There are pluses and minuses to classifying eating disorders as psychiatric diseases. Although the mental component is clear, managing an eating disorder is primarily a medical issue. The longstanding effects of starvation, binging, purging and other compensatory behaviors like laxative abuse or excessive exercise lead to a host of chronic medical conditions that need regular attention to limit the damage of an eating disorder. The confusion around classification is palpable, and too often the medical consequences of these illnesses remain inadequately treated.
The central psychological aspect of an eating disorder is an aberration in determining hunger and fullness leading to very erratic eating patterns that follow arbitrary rules instead of the body's needs. The thought processes that underlie the illness can range from the fear of gaining weight and self-loathing to seeing food as terrifying, unnecessary or harmful. These thoughts generally follow the initial change in behaviors around food and become fixed as the behaviors become more fully established. Once these new patterns are set, they become the new norm and exceedingly difficult to change.
While treatment focuses on the therapeutic attempts to alter the eating disorder patterns, the person endures long stretches of starvation or traumatic events such as binging, purging or laxative use. The emotional and psychological effects of these behaviors biologically reinforce the eating disorder patterns. Starving begets more starving as the eating disorder behaviors are reinforced when the body's metabolism adjusts to the lack of food, binging more binging as compulsive behaviors create a cycle of thoughts and actions.
More importantly, months or years of these behaviors cause significant damage to the body that require medical attention. During the difficult period of recovery, management of these medical issues is critical for long term health and increases the likelihood of full recovery.
There is a basic fact about medical treatment for people with eating disorders: medical training does not equip physicians with the information needed to treat these illnesses. Teaching the medical management of starvation comes up in only two circumstances: distant poor countries and end-stage cancer.
Chronic starvation in the western world is largely considered impossible while obesity instead catches medical interest. Binging, purging, laxative abuse and other eating disorder behaviors are not at all a part of medical training. In fact, all of these behaviors, rather than being seen as symptoms of an illness, are instead considered personal choices of the patient. The effect is to blame the patient and ignore the medical consequences. Adequate treatment is far from a reality for most people with eating disorders.
Viewing eating disorders as a medical illness would increase the likelihood that doctors learn how to treat the medical consequences of these illnesses. Too often doctors overlook serious medical issues for these patients and instead reinforce two concepts: they are healthy and they just need to choose to eat. These two messages only make patients less likely to continue their path to recovery. The real question is how to educate physicians about diagnosis and treatment of the medical effects of eating disorders.