MUSC eating disorders clinic provides a welcome, safe haven

Dawn Brazell
June 22, 2016
Donna Friedman and Dr. Renee Rienecke say the Friedman Center for Eating Disorders offers treatments
Donna Friedman and Dr. Renee Rienecke say the Friedman Center for Eating Disorders offers treatments that have a strong track record and emphasizes including the family in the treatment process. Photo by Dawn Brazell

If there’s one thing Donna Friedman has learned the hard way, it’s that sometimes the worst monsters we face are inside of us.

She and other health professionals will gather June 23 for MUSC Health’s celebration of the opening of the Friedman Center for Eating Disorders. Friedman said it’s a dream come true, because another major life lesson she has learned is that what makes it easier to face the monster, which for her was anorexia nervosa, is not doing it alone.

Her hope is that the opening of the center will mean that people struggling with eating disorders will not have to suffer as long as she did to get help. The center will use a multidisciplinary team trained in treating eating disorders, including anorexia nervosa, bulimia nervosa and other unspecified or restrictive eating conditions.

The clinic, for patients age 8 to 24 and their families, will offer a range of programs, including partial hospitalization and intensive outpatient options. The director, Renee Rienecke, Ph.D., is the first certified Family-Based Treatment (FBT) therapist in the state. She brings her expertise from the University of Michigan, where she served as director of Clinical Services and Research of the University of Michigan Comprehensive Eating Disorders Program. 

Rienecke said it will be a one-stop shop and a safe haven for families who have a loved one with an eating disorder. Her team relies on evidence-based approaches. She prefers FBT therapy because of its track record. It has a 90 percent improvement rate for patients recovering from eating disorders that is maintained four to five years afterward.

This is no small feat. 

Eating disorders are prevalent and have the highest mortality rate of any mental illness. In the United States, an estimated 20 million women and 10 million men have a clinically significant eating disorder. The mortality rate with anorexia nervosa is 12 times higher than the death rate for someone without the disorder.

Unfortunately, many teens and parents fail to realize how serious the problem is, Rienecke said. An estimated 20 percent of people suffering from anorexia nervosa will prematurely die from complications related to their disorder, including suicide and heart problems, according to the South Carolina Department of Mental Health.

Friedman, whose philanthropic support helped launch the center, said eating disorders change a person’s brain chemistry because of the lack of nutrients they’re receiving. The Mount Pleasant resident weighed 68 pounds at age 19, and it took her 26 years, in and out of treatment, to find her path to recovery. Today, she is the healthy wife and mother of four children and can look back and see how the disorder turned her into a “monster” she didn’t recognize.

She counsels parents not to see the current behavior of a child with an eating disorder as the “real” person. They are seeing the disorder.

“It feeds the monster that you become. Parents see a shift in their relationship with their child. They have to remember, this is not your daughter or son. This is your child with an eating disorder.”

She knows the center will make a difference.

“It’s wonderful. With Renee’s expertise and her background, we’re going to offer the state what it’s needed for a long time.”

Even though there has been little advertising, the clinic’s team has seen patients seek it out since opening its doors. The center currently has a multidisciplinary team of five people, including physicians and therapists who specialize in adolescent medicine, with plans to grow the staff to 13.

Rienecke said an extensive staff is needed because these are challenging cases. There are mental health as well as medical issues, and the center needs people who can address the various aspects. “Anorexia has the highest mortality rate of any psychiatric illness. There are a lot of misconceptions about the disorder. It’s glamorized in media and many people fail to take it seriously,” she said.

Eating disorders affect all socioeconomic levels and genders. While it’s estimated that the disorder affects about 10 percent of adult males, in adolescence that is closer to be being an equal percentage.

One of the clinic’s main roles will be education. It’s estimated that only 1 in 10 people with eating disorders receive the treatment they need.  “We need to get the word out to the community and put to rest some of these misconceptions about eating disorders that is preventing people from getting the treatment they need.”

There are treatments, backed by research, that have been shown to be effective, and outcomes seem to be better the earlier a patient gets treatment. “If you can intervene early, then they can recover, and it’s not a lifelong issue. It can be a blip in their life and not their whole life.”

Rienecke said she prefers FBT, also known as the Maudsley Approach, for its pragmatic, family-based approach. Research shows it works, she said. Therapists also use it with other types of treatment, such as cognitive behavioral therapy. The goal with patients, especially those with anorexia who tend to be ambivalent about seeking help, is to take the pressure off of them.

“Asking someone with anorexia nervosa to make all the decisions about their food is overwhelming. You end up putting kids in an unhealthy place. With family-based planning, you end up saying, ‘We’re going to take that pressure away from you for a little while and give it to your parents.’ The parents are the main agents of change.”

For older patients, that help may come from may be a close friend or partner.

Rienecke said parents used to be told to stay out of treatment and even got into the situation of blaming their child for the disorder. “Now it’s about ‘We’re going to help you get better whether you want to or not. We’re not going to let you die.’”

It’s also about education for the community, as well as parents and caregivers.

“Parents often are well-meaning, but how to intervene constructively does not always come naturally. But with a little guidance and education, they can do a great job.”

The center focuses on team communication among the members of its staff, which is critical for success. They meet regularly to bring their various areas of expertise to the table and get everyone on the same page.

Friedman said the approach works, and she loves that now it’s available locally. One reason she became the center’s ambassador is that she wanted patients to be able to stay home for this type of treatment. She saw the stress it was putting on families being referred out of state and knew a program had to be started.

 

“With family-based therapy, they are not pulled out of their family. It tries to get them back into their life as quickly as possible. The preference is not for residential treatment. These kids have to go on and lead their lives. You have to make peace with the poison. By doing this in a comprehensive way, they don’t have to leave home.”

It causes less financial strain as well, and the clinic is approved for Medicaid funding, so it’s accessible for all socioeconomic levels. The other way the center will be able to extend treatment accessibility is via telehealth services that will be added.

Rienecke said she’s concerned that people may leave a program and not get follow-up treatment from their doctors or have doctors who have little experience with eating disorders. The telehealth program will offer another way to support patients and help keep families together.

It also will keep teens and young adults from slipping through the cracks. Friedman said she looks back to the time she was in the throes of her disorder and is shocked at what a different person she was. Eating disorders can cause social withdrawal, lying and obsessive thinking. “It really narrows your life. You’re really in a small box.”

Rienecke agreed. “When you’re in the thick of it, why would you want to change?”

The goal in the beginning is to get patients adequate nutrition. “Then they start to come back online and their brain’s not eclipsed by the eating disorder. Then we start talking about it.”

The staff develops a supportive, team-family network for the hard work of recovery. “A big part of the treatment is to support and educate the parents. It’s easy for parents to get frustrated and blame. They have to remember it’s not your healthy child, it’s the eating disorder. You have to be firm about the eating disorder while supporting this,” Rienecke said.

Friedman nodded. “These kids don’t want this. It’s not a choice. We need to give them the tools to fight.”

For more information about the center, call 843-876-1491.

About the Author

Dawn Brazell
MUSC Hollings Cancer Center