One Key Limitation to Expanded Eating Disorder Care

Eating disorder treatment and recovery isn’t just about mind over matter. Access to so many types of clinical care, in person and online, doesn’t change the intractability of an eating disorder—illnesses that are physiological as well as emotional.

The psychological draw of an eating disorder can be powerful in many ways, for example the emotional numbing through the release from overeating/binging or the protection from traumatic symptoms via restriction. Over time, the repeated disordered eating behaviors can engender a physiological response in the body’s gastrointestinal system which adapts to the new disordered eating. Once their bodies get used to this new pattern, people have a much harder time escaping the entrenched behaviors.

Many people use food in emotional ways, but not everyone is wired so that the initial manipulation of food becomes a full-fledged eating disorder. For some normal eating returns, and for others the behaviors lead to an eating disorder.

Any treatment needs to take into account the necessary steps to normalize food, track the healing and regulation of various organ systems and engage the resiliency of the gastrointestinal system both for digestion and for hunger/fullness. The physical healing almost always precedes the emotional healing. The body needs to function first for the mind to follow.

Most of the newer support systems focus on the emotional and psychological healing. In many ways these programs are modeled on the older, more established network of treatments available for substance abuse. The treatments are very educational; patients and families alike are much more informed about eating disorders than ever before. But the programs need to include the medical aspect of eating disorder recovery as well.

Without the focus on physical healing, the risk in treatment is for many people to make emotional strides and remain physically sick, unable to make consistent progress with normal eating and gastrointestinal function.

Treatment programs help to a point, but too many people experience programs as intrusive, as if people have to endure forced eating which they can reverse once discharged back into their lives. All the more recent chatter about weight loss drugs and surgeries in recent years only reinforces the glorification of thinness.

Expanded access to treatment has greatly improved the education about necessary emotional and psychological strides for recovery. These illnesses are known to be intractable for a reason, and the entrenched physiological effects are a major cause. It’s the job of any clinician to recognize this fact and be sure to include physical and psychological needs in any treatment.