New Directions for the Medical Treatment of Eating Disorders

There is a sweeping change coming to eating disorder treatment in the near future. The connection between the onset and severity of eating disorders and an assortment of vaguely defined illnesses is likely to play a role in early diagnosis and care for people with eating disorders, especially anorexia. If there is enough interest in the medical field, these new changes may profoundly change the scope of eating disorder treatment from purely psychological to a combination of medical and psychological conditions.

Some patients with eating disorders respond quickly to standard eating disorder treatment. Many of these patients seek treatment early, more often exhibit binging and purging symptoms and have thoughts mostly focused on weight before seeking any treatment. Regulation of meals, education about diet culture and prioritization of health and well being, all central to standard treatment, can right the course fairly quickly.

These patients are a substantial population of the people getting help for an eating disorder, but they are not even the majority.

A large percentage of people have intractable symptoms not focused on food and weight which are the core factors in their eating disorder. In addition, they often develop symptoms for a multitude of other reasons unrelated to diet culture and have unexplained and often ignored medical symptoms that are deemed unrelated.

As I have written about in this blog recently, a host of other medical illnesses appear to have some connection to eating disorders, especially anorexia. The most common ones are Ehlers Danlos syndrome, mast cell activation syndrome and general inflammatory/autoimmune symptoms. The first is a genetic variant which leads to looser connective tissue, the second a varied illness with multi-organ effects and the third consists of chronic pain and discomfort. They are minimally researched, and the medical establishment shows little interest.

A final common diagnosis connected with the above is hypersensitivity, a vague title meant to indicate acute sensitivity to sensory input and emotional input. The symptoms of this condition play a role in the extreme difficulty and pain some people experience upon eating, but there is even less information about this condition.

These four together don’t generate much interest from the medical community yet impair the lives of so many women and are strongly linked to eating disorders.

Many medication treatments are now options for people with these symptoms: low dose naltrexone (an anti-inflammatory), many mast cell medications such as Cromolyn, cetrizine and famotidine and even very low dose GLP-1’s being studied for severe anorexia.

The progress in diagnosis and treatment thus far is nonexistent, but some providers have begun to look for new ways to approach chronic eating disorders.

I hope we clinicians look back at the blame I wrote about in the last few posts as a sign of ignorance and instead begin to show interest in some of the underlying medical issues related to eating disorders. Current eating disorder treatment guidelines help some people, but we need better options for a large number of people seeking help.