Eating Disorder Treatment Reimagined: Proper Diagnosis and Treatment of All Associated Illnesses

Eating disorders primarily are seen as psychiatric disorders in the medical system. Even though much of the treatment focuses on stabilization of food and health, which are necessary components of treatment, the success of long-term treatment rests in the hands of mental health clinicians.

There are a number of factors which led to this clinical decision: the lack of knowledge about the biological causes of eating disorders, the social construct and expectations around food and weight and the cultural dynamic of thinness which handcuffs women.

Reservoirs of health insurance money engendered a recent takeover of the eating disorder treatment field by private equity companies. Accordingly, the system is even more organized around ineffective mental health treatment and less about healing and getting well. Any progress integrating medical and mental health treatment is not a priority at the moment.

Years of experience treating people, primarily women, with eating disorders revealed to me that there are a host of misunderstood, complex illnesses for many people with chronic eating disorders.

The cohort of patients who typically fall into eating disorder symptoms without much volition and stay very sick often don’t benefit from current eating disorder treatment. It may very well be that these people are treated for a psychiatric disorder when the primary issue also includes an underlying medical problem that is not addressed.

In recent posts, I have written about EDS, MCAS and other disorders that appear to be linked with eating disorders. These illnesses are some of the medical struggles people with eating disorders face without any diagnosis or treatment from doctors. People with chronic eating disorders also can have hormonal disorders, swallowing disorders, neurological disorders and many other issues. Rarely are the medical issues treated. Instead, doctors blame all physical symptoms on the eating disorder, and thus on the patient, for not getting better.

What needs to be considered for people with chronic eating disorders is to include medical screening in a comprehensive treatment plan for these patients.

Outpatient treatment with therapy and nutrition counseling is critical for recovery. Food stabilization and therapeutic work around learning how to live without the eating disorder remain essential to get well.

However, too many people stay sick, and providers tend to give up in one way or another so these patients only blame themselves for their illness and become hopeless. These outcomes are inexcusable.

Doctors need to be more involved in all elements of eating disorder treatment for these patients to get well, and the field needs to consider all other medical illnesses and incorporate a wider net of diagnosis and treatment to help more people truly get well.