A Message of Hope for Eating Disorder Recovery

Many of the posts in this blog reflect my concerns about current treatment practices for people with eating disorders. Perhaps, progress in the field is less conspicuous in these reflections.

A wider lens makes clear how far the treatment of eating disorders has come.

Access to care is the most widespread and significant change. The number of treatment centers—and thus the number of providers familiar with eating disorders—has increased dramatically in recent years. In person and virtual care allow anyone in the country to find trained providers. The clinical options used to be a handful of programs run by a few dedicated clinicians and now are too numerous to count.

Similarly, information available about eating disorders comprises of a few books and only a few perspectives. Now the range of sources to learn about eating disorders is vast. It’s almost impossible for someone to feel completely alone with their eating disorder anymore once they started looking for others like them.

With more people vocal about eating disorders, the broadening of social acceptance of all body types has grown as well. The body positivity movement ranges further into our culture than ever in recent years. Even if the pendulum is swinging back at times—now due to the use of GLP-1 medications—progress is still evident.

More treatment also opens the door to new ideas about therapy and recovery. Different ways to approach therapy and recovery give patients many ways to find the right path for them. Treatment is no longer one size fits all.

The burgeoning medical interest in eating disorders, spurred in large part by patients on social media, promises a future with concomitant treatments in addition to therapy. Various medical illnesses connected with eating disorders, elucidated in detail in recent posts over the last few months, are going to provide avenues for recovery for many people in the future.

I wanted to end the year with a message of hope. There are many ways to seek help and recover from an eating disorder, more than ever before. It’s ok to be picky and find the treatment that fits. Once that happens, hard work and commitment will help many people find peace and well-being in the recovery from their eating disorder.

A Philosophy of Treatment for Chronic Anorexia Nervosa

Treating chronic restrictive anorexia remains difficult and greatly unchanged in recent decades. Other eating disorders morph over years of an illness into new iterations of symptoms with varying types of treatment and leading to more successful outcomes. Chronic anorexia seems like a different illness altogether.

The disorder only really has one symptom: severe food restriction. These people continue to restrict over many years and decades. For some people, the long period of being malnourished leads to extreme hunger that takes over and leads to binging or eating/purging over time. A small percentage of these patients—the ones I’m talking about—only restrict and can’t stop no matter the severity of the medical illness and even when faced with imminent death.

There is no sense of vanity about weight or size but simply an inability to overcome the thoughts to restrict which function more like commands than how one perceives typical daily thoughts. The thoughts are to be obeyed.

Over the years, numerous studies focused on a wide variety of medications and treatments without benefit. Doctors have studied procedures as well such as Transcranial Magnetic Stimulation and ketamine infusions alone others. Nothing works.

Recently, links between this type of Anorexia and Autism, PTSD, ADHD, mast cell activation syndrome and metabolic disorders have been suggested. There is no research yet definitively connecting any of these disorders and no treatment options known to be helpful. However, new ideas about restrictive anorexia have spawned theories about the underlying causes and possible treatments.

My approach with people with this type of chronic anorexia is to create highly individualized treatment plans. The plan is to work with a team of clinicians who are right for this person, address any medical issues that come from chronic anorexia, clarify goals and above all create treatment based on medical knowledge, understanding, kindness and compassion.

A plan that incorporates all these facets ensures that the progress is appropriate for each person and focuses on the needs and goals of each individual. No plan can prioritize other ideas such as legal protection for the clinicians, the punitive approach of residential treatment or unrealistic goals. The purpose of treatment needs to center on the person’s life and well-being.

The approach to help people with restrictive chronic anorexia is different from other eating disorders. I suspect one day there will be a clearer medical explanation for this illness and new types of treatment. However, there is enough knowledge now to often help these patients get a lot better.

Eating Disorders Are Not (And Have Never Been) About The Food

Recent blog posts reflected on the receding body positive movement, the collective idealization of thinness and the promised land of medications that will fix all our problems. As too many of us flock like moths to the fire, we forget there is no magic cure to our food and body woes. The myriad reasons weight loss, food obsession and eating disorder behaviors run so rampant in our society won’t change with one miracle.

The most common and powerful adage in eating disorder treatment is that it’s not about the food. The onset and diagnosis of eating disorders start with behaviors, weight and health. Long after these symptoms normalize, the underlying cause for the eating disorder emerges.

There is no question that normalizing eating and nourishing one’s body consistently is a foundation of treatment; however, eating disorders stem from emotional, existential and psychological struggles. Pretending otherwise only ensures lifelong discomfort and unhappiness.

We are all susceptible to the cultural pressures for thinness, but not everyone develops an eating disorder. Some people have a genetic predisposition. The large majority have psychological and emotional underpinnings—elucidated at length in this blog—that transform disordered eating into an eating disorder.

The marketing of magic drugs to turn off food noise conveniently avoids and ignores the emotional needs for people with eating disorders. Since regulating food and weight through recovery never leads to truly getting well, medications won’t be any more effective. The cynical conclusion is that eating disorders and disordered eating are just about the weight and food. Feelings will be ignored at our own peril.

The result is likely to be a strong and prolonged backlash of weight gain and compensatory eating after the medication-induced food restriction. As more people need to go off medications due to side effects, rapid weight gain and the flooding with old feelings are going to affect many more people in severe ways.

The solution is not to lose track of emotional needs or allow the thinness obsession to obscure deeper meaning in life. No drugs will really affect our need to be human and attend to our emotional selves.

The Paradox of Having Too Many Treatment Programs

Ten years ago, I was still writing about the lack of treatment programs available and how damaging this void was for people with eating disorders. Now, the opposite is true. There are so many programs, it’s hard to keep track.

No longer are people languishing at home desperate for more help. The broader issue now is that there are so many spots available in these programs that treatment is an easy decision for an outpatient provider or patient to choose.

A clinician needs to assess the pros and cons for each person to go into residential treatment. When someone is struggling and battling the internal struggle with the eating disorder thoughts, a program is not always the best option. Treatment or not, each person who is in recovery will have long periods of battling these thoughts and trying to move forward. Every moment of struggle doesn’t merit a treatment program.

Working with someone through the recovery process means tolerating the difficulty of progress and struggle. Of course, the patient bears the burden, but clinicians also need to tolerate difficult periods and allow the person their own struggle. Jumping to treatment ultimately shows a lack of trust and confidence, not always a sign of caring.

For some people, programs don’t really help. The outcome might be temporary improvement in medical symptoms but no change in the psychological part of the eating disorder. It’s just as important to realize that some people need outpatient treatment even while they struggle because that’s the way they can get better. The alternative of available programs doesn’t mean residential treatment is the right answer for everyone.

The explosion of programs has greatly improved access to care which was a significant barrier to recovery in the past. Clinicians who treat people with eating disorders are thankful for the change. Now, the provider also needs to weigh when treatment is appropriate and be sure to consider what is best for each person.

Relying on a program when things get hard in therapy isn’t always right either. Recovery is hard, looks different for everyone. The best definition I have for recovery is being able to live a life not dominated by the eating disorder.

Recovery is not the promised land of happiness. It means living your life with minimal impact of the eating disorder. Treatment is a part of the process but not a panacea.