily.
Menninger provides diverse group therapy options to meet the needs of individuals with eating disorders and multiple-diagnosis disorders. Patients attend specialized groups in the program, as well as groups that are available hospital wide that address underlying issues such as anxiety disorders, obsessive-compulsive behavior, depression, posttraumatic stress disorder, substance abuse and psychosis. Therapy includes both process groups and education groups.
Psychopharmacology: A psychiatrist (medical doctor who has completed psychiatric residency training) is a member of the treatment team and works with the patient and other treatment team members to establish the most effective medication regimen. Because research results show that antidepressants known as SSRIs (selective serotonin reuptake inhibitors) are effective in treating eating disorders in most patients, this type of antidepressant medication may be prescribed. Medications are used only when necessary and are based upon the patient's behavior and diagnosis.
Upon admission the patient meets with the psychiatrist for an initial assessment of medication needs. The medication regimen is reassessed at least twice each week during patient rounds. Patients receive medication education, including intended effects and possible side effects of their medication. The purpose is to provide the patient with an opportunity to participate in monitoring the effects of medication and to prepare her/him to assume responsibility for following the appropriate medication regimen after discharge.
Nutrition & fitness: The patient’s treatment plan will include nutrition and exercise education for the patient, nutrition and exercise management, a specialized body image group, assistance with meal planning and ongoing assessment of nutritional and physical health status.
Therapeutic activities & recreation: The activity therapist coordinates an active program of recreation and skill-building activities that focus on work, play, education and creativity—all integral parts of everyday life. Improved functioning in these areas ultimately leads to improved mental health. The activity therapist assesses the life skills of the patient and designs, implements and monitors activity programs to meet treatment goals. Fitness education and art therapy are incorporated into the treatment program. Patients and staff use the on-site gymnasium.
Milieu therapy: The milieu is a supportive holding environment in which staff members work with the patient to provide safety and structure while at the same time assessing the patient's relationships and behavior.
A consistent routine is maintained, which fosters predictability and trust. Milieu structure assists patients in containing negative responses and provides an opportunity to manage such responses through staff and peer feedback, and modeling.
A milieu is considered therapeutic when there is an environment that provides a sense of membership and belonging. Patients work with peers and with staff to take responsibility for the welfare of others in their community and the community as a whole. The therapeutic community provides a set of values and norms for behavior with the expectation that community members will participate in activities, value one another as individuals and learn to care not only for themselves, but for their peers.
The objective of the therapeutic community is to provide a safe, nurturing environment in which patients can develop a sense of trust in staff and other patients in order to share and scrutinize their problems, feelings and beliefs. The patient community provides the patient with an opportunity to integrate new and positive experiences, practice new skills and gain self-understanding. Activities that foster these objectives include a community meeting, consisting of staff and patients, patient leisure activities and daily group activities on the unit.
Specialized skill-building groups: Groups such as anger management, interpersonal effectiveness and depression group, as well as relapse prevention and discharge planning, are part of the core program.
Therapeutic activities & recreation
Group activities and activities to promote self-esteem and self-understanding are an integral part of the Eating Disorders Program. An activity therapist coordinates and designs therapeutic activity to promote teamwork, develop interpersonal and social skills, and promote dynamic understanding and skill building. Physical exercise and art are incorporated into program activities. Patients and staff utilize an onsite gymnasium and a walking trail on the grounds.
Spiritual & cultural programming
Cultural and spiritual needs are assessed at the time of admission and the clinical team utilizes Menninger's chaplain and community resources to address these needs. A spirituality group meets weekly and there are weekly nondenominational chapel services at Menninger. The Menninger chaplain is available for individual consultation upon request.
Family workshop
The families of patients in the Eating Disorders Program are encouraged to attend a two-day family workshop. The workshop helps families increase their knowledge about eating disorders, treatments, their own needs and the functioning of the family system in response to their family member's vulnerabilities. Experiential, classroom and interactive activities are incorporated within the workshop schedule. Some activities are primarily for the family members while other groups include the patient group as well. During the workshop, a patient and their family members will also meet with their primary clinician to discuss further treatment issues and plans.
Specialized programming: In addition to the core programming, the treatment team prescribes individualized adjunctive programming based on the patient’s clinical needs. Additional programming is decided upon in team meetings. Some interventions are available through other specialized programs at Menninger.
Patients with substance abuse issues
- Substance abuse evaluation
- Individual substance abuse counseling
- Substance abuse educational groups
- 12-step group treatment
- Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) groups
Patients with impulsive, anger management and suicidal/self-harm issues
- Anger management group
- Trauma group
- Dialectic behavior therapy (DBT) group
- Interpersonal relationships group
- Individualized milieu structure
Patients with anxiety disorders or obsessive-compulsive symptoms
- Cognitive behavior therapy (individual or group therapy)
- Obsessive-compulsive disorder consultation
- Response prevention (individual and group therapy)
Discharge planning: Discharge planning is an ongoing process that begins at admission. An initial discharge plan and estimated length of stay is established within the first week and discussed with the patient during individual meetings with his/her primary clinician and during rounds. This plan is reviewed and revised in biweekly team meetings. For adolescents, the plan is also communicated and discussed with the family.
As patients near completion of treatment, therapeutic passes from the hospital to the home are scheduled to promote the application of skills, behaviors and symptom management techniques within the home setting. Coordinating outpatient services and setting up an effective relapse prevention strategy is also part of the discharge process.
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