Does an Eating Disorder Diagnosis Mean Losing Your Humanity?

What happens if someone with an eating disorder chooses to live their life with disordered symptoms? What if they either don’t want to get better or don’t want to go through the painful, and often harmful, treatment process?

Some doctors call this harm reduction or palliative care. Others call it unethical. Which description is appropriate?

Thus far, there isn’t much appetite to talk about these options in treatment. Providers are typically closed minded and even self-protective when it comes to looking into different ways to approach long-term care.

Patients are presented with a standard approach for care which includes therapy, nutrition counseling, psychopharmacology and a primary care doctor. If symptoms are severe, the team will consider higher levels of care: outpatient programs, residential treatment or hospitalization. If patients refuse more care, most practitioners will refuse to continue treatment, ostensibly for the sake of the patient, but largely to avoid liability.

Many of these patients with long treatment histories have either experienced harm in treatment settings or don’t want to comply with the indignities of being locked up in a mental facility. They are entitled to make that choice and still receive more help if they so desire.

Instead, patients who choose not to go to a higher level of care often are abandoned by their support and made to believe their decision is influenced by the “eating disorder thoughts.” In other words, they are not entitled to make a personal decision without blame and shame for making the “wrong” decision. Somehow, the diagnosis of an eating disorder also means losing one’s autonomy.

Why does this psychiatric diagnosis also justify losing independence and the basic human right to choose your destiny?

In my experience, many people with eating disorders are exquisitely attuned to other people, can see emotional and non-verbal cues acutely and accordingly make clear decisions. Other people may not agree with their decisions around their eating disorder but also don’t often try to understand how those decisions might make sense for each individual.

There are other forces connected to eating disorder treatment that seem to be more powerful than simply helping a set of people get better. Financial gain by private equity companies is the best example of exploitation. As I have written many times in this blog, eating disorders are one in a long line of mental illnesses used to justify disempowering a population.

For a country obsessed with weight and thinness, there appears to be some unconscious need to force a group of people to eat large amounts of food against their will while so many other people are lauded for undereating, primed even more by the GLP-1’s.

Only privileged populations are allowed to restrict their food or take medications to lose weight. Others are instead diagnosed with a mental illness and punished accordingly.

Who determines which category we fall into? How can this hypocrisy go unnoticed in our country for decades at this point?

I consider the answers to these questions and more in the coming posts.