People with Eating Disorders Need to be Heard to get Better

If inpatient and residential treatment can be traumatizing, family based therapy doesn’t work for people 18 and over and people with eating disorders are trapped by the power of the thoughts of the illness, what are the other paths forward towards recovery?

The urgency for families and practitioners to do something, to have a concrete plan, is overpowering despite the evidence that these steps are unlikely to work after the first couple of tries. Even after many failed attempts at the options mentioned above, families and clinicians will often repeat the same plan futilely.

Increasingly, the focus of treatment is on meal plans and maintaining a symptom-free period of time at a determined weight as a magic cure. The evidence does show that remaining at a target weight long enough improves the chance of recovery. However, eating disorder thoughts often remain so strong at these weights that relapse is a common result. When this plan does not work, the patient is blamed.

Our culture tends to focus on the latest shiny object on social media and that is no doubt the case for eating disorder treatment. More and more, patients find their information about recovery on TikTok, but we have forgotten how much older information about treating eating disorders remains as useful as ever. Many of the lessons learned about eating disorder treatment in the past are fading into history.

Young people with eating disorders are often used to not being heard or seen. The eating disorder tends to be the only mode of expression younger people find effective after years of being seen as their illness rather than a real person. Expecting family and clinicians to ignore their thoughts and feelings as “just an expression of the eating disorder,” people in this situation express their frustration through even more severe symptoms until relapse feels like their only mode of being in this world.

A tried and true element of treating younger people with eating disorders is to listen to what this person is expressing through their illness and what they have to say. They feel so trapped and don’t expect anyone to care or listen to them. The isolation of being seen only as their illness leaves them no recourse to say how they feel. Really listening to their concerns can open a new path towards healing.

With treatment as an easy decision for clinicians, recovery often starts with ignoring what patients have to say. Before long, they have gone through a variety of outpatient programs and inpatient programs aimed at weight restoration only. Patients learn that the only way to be heard is through symptoms and behaviors. They learn there is no point in being honest because honesty is labeled as “the eating disorder talking.”

It would behoove families and clinicians alike to remember that people only get better from eating disorders when they are heard. Of course, food and health matter, but they are never enough to get better.