Directly Observed Therapy

Parents put a high value on building trust. We're proud of the words "I'll do it myself."

Trust, however, is no favor to someone who is too young or too ill or being controlled by stronger powers. This is often the case with mental illness and very much so with eating disorders: we're talking about an illness with a "cloaking mechanism" where the patient often can not see how ill they are or understand the necessity of treatment. We're talking about a brain condition where the treatment seems far worse than the illness at the time, and the compulsion to avoid treatment is so strong it can drive otherwise honest and deeply moral people to do things that appear deceptive and self-defeating.

It is our job as parents and loved ones to see when the illness is in control and driving the patient to these extremes. By leaving no opportunity to "cheat" or "lie" we are actually offering safety, not coercion.

Dr. O'Toole at Kartini describes the rationale and methodology of monitoring medicine intake, but I think it applies to meals as well:

Medication for treatment of eating disorders and Directly Observed Therapy

Hospitals do this, and we should not be afraid to offer this safety as well.

My favorite quote: "I swear, DOT could have been invented by my grandmother (or yours); it makes such intuitive sense."


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