Overcoming Judgment and Bias from Eating Disorder Clinicians

When people struggling with eating disorders seek help, they often feel like they are not really seen. Clinicians react so strongly to the disorder itself, they forget to see the actual person.

The focus on body, weight or health overrides the true person who sits in front of the practitioner. This is a human being seeking help for their own personal struggle. First and foremost, they deserve to be treated as an individual who was brave enough to show up for an appointment.

The problem is that eating disorders engender very strong reactions from clinicians or doctors.

Anorexia draws fear from almost all practitioners that this person may get very sick or even die. So almost every response translates into the fact that it’s time to go to a residential program or hospital.

Bulimia similarly brings out fear but also disgust. It can be hard for clinicians not to judge people with this illness and struggle to take the important step to see how and why this person is suffering so much.

Binging or compulsive overeating immediately leads to the inherent fatphobia in our society. Rather than work to understand the reason for the eating behaviors, treatment focuses on weight and potential health risks when many of these risks are fabricated by the medical establishment and diet industry.

Some of these concerns are real. Consistent starvation will lead to significant medical risks. Bulimia has medical risks as well. Binging causes enormous distress.

However, any doctor or clinician needs to temper those immediate concerns. The person who seeks help is searching for answers as well. They are aware that the psychological and physical manifestations of the eating disorder affect their lives. That’s why they came for support in the first place.

Any eating disorder clinician needs to see a patient as a person first. They need to understand the root for the behaviors and thoughts and establish a relationship with this actual person. That means putting away the biases around body, weight and food behaviors in order to establish a therapeutic relationship built on trust.

Any improvement in eating or health is important, but in the end these changes are meaningless unless they come from a foundation of emotional understanding and change. The eating disorder clinical world can embrace compassion over judgment, kindness over bias in order to help people start a path to health and recovery.

Disordered Thinking in Anorexia: the Most Concerning Symptom

A complicated aspect of anorexia is the underlying belief early in the illness that one is not truly sick.

Disordered thinking is a psychiatric term that means one’s brain cannot follow facts logically and cannot process information correctly. In other illnesses, examples of disordered thinking are paranoid thoughts, an inability to make sense and delusions (a fixed false belief) about the world.

Some eating disorder symptoms begin to appear somewhat disordered but never represent overall disordered thinking, such as body image distortion or wildly overestimating the calories of food.

However, severe anorexia does have one thought process that appears disordered. In some of the worst cases of anorexia, people don’t believe they are truly sick. Sometimes people who are clearly underweight can’t see it. Others who are eating very little food in a day believe their body doesn’t need more. In the worst case scenario, people with significant medical problems from their illness cannot believe they are truly sick. These people may be shown irrefutable evidence of their illness and simply do not believe it.

The disordered thought process in anorexia is important for another reason. These cases are the most severe and have a likely chance of chronic illness and early death.

Tackling and challenging this thought process is imperative. In less severe cases, the standard treatment is nourishment and restoration of health because some issues with brain function reverse with food. In the most severe cases, food doesn’t change the underlying thoughts and may reinforce them because any weight gain only solidifies the disordered thoughts.

For these patients, it’s critical to have therapy focus on questioning these thoughts. The goals are to present the case for why the anorexia is severe over and over again. The disordered thoughts give the patient relief since they justify the need to restrict. Instead therapy needs to make the person question these thoughts each day. The risk of the disordered thoughts is that they become an undeniable truth. If that is too solidified, the chance of recovery goes down significantly.

It’s necessary for the person to know that this battle between disordered, untrue thoughts and the unpleasant reality needs to be the crux of treatment. Without a clear sense of the truth, all therapy will seem meaningless and the anorexia will take over completely.

Starting Treatment for an Eating Disorder during the Pandemic

For many people, the pandemic can be a reason to delay starting treatment for an eating disorder. Virtual treatment is not a valid justification to allow an eating disorder to continue to dominate your life.

Eating disorders rule one’s life and make it so difficult to forge a path. The eating disorder thoughts and behaviors can take up more and more time each day. The lack of structure for many people during this time allows the eating disorder even more footing, especially if that person is not in treatment.

As I described in the last post, virtual therapy is very effective and may even have some benefits for people starting eating disorder treatment. The main positive aspect is around body image thoughts. Not being in a room with a new therapist is easier than feeling physically exposed by being face to face.

The time and lack of structure actually give recovery a lot more room to try to make a dent in the disorder. Logging food is more possible. Connecting in between sessions, writing about emotional reactions to food and changing meal plans all can happen now without distraction.

In addition, it’s easier to meet with a few people in order to find the right therapist, another critical part of determining the best path to move forward.

Last virtual therapy can allow for a true bond to form to fight the eating disorder just as much as in person therapy. Any step into recovery matters. In times like these, the illness can take over more or it can galvanize a person to put their all into changing their life.

The Pros for Virtual Therapy for an Eating Disorder

Virtual therapy by video or phone is the current new norm and has been a part of my practice for many years, although never the exclusive form of treatment until now.

Traditional psychotherapy always valued the therapist and patient in a private, safe room together. This framework has been considered essential to effective work.

There is truth to this therapeutic axiom, but eating disorder treatment has different needs that can be well suited to virtual therapy. Two specific and important components of eating disorder treatment come to mind.

First, a critical part of eating disorder therapy is distorted body image. Typically, therapists who treat people with eating disorders have pillows or blankets available for people to cover their body during the session. Seeing one’s body can be upsetting and distracting during the session, so covering up can actually make the session more productive.

Virtual therapy obviated the need for a pillow or blanket. Phone or video takes away the experience of being seen by the therapist and immediately focuses on the work at hand rather than a need to cover up in order to feel comfortable.

With the physical body image less central to the treatment in a virtual format, it can be easier to dive into important work more quickly. However, at the end of the session, deeper work leaves the patient feeling more exposed and vulnerable.

Many people in the therapist’s office might subconsciously begin to pull back from this work towards the end of a session since they know they will leave soon and have to face the world again.

In a virtual session, they are already in a safe space. So if the session ends at an emotional or vulnerable place, they will be somewhere that allows them time to regroup before restarting their day.

The virtual sessions take away two significant obstacles for effective treatment: the physical self and the act of going back into the world after the session.

Although the in person sessions provide a sense of safety together in the office, these two benefits from virtual sessions often lead to very effective treatment as well.