Why is it so Hard to Find Competent Treatment for Eating Disorders

It is notoriously difficult for people with eating disorders or for their families to find competent help in the mental health field. Despite the increasing incidence of eating disorders, the most frequent complaint I hear is how difficult it is to navigate the eating disorder treatment world.

People frequently say they have seen treatment providers who purport they know how to treat eating disorders and then turn out to have minimal experience. Over and over again, they report the ignorant things professionals have said about eating disorders. This frustration often leads to giving up and a sense that there is no real help to be found.

Even when I cannot see someone, I will try to provide connections to the eating disorder treatment world in New York. Similarly, people contact me from all over the country, and even in other countries, with the same complaint seeking any kind of guidance.

It’s confusing how a set of disorders so prevalent have such limited infrastructure in the mental health community.

There are a number of reasons for this discrepancy. First, the training programs to teach clinicians how to treat people with eating disorders are very limited and completely unregulated. The programs vary from analytic programs, short-term certificates and informal training at residential programs. All these training areas focus on their own way of treating eating disorders but don’t coordinate to teach an overview of treatment and basic knowledge about these illnesses.

Accordingly, there is no formal accreditation for clinicians to attain and advertise. Instead, any experience helping with eating disorders will do, and clinicians can say they have experience treating people with eating disorders even if that’s not true.

Similarly, most academic medical centers have limited treatment and knowledge of eating disorders as well. Instead, the mainstay of treatment is residential centers which are for profit private companies and have no motive to consider treatment and wellness as their ultimate goal. Although these programs can be beneficial, they don’t help codify a basic knowledge for clinicians in the community and don’t encourage research into best practices.

Three more social components of eating disorders make them very different from other illnesses in psychiatry. First, eating disorders are relatively new and there is a short track record for understanding and treating them. Second, treatment is difficult and frequently long-lasting, something anathema to the current mental health world. Third, these illnesses have a central medical component typically not part of psychiatric treatment. These three differences appear to have made it less desirable for the medical community to prioritize treatment for these illnesses.

The lack of formal training for and complex social aspects of eating disorders have created a void in competent eating disorder treatment. The real question is how to recognize this public health crisis (outlined in the last post) and begin to change the treatment landscape to make good treatment easier to find.