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Is Your Eating Disorder “Specialist” Really a Specialist?

Is Your Eating Disorder “Specialist” Really a Specialist?

Eating disorders have been shown to have high rates of hospitalizations and death (Arcelus, Mitchell, Wales, & Nielsen, 2011; Klump, Bulik, Kaye, Treasure, & Tyson, 2009). So it is imperative that both those who struggle with eating disorders and their caregivers are able to identify competent treatment providers.

This is the third part of our series intended to help demystify the process of seeking qualified outpatient care in the field of eating disorders. Previously, we have shared information about insurance provider specialist lists, Consumer Beware: What You Should Know About In-Network Insurance Provider Lists, and why eating disorder specialists may not join insurance panels, Having Trouble Finding an Eating Disorder Therapist Who Takes Insurance? Here’s Why. In this post, we clarify advertising terms and phrases consumers may encounter when selecting providers. For example, “eating disorders specialist” and “certified” in treating eating disorders can sound reassuring to consumers seeking treatment. In reality, either phrase may not mean what you would think or hope.

Please note that we use gender-neutral terms, “they/them/their,” in place of the gender-specific third person singular.

Common Advertising Terms and Phrases

When seeking an eating disorders treatment professional, you will see that providers typically describe themselves as one of the following:

  • They “treat” eating disorders
  • Treatment of eating disorders is a “specialty” of theirs
  • They advertise as being an “eating disorder specialist” or “expert”

Here’s what these terms and phrases often mean.

“Treat”

When someone indicates they treat eating disorders, this usually signifies that the provider is willing or wants to work with patients with eating disorders. However, willingness and want may not correspond with sufficient training and experience. Some who list this may not have treated any or many patients with eating disorders in their practice.

To be accepted by insurance panels, providers can be incentivized to check maximal numbers of specialty or competence boxes. (The insurance panel instructions often state, “check all that apply.”) Further, to receive referrals from therapist directories and online profiles, providers may also indicate multiple areas of treatment specialties. Though you could be thinking that this sounds intentionally misrepresentative, that is not necessarily the case.

Because treatment of eating disorders is often minimally covered (if at all) during higher education or even at training facilities, clinicians often genuinely feel they are qualified to treat people with eating disorders. Information necessary to provide standard of care treatment is not widely known nor is it required to be taught in educational and training settings. (Yes, this might feel shocking considering that eating disorders are serious, complex, and sometimes life-threatening illnesses that affect just under one-tenth of the population of the United States [United States Census Bureau, 2018; Wade, Keski-Rahkonen, & Hudson, 2011] and can ameliorate with effective treatment).

“Specialty,” “Specialist,” and “Expert”

When someone lists treatment of eating disorders as a specialty, that can mean that the clinician sees patients with eating disorders, and they have training or experience that qualifies them to use the designation of specialist. However, it can also mean that the clinician would LIKE to specialize in the eating disorder field but may lack practical experience.

Regarding a therapist advertising they are an eating disorder specialist orexpert, either title sounds specific. However, neither is a protected term. Anyone can title themselves an eating disorder specialist or expert if they feel they qualify.

Wrap-up on Common Advertising Terms and Phrases

As you can see, a directory or insurance listing as treats/treating eating disorders and specializing, specialist, orexpert in eating disorders does not assure a minimum level of competence. So what does?

Below, we address some important concepts and a credential that can help verify a provider’s level of experience.

Clarification of “Certificate of Completion” vs. “Certification”

Providers may offer evidence of training and qualifications by posting titles of certificates on their websites or displaying these certificates in their offices. A certificate of completion is not a certification; it is a document that indicates completion of a class, workshop, webinar, conference, or a certain number of educational hours. For example, if a clinician attends an eating disorders class that was two hours, they often will receive that certificate of completion indicating that two hours of education were both attended and completed.

Eating Disorders Certification

At this time, there is only one nationally recognized certification credential for eating disorders. This is issued by the International Association of Eating Disorders Professionals (iaedp™).

Official iaedp™ specialist designations include:

  • Certified Eating Disorders Specialist (CEDS), which applies to licensed therapists, medical doctors, and nurse practitioners;
  • Certified Eating Disorders Registered Dietitian (CEDRD), which applies to registered dietitians;
  • Certified Eating Disorders Registered Nurse (CEDRN), which applies to registered nurses;
  • And Certified Eating Disorders Creative Arts Therapist (CEDCAT), which applies to Music, Art, Recreation and Dance/Movement Therapists.

Iaedp™ core course content and comprehensive exam questions are compiled from both the leaders in the field and from evidenced-based research. Both are updated on a consistent basis. Multiple certification committee members review each application to assess if an applicant meets (or exceeds) requirements. Providers who qualify for the CEDS/RD/RN/CAT do so through one of two routes: Equivalency or Traditional.

Equivalency indicates that the professional meets a specific level of advanced education. Prior to applying, the candidate must have experienced at least five years/10,000 hours in treating eating disorders (as of 2018, the minimum was increased to seven years) and have a significant history of involvement in a number of the following:

  • Supervision of other eating disorders treatment professionals;
  • Presentations at eating disorder-related workshops, conferences, and events to include both professional and community speaking opportunities;
  • Authorship of books, book chapters, peer-reviewed or trade articles and consumer publications on eating disorders;
  • Academic affiliation and instruction in eating disorders, to include adjunct professorship, guest lecturer, or program coordinator for educational institutions;
  • Participation in eating disorders research;
  • Presence in the media as an eating disorder expert;
  • Appearance in the legislation and/or courts of law as an expert witness regarding eating disorders;
  • Volunteer work, community service, or similar experience that was related to or associated with the eating disorders treatment field;
  • And more.

CED-equivalency providers are also required to:

  • Attend at least fifty eating disorders continuing education hours in the five years before applying for the CEDS/RD/RN/CAT.
  • Submit three recommendation letters, specific to their work in the field of eating disorders, for committee review with their application.
  • Agree to abide by the iaedp™ Professional Code of Ethics Statement.

Customarily, Equivalency applicants have been exempt from having to take the comprehensive iaedp™ Final Certification Exam. Starting in June 2019, all CED applicants will be required to pass the test.

Traditional indicates that the professional meets a minimum level of advanced education and has:

  • Experienced 2,500 supervised patient care hours directly in the field of eating disorders by an iaedp™-Approved Supervisor. (This usually takes a minimum of two years of concentrated eating disorders experience.)
  • Provided a 1,500-word eating disorders case study reviewed by both their supervisor and the certification committee.
  • Completed the following iaedp™ Core Courses and passed each corresponding course exam:
    • Introduction to Eating Disorders;
    • Treatment Modalities of Eating Disorders;
    • Medical Aspects of Eating Disorders;
    • And Nutrition Guidelines for Treating Eating Disorders.
      • Recommended reading lists accompany these courses.
  • Passed the comprehensive iaedp™ Certification Exam.

All CED-traditional providers are required to:

  • Provide proof of 6-10 recent eating disorders continuing education courses attended before applying for the CEDS/RD/RN/CAT.
  • Submit three recommendation letters, specific to their work in the field of eating disorders, for committee review with their application.
  • Agree to abide by the iaedp™ Professional Code of Ethics Statement.

If awarded the CEDS/RD/RN/CAT, the certified professional must keep up with ongoing eating disorders-specific continuing education to maintain their CED-designation.

As you can see, this is a rigorous and standardized process.

Other Eating Disorder Designations

When writing this article, we searched online for “eating disorder training programs” to find additional organizations and providers who offer certificates and certifications in eating disorders. Our Internet search provided a result of ten, ranging from community college-based to individual, therapist-created training programs.

Some of these less well-known courses may offer current and thorough training. For example, a number of the school programs we found might fulfill the iaedp™ Core Course requirement portion of the Traditional route. However, for the other training programs, we could not assuredly guess the levels of legitimacy or rigor from the information provided, the content did not seem mainstream, etc. Even as professionals, it was difficult to parse out potentially helpful trainings.

On that note, two increasingly recognized advanced eating disorder-related training programs of which we are aware deserve mention here:

  • Family-Based Treatment (FBT) has a certification program by the Training Institute for Child and Adolescent Eating Disorders for certification in that treatment specifically for eating disorders.
  • Certified Intuitive Eating Counselor by Intuitive Eating Pros focuses on teaching Intuitive Eating. Although, Intuitive Eating is not an eating disorder-specific certification, Intuitive Eating is often used in the treatment of eating disorders.

We were able to verify that these are considered training programs rooted in current best practices.

Helpful Information and Questions to Ask

In general, there is limited to no oversight of the content of eating disorders certificate programs across the United States. So the consumer will need to assess a provider's level of expertise and competence. Sadly for the consumer, this often has to happen while in a crisis-state of the illness.

While the various certificate programs may seem difficult to evaluate for quality, the iaedp™-awarded CED-designations should be generally reliable to assure an advanced level of training and experience in eating disorders treatment. As with anything, though, it’s possible that some less qualified CEDS/RD/RN/CAT might have “slipped through the cracks” throughout the years. Thus, we want to offer you some questions to help you to vet any potential provider:

  • “What qualifies your designation of treats/treating, specialist, or expert/specializing in eating disorders?”
  • “Who/which organization are your certified by?”
    • If you are not familiar with the person or organization, you will benefit by asking, “What qualifies the person or organization to provide an advanced eating disorders designation?”
  • “What is your treatment philosophy?”
  • “Do you utilize/include current evidence-based practices that have been sanctioned as mainstream and efficacious? If so, which?”
  • “How long have you been treating patients with eating disorders?”
  • “What percentage of your practice is the treatment of eating disorders?”
  • “What year and what was the last eating disorder-specific conference you attended?”

In a previous peer-reviewed published paper, “Eating Disorders and Scope of Competence for Outpatient Psychotherapists,” we identified minimum domains of knowledge for providers treating eating disorder patients:

  • Assessment and Diagnosis
  • Medical Factors
  • Nutrition and Malnutrition
  • Treatment Strategies
  • Multidisciplinary Collaboration and Levels of Care

Your potential provider should have experience and training in each. Feel free to ask about any of the above. Furthermore, the National Eating Disorders Association offers a free, detailed list of questions to help vet a potential eating disorders provider.

In Conclusion

The field is continually evolving. New and old certifications can be completely legitimate. However, the burden of vetting competence and legitimacy of training and experience rests on the consumer.

We were not paid to write this article nor do we have a vested interest in promoting iaedp™. Although we both have our CEDS, are iaedp™-approved supervisors, and sometimes serve on committees, there is no other interest other than wanting to help inform the public in order to improve eating disorders care.

We hope that this article has been helpful and increased your confidence in seeking an eating disorder provider.

References

Arcelus J., Mitchell A. J., Wales J., & Nielsen S. (2011). Mortality rates in patients with anorexia nervosa and other eating disorders: A meta-analysis of 36 studies. Archives of General Psychiatry, 68(7), 724-731.

United States Census Bureau. (2018, September 24). U.S. and world population clock. Retrieved from https://www.census.gov/popclock/

Klump, K. L., Bulik, C. M., Kaye, W. H., Treasure, J., & Tyson, E. (2009). Academy for eating disorders position paper: Eating disorders are serious mental illnesses. International Journal of Eating Disorders, 42, 97–103. http://dx.doi.org/10.1002/eat.20589

Wade, T. D., Keski-Rahkonen A., & Hudson J. (2011). Epidemiology of eating disorders. In M. Tsuang and M. Tohen (Eds.), Textbook in Psychiatric Epidemiology (3rd ed.) (pp. 343-360). New York: Wiley.

Allison Spotts-De Lazzer, M.A., LMFT, LPCC, CEDS-S, is a Licensed Marriage and Family Therapist, Licensed Professional Clinical Counselor, and Certified Eating Disorders Specialist practicing in the San Fernando Valley, Los Angeles area. She is also the creator of #ShakeIt for Self-Acceptance!® www.TherapyHelps.Us

Lauren Muhlheim, Psy.D., CEDS-S, is a Psychologist and Certified Eating Disorders Specialist practicing in Los Angeles. She specializes in providing evidence-based psychotherapy for adults and adolescents. www.eatingdisordertherapyla.com

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