Hope: the Cornerstone of ED Treatment

Too many people with chronic eating disorders feel like they run out of options. It often takes quite a bit of time to summon up the courage to look for help and then actually get to an appointment. The shame about the illness and the fear of discussing the disorder—making it real—are overpowering. But after that first difficult step, what’s happens next?

Too often, people end up very frustrated and disappointed. Perhaps they see a clinician without much experience treating people with eating disorders. Perhaps they see someone who shames them for their illness. Perhaps they feel blamed for being sick. Or perhaps they go to treatment for a while and make no progress at all.

If that pattern happens a handful of times over a few years, it’s easy to see why someone would become demoralized and expect that the eating disorder is likely a chronic condition. As time passes and opportunities are lost, a sense of hopelessness grows even larger.

I have seen many people 10-15 years into an eating disorder in this frame of mind, devoid of hope and stuck in a cycle that feels like it will swallow their lives.

I don’t pretend to have all the answers to help these people. Sometimes they need behavioral intervention just to break the eating pattern. Sometimes they need education to understand the difference between their own thoughts and eating disorder thoughts. Sometimes they need someone to believe in them. Sometimes they need to see that love is the antidote to an eating disorder.

Most of all, the one component of treatment that is critical is hope. What these people who have struggled for years without any true progress need is hope. They need to see there is a way to recovery and that people who have been sick for years can fully recover. They need to see that the path may be hard, but someone has an idea of what that path might look like.

My wish for the many people struggling with chronic eating disorders is to know that help does exist for you. Look for the right kind of guidance and maintain hope that wellness and recovery can be in your future.


The Political and Social Biases of Eating Disorder Treatment, Part III

The difficulty with fully understanding the eating disorder epidemic of the last forty years is distinguishing between the clinical and social aspects of the illnesses. Psychiatry has historically created disorders aimed at marginalizing minority groups such as pathologizing homosexuality or hysteria as a form of invalidating women’s emotions. However, eating disorders are real psychological and medical problems that need treatment but which also just happened to begin a few decades ago. These two facts make them unique in the field.

In this blog, I have written extensively about various components of eating disorder treatment. Clearly, these are serious illnesses that demand medical attention. That must be clear.

However, unlike other psychiatric illnesses, eating disorders are relatively new and have only become a problem because of social pressures largely aimed at girls and women. No other psychiatric disorders are directly caused by the social construct of our society. No other psychiatric disorders affect 90% women.

Although there are genetic and psychosocial factors that cause eating disorders, the number one risk factor is dieting. Without dieting, people very rarely develop eating disorders. Before dieting and thinness became social and cultural norms, these disorders did not even have a name.

The pressure to diet comes from our culture of thinness. The mass marketing of the diet industry, exercise industry, the pervasive images in the media and the false information spread by the medical establishment have created a culture that says thinness is superior and healthy. Any increase in weight is failure. And this information is mostly aimed at girls and women.

The result is a society that condones dieting and starvation and ignores the enormous risk for girls and women.

One aspect of combatting eating disorders is treatment. That machine exists despite the issues discussed in the prior posts. 

The second aspect is preventative. It is necessary for those knowledgeable about eating disorders to start to speak out about the pressures that continue to foster dieting among girls and increase the risk factors of developing these illnesses.

The founders of residential treatment programs were often charismatic and were in the process of starting the groundswell of support that could buoy a social movement to combat dieting pressures. However, the financial companies that have absorbed these programs have also silenced their leaders.

Girls need to learn and understand the pressures they face and the risks they endure. Dieting is not a rite of passage. It’s a form of subjugation and potentially a cause of life threatening illness.


The Political and Social Biases of Eating Disorder Treatment, Part II

The shift in eating disorder treatment needs to take into account the historical patriarchy of psychiatry. From the earliest days of the psychoanalytic theory, women’s emotions and experiences were marginalized. This trend remains central to the recent history of eating disorder treatment.

The spike in the incidence of eating disorders during the 80’s triggered a response by a handful of psychiatrists to begin hospital-based programs led almost exclusively by men. These revered psychiatrists were known to have created mini-cults of vulnerable, sick women who had nowhere else to turn for treatment.

Largely in response to these treatment models, several women who had recovered from eating disorders themselves began residential programs outside the hospital systems using a new model based largely on addiction treatment.

These strong, outspoken women created a concept for treatment aimed at full recovery, largely taken from their own experiences, rather than the previous approach of maintenance of chronic illness. The programs were for women and run almost exclusively by women. The program philosophy was organized around empowering women to accept themselves and accept the support and love needed to live a full life. Embedded in the idea of recovery was freedom from the tyranny of thinness and beauty society has burdened on women in recent decades.

The downfall of these programs was their success. Seen as potential moneymakers, financial firms run by men bought these programs and have spawned a multitude of new ones throughout country with the aim of making a large profit for their investment. There is still a hint of the old treatment philosophy, but the individualized approach offering true help has morphed into a corporate strategy with much more limited compassion for the people they treat. The ultimate aim is to build a company and sell it at a profit.

As a man in the field, I am hard pressed to insert myself into this dynamic. The current treatment options are no longer aimed at curing the societal ills that essentially create eating disorders. Instead corporate greed has infiltrated the ranks.

The true way to fight these illnesses is to promote a new way for girls to see their bodies through their own eyes, not through the eyes of boys and men. The leaders of the residential programs when they first began were creating a path to teach girls these critical points.

If the health teachers across this country are saddled with this teaching point, there is no way to insert a new message into the heads of the next generation of girls about to suffer from anorexia, bulimia or binge eating.

Educating adults with eating disorders will help recovery but won’t stem this set of psychiatric illnesses aimed to silence women’s voices, emotions and anger. The future needs to cut off the message at its head. When girls are inculcated in this false belief about who they are, the incidence of eating disorders and the cynical corporate machine that profits from it will only continue to grow.


The Political and Social Biases of Eating Disorder Treatment, Part I

Not much has been written about why most people with eating disorders are women. The standard explanation is that the pressure of thinness and dieting is much stronger for girls and women. Since undereating is the number one risk factor for developing an eating disorder, this explanation has some merit. However, it feels like a facile and elusive way to understand a much more complicated situation. 

Psychiatry has often used certain diagnoses to explain women’s emotions. Hysteria, fainting spells and erotic fixation are examples of ways the mental health establishment has attempted to silence and pathologize women’s human reactions, whether emotional or sexual.

The question psychiatry and the eating disorder treatment world needs to address is whether eating disorders represent the newest way to silence women.

First and foremost, I know these illnesses are serious and real, much as the other illnesses I mention above are real. In no way do I doubt the severity of these disorders.

The problem is how psychiatry uses these illnesses to quiet women and explain away valid emotions women express.

For instance, most psychiatrists can compete their entire residency training program learning very little about how to treat people with eating disorders. This is odd considering how prevalent eating disorders are in this country. Accordingly, most eating disorder treatment exists as privatized business outside of the medical establishment and one that very often excludes the treatment of men. In fact, many eating disorder treatment programs openly endorse a feminist slant to their treatment, politicizing the existence of eating disorders. 

Sometimes, as most laypeople assume, eating disorders stem from a desire to look a certain way in order to invite attention to physical appearance. Much more frequently, eating disorders serve as a way to be more invisible either by being very underweight and resemble a young girl or by being overweight and effectively invisible in a fat phobic world.

I have written extensively about the treatment of eating disorders and said multiple times how the core of treatment involves close personal connection and that the antidote to an eating disorder is love.

These facts and treatments are very different from the treatment of any other mental illness such as schizophrenia or bipolar disorder. Clearly, there is a strong social component to this illness, and one aimed specifically at women.

The difficulty with these revelations is how to address them. I’ll write more about this in the next post.


Facing Eating Disorders as True Medical Illnesses

By considering the reality that eating disorders can be fatal, it’s hard for a loved one or clinician to ignore the severity of these illnesses. It’s too easy for people to minimize eating disorders as extreme diets or a passing phase to lose weight, but there is a stark difference between some weight fluctuation and serious medical illness. 

People with eating disorders find that their lives are taken over by the thoughts and behaviors. Attending to work or schoolwork becomes more difficult. Friendships tend to go by the wayside. One’s personality fades in order to accommodate the eating disorder. Any life goals that seemed important don’t matter in the same way anymore.

Someone may get distracted by a diet or weight loss plan for a few weeks and become upset once the period ends, but that person isn’t likely to lose track of everything and everyone that matter in life. The obsessive focus on eating disorder goals is all that is important to a sick person. This singleminded goal combined with the loss of everything relevant to that person are the key distinctions between an eating disorder and a diet.

Once that line is crossed, loved ones and clinicians need to stress the severity of the condition. Without adequate treatment, eating disorders can be chronic, even life-long illnesses, and compromise quality of life and longevity.

Treatment is not a guarantee of health and recovery and tends to take time, but minimizing the illness and avoiding necessary steps to get help can be dangerous. The risks to health and living a full life are great. Stressing this reality can make a difference in the long run.


Mortality and Eating Disorders

Eating disorders are so often misunderstood by laypeople. It’s too easy to chalk up the food behaviors to a desire to lose weight and disregard the severity of the symptoms. 

What’s even harder to comprehend is how these illnesses are not only debilitating but can be lethal.

I focus more often in this blog on the eating disorder behaviors and the psychological component of these disorders. Just as important in managing eating disorders is taking care of the medical complications. 

Purging and laxative abuse can lead to electrolyte abnormalities which cause two serious long term medical issues. The first is an abnormal heart rhythm from a low potassium level which can lead to death. The second is kidney dysfunction and even kidney failure necessitating kidney transplant. 

Starvation can cause poor function in many organ systems: metabolism, temperature regulation, heart function, brain function including cognitive symptoms and emotional dysregulation, bone marrow suppression leading to susceptibility to infection and anemia and the list goes on and on. The true takeaway is that starvation can cause any system to shut down. Whichever part of the body is more vulnerable is the one likely to shut down first. 

And even more central is the hopelessness many people feel when in the throes of an eating disorder. Being so trapped makes many people feel helpless enough to consider or even attempt suicide.

The combination of the myriad medical consequences of eating disorders and suicidal thoughts makes an eating disorder much more than a desire to lose weight. It’s crucial to take these illnesses very seriously and understand how often an eating disorder can take a life.


Two Things to Look for in Eating Disorder Treatment

Even though the prevalence and severity of eating disorders has become clear to clinicians and laypeople, it remains very difficult to find skilled practitioners who can assess these illnesses and find he best course for treatment.

There is no clear license or certificate that proves competence in treating eating disorders, so there is no deterrent for anyone to hang out a shingle as a specialist.

For patients and families, the result is frequently a haphazard search for an able caregiver with multiple ineffective or failed attempts. Anyone would quickly get frustrated and demoralized by the process.

Understanding eating disorders doesn’t just mean being familiar with the physical symptoms and effects of eating disorder behaviors. More important is what people with eating disorders call “getting it:” a crucial understanding of the eating disorder thought process that drives the illness.

Most people with eating disorders light up when a clinician understands these thoughts. It means they won’t feel different and alien. They won’t need to explain every thought and action. They’ll be able to talk freely and know they will be understood and won’t be judged. The result is a truly open forum of conversation.

Understanding the thought process is necessary but not sufficient. The second critical aspect of a clinician is hope for improvement and change. Instilling true hope that there is a path out of the confusion and torture of an eating disorder is a critical step in starting recovery. The hope cannot be hollow but has to reflect real experience and confidence.

Once a patient or family finds both understanding and hope, a therapeutic relationship can have real meaning. It can jumpstart a new path in life and meaningful change.