Current Anti-feminist Trends in Eating Disorder Treatment

Culturally eating disorders aren’t only mental illnesses. They represent the newest expression of suffering and oppression women experience in our society.

These illnesses are borne out of the relentless pressure for women to be thin in order to be attractive, to be employed and to be heard. Eating disorders can be seen as an expression of protest against this oppression but then become a prison of their own accord.

Over time the direction of eating disorder treatment and the cultural response to the imperative to be thin leaned into feminism and freedom.

The second generation of eating disorder treatment programs were founded and created by powerful women in recovery who themselves became the focal point of change and hope. They created worlds aimed at feeling one’s own autonomy and agency. They structured recovery around a community of women valuing friendship, connection and love, not a show of eating to prove to men how they can follow the rules.

In the decade after, the body positivity movement encouraged women to appreciate and respect their own shapes and sizes. The power of this new message stretched even to celebrities and clothing’s stores.

However, both of these steps to empower and liberate came crashing down.

Private equity bought most of the treatment programs and transformed them into money making ventures run primarily by less experienced clinicians cynically aimed at exploiting young women and insurance benefits.

Ozempic and the other GLP-1 agonists, in addition to the newer, stronger medication on the way next year, drew in women by promising a magical way to be thin. The body positivity voices have been drowned out by the lure of the weekly injection and by the unsubstantiated claims of doctors that losing weight is the key to good health.

It’s hard to watch these capitalist changes in recent years and not conclude that market forces benefit from keeping women enslaved to the goal of thinness. An empowered society of women immune to external pressures about appearance doesn’t benefit the financial goals of a male-oriented business culture.

This depressing fact does prove that the epidemic of eating disorders won’t improve without a strong feminist base to recovery. Women need to collectively remember that the pressure for thinness and the scourge of eating disorders are never in their best interest. Recovery, for the individual and the collective, begins with education, autonomy and inevitably the power to stand tall.

Eating Disorder Recovery is Grounded in Connection

The last few posts outlined new directions for eating disorder diagnosis and treatment. Conversations between people with eating disorders and the openness and ease of communication using social media open doors to new links between eating disorders and other illnesses and new treatment ideas as well.

However, it bears repeating that the psychological underpinnings of eating disorders are the most important reasons people have so much difficulty getting well.

The various emotional effects of both eating disorder behaviors and thoughts are incredibly powerful and keep people entrenched in their disorder.

Eating disorders can create excitement and also numb feelings; they can cause calming structure or deliberate chaos; they can offer clear moral guidelines for life or offer a lofty but ultimately unattainable goal.

In the end, eating disorders offer a solution to the challenges of connection in our lives. The connection with the eating disorder supplants connection with ourselves, other people, our emotions and our body. The eating disorder stops people from connecting in a true and deep way with others.

Any successful treatment needs to include learning how to connect with oneself and with others as a fundamental antidote to the allure of the eating disorder. Most people with eating disorders have had limited connection in one or all of these forms, and treatment helps them learn about the fundamental human need for connection and how to find it.

Typically, learning about connection starts in therapy. That experience is in part didactic but often it is also experiential through learning about connection through the safe and boundaried relationship in the therapy. The therapist creates a space that is safe, warm, open and validating. There needs to be room for all sorts of experiences and feelings in therapy so the person can learn to be open and accepting of their own emotional experiences and needs.

With these newfound ideas about self-worth, feelings and connection, people with eating disorders can conceive of a world less reliant on the eating disorder to satisfy those emotions.

So even though a broader idea of diagnosis will benefit many people with eating disorders, any recovery has to include profound learning about emotions and connection.

The Generator of Progress in Eating Disorder Care: Social Media

Progress in diagnosis and treatment in psychiatry historically relies on the experience and knowledge of clinicians who use their time with patients, educate themselves about new treatment ideas and collaborate with colleagues to further the field and hopefully improve overall clinical care.

Social media opens a new door to how the field progresses. Patients themselves express original ideas based on their lived experience and communicate with each other to find ways to assess and even consider new treatment for their condition. And this new path is starting to affect progress in psychiatry.

One result is to connect other medical and psychiatric illnesses to eating disorders, as I wrote about in the last two posts. People are communicating with other patients about these connections and bringing to light new ways to conceive of eating disorders.

The medical establishment, however, has not yet caught up with the findings. Clinical work remains fixed in older ways to treat eating disorders. Accordingly, patients come to treatment with new ideas about the individual symptoms and possible treatment for their own eating disorders and then try to find clinicians willing to work with them.

Social media has changed the way psychiatry is going to treat patients with eating disorders. The more difficult the disorders are to treat, the more patients are likely to look into alternative options and shop for doctors open to these new ideas.

So clinicians need to take these new concepts into account. Moreover, comprehensive assessment of eating disorders, including concomitant psychiatric and medical conditions, is imperative.

Patients will find other ways to get the help they need by cobbling together doctors who will do separate assessments and then find their own individual way to try to get well. The more clinicians band together to create a better way to assess eating disorders, the less patients will feel compelled to try to piece together their own treatment.

Treatment is no longer clinicians diagnosing and making treatment plans. The process of eating disorder treatment needs to be collaborative.

The Need for Inclusive Eating Disorder Treatment

Typically eating disorders are treated as psychological illnesses. A doctor manages any medical symptoms, lab abnormalities and medications, but the primary work in recovery is mental and emotional in nature. The root cause of an eating disorder is almost always seen as a mental health issue.

For many people with eating disorders, this paradigm is accurate. Separation and individuation from an enmeshed parent relationship, numbing of emotions from traumatic experiences and the strong desire to avoid adulthood are still common initial events that lead to an eating disorder. Treatment still needs to encompass these clinical situations.

However, more correlative data links eating disorders with other medical and psychiatric disorders—a connection elucidated in the last post. Treating these concomitant, if not perhaps causative, illnesses falls outside the purview of typical eating disorder treatment.

For instance, chronic inflammatory illnesses such as MCAS or general autoimmune symptoms may be alleviated through eating disorder symptoms. The same may be true for people with chronic metabolic issues. If these patients recover from their eating disorder, the medical symptoms return and often worsen; thus, recovery needs to address these other medical issues to allow people to recover and manage these other illnesses too.

Similarly, eating disorder symptoms may help mitigate some psychiatric symptoms for people with untreated ADHD or undiagnosed autism. Eating disorder recovery that doesn’t address these other disorders won’t be helpful for true recovery.

Eating disorder treatment not only needs to screen for other connected medical or psychiatric illnesses but also needs to incorporate a more complete approach to allow for full recovery.

The standard psychiatric treatment screens out many people with other comorbid medical or psychiatric illnesses when the approach needs to be more inclusive. These other patients deserve more complete treatment too.