The Ongoing Need to Eradicate Blame from Eating Disorder Treatment

In recent decades, eating disorder treatment opened up access to care and improved the initial diagnosis by primary care doctors and pediatricians. Awareness has clearly increased, and doctors who see people with an eating disorders have resources for referrals. That’s a great improvement.

What has not changed is the overall mindset and morality about the diagnosis and towards patients, even among health care professionals.

Since the advent of the eating disorder diagnosis in the early 1970’s, clinicians remain perplexed about the cause and persistence of eating disorder behaviors. For people with little familiarity with these illnesses, it’s unthinkable to struggle with restriction, binging or purging, especially after months or years of treatment.

Incredulous as to what motivates people to continue the symptoms, clinicians and laypeople fixate on the myth that people are to blame for their illness. In this line of reasoning, eating disorders expose weakness or a lack of willpower in the individual—still the most used trope in recovery. Any failure to get better is the fault of the patient. Any medical symptom is caused by the eating disorder. The emotional and physical pain wrought by the disorder deserves no compassion and only further blame, insult on top of injury.

Blaming patients for their illness is a convenient way for clinicians to absolve themselves of any responsibility to help people get well. There is no need to think outside the box or consider other possible directions in treatment or to posit new ideas for causes of the illness.

The current business model for treating eating disorders is successful and lucrative. The philosophy is buoyed by a culture used to forging a connection between weight and self-reproach. The population with eating disorders are more likely to opt out of destructive treatment than fight back against an ineffective and often destructive system.

Creative options for care exist, and I have been writing about them in recent months. There is little appetite within the eating disorder field to look outside the current guidelines for treatment and care. Medical diagnoses that may be related to eating disorders don’t get any attention from a psychologically oriented community. The people who don’t get better are labeled chronic without much thought given to improving treatment for them.

In time, I suspect many eating disorders are likely to be seen as medical in nature. Research into the hormonal balance of gastrointestinal and metabolic functioning, a haywire allergy/immune system and misfiring of hunger cues likely will change the landscape of eating disorder treatment.

There will certainly be a psychological component to almost everyone’s eating disorder, but medical knowledge and interventions will help with diagnosis and a higher rate of successful treatment. Blame has no place in eating disorder treatment, and time will prove that to be true.