Respect and Autonomy Help Avoid Treatment Trauma

The evolution of eating disorder treatment began with adolescent girls with Anorexia Nervosa starting in the 70’s through the early 80’s. The field was new and the symptoms and course of illness confusing. Clinicians were not sure how to approach children in severe medical and psychiatric distress because they were unable to eat. However, the initial population needed to be treated as children because they were for the most part young, very ill and severely impaired by starvation.

Treatment programs in hospitals and later residential programs designed clinical approaches with this population in mind. Systems included a reward/punishment model based on good behavior, chaperoned bathroom visits and passes for any trips outside the program’s designated space.

It was possible to justify these guidelines because the majority of patients were young, but the larger problem is that programs have not substantially changed their thought process despite the much broader set of patients now seeking care. The varied eating disorders encompass many more types of symptoms, and the patient population spans a much larger age range.

At this point, patients often avoid treatment programs because they know the approach is not meant for people like them.

Infantilizing patients sends many troubling messages. Patients feel responsible for and ashamed of their illness. It’s impossible to equate eating disorders with other illnesses using this treatment approach. And people struggle to trust clinicians who blame everything on the eating disorder and don’t respect or value the people themselves who are struggling.

Eating disorder recovery needs to be a collaborative process. Certainly, patients need to learn about their disorder, how the thoughts and symptoms work in tandem and why the symptoms are so hard to overcome. At the same time, clinicians and programs need to respect the autonomy and maturity of their patients. People with eating disorders are real valuable people who need to hear that message from any program from the very start of treatment.

The double-barreled destructiveness of a program treating people like children and not showing respect is hard to overcome. The message is to not trust themselves or clinicians. How can this message lead to recovery and health?

Any program must pay attention both to the immediate welfare of anybody entering their program and chart a reasonable course towards true recovery. Treating people like children who can’t be trusted frankly does the opposite and potentially opens the door to traumatic experiences which only makes the eating disorder more entrenched. Trust, respect and autonomy are the bedrock of starting any eating disorder treatment in any setting.