The Challenges of Medical Treatment for People with Eating Disorders

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. 

Bridging Two Worlds: A Path Between the World of an Eating Disorder and Freedom

Living in the shadow of an eating disorder is a very foreign place. The laws that govern that world, the ways decisions are made and the natural flow of events and relationships are all very different from the world everyone else populates.

But this fact is not clear to people with eating disorders, often for a long time in recovery and for a very specific reason. The combination of self-awareness and our limitations of empathy make humans preternaturally self-absorbed beings. Thus, we humans have a natural tendency to see our own perspective as reflective of everyone's view of life. Although this is clearly false, it's hard to remember that in day-to-day life. 

After living with an eating disorder for some time, it similarly becomes hard to remember that most people don't live by the rules of this illness. Freedom to choose their food is a basic fact of life for everyone else. 

The realization that life without an eating disorder means entering an entirely new world is often shocking for people in recovery. It takes time to understand that entering this new world comes with a host of new rules, most of which do not revolve around food. An eating disorder creates a very rigid system of decision making in life that limits many aspects of what everyone else sees as relatively free: food, friendships, relationships, emotions, self-care and self-determination. Eating disorders restrict not just food but life. 

That restriction is terribly limiting but also provides security from the overwhelmingly unpredictable and seemingly dangerous world. People typically find that they don't have the personal skills to function in the world without the eating disorder clearly directing the way. After the shock of this discovery, there is a moment of panic followed by a steep learning curve about life. 

Although many people use this sensibility to describe an eating disorder as a lifestyle choice, this seems largely misguided. It appears to be better described as a crutch. The eating disorder may make navigating life a bit easier on the surface, but it severely curtails possibility and opportunity to grow, connect and love, essential qualities that makes life full and whole. 

What sparks the opening of a window into the world without an eating disorder is almost invariably a strong, personal connection. The eating disorder blinds the person from seeing and believing that real connection can provide solace from life's challenges and meaning to daily life. The inherent isolation leads people to present the world a shell of who they are. The jolt of a connection typically allows people to remember past experiences of connection and trigger the universal yearning to be understood and heard. 

But here lies the paradox. It's so hard to be truly heard while living in a foreign land. It feels almost impossible to explain what it's like to live dominated by the eating disorder to someone who's never visited this strange place. Once that person in recovery begins to understand the world without an eating disorder, it becomes easier to explain the hell of the world of the eating disorder. The opportunities to connect with others are revealed, and a path to freedom opens.