How Vulnerable People with Eating Disorders are at Risk of Harm and Abuse

Patients who are sick with eating disorders are vulnerable in our society for many reasons. They are often desperate for help and unsure where to turn. They are both held hostage by the illness and ready to accept any promise of help. They are physically and emotionally compromised and easy to take advantage of.

Even more, people with eating disorders don’t receive much compassion and understanding for their illness. They are blamed for their problems and told they should just stop the behaviors and eat—not very comforting for people who are really sick. The denigration only reinforces self-recrimination at the heart of the disorder and often leaves people feeling like they deserve poor treatment.

One result of the epidemic of eating disorders is that investors see the potential for profit. The private equity takeover of residential treatment programs is a testament to that reality. Instead of finding access to improved care, patients end up in a revolving door of care, sometimes for years, as long as insurance coverage will pay for it. Endless treatment has no benefit, but the system can make a lot of money on vulnerable people.

A more terrifying trend for these patients, both in hospital settings and treatment facilities, is overt verbal, physical and sexual abuse. Vulnerable patients tell me about settings where they are verbally abused for not eating, treated like prisoners forced to comply with orders and coerced into abusive acts by predatory staff.

I am sure I am not the only clinician who hears these stories. It has become standard to do trauma therapy for people abused in treatment and frightened of getting health care for their eating disorder. I have a harder time recommending inpatient or residential care based on these terrifying and disturbing stories.

Empowering sick and scared people to stand up for themselves is often too much to ask. If a heartless financial industry is bent on capitalizing on a vulnerable population, even an eating disorder clinician can’t be clear about the right decision for a patient.

The result is an exploitative system without any guard rails. I don’t see how clinicians can make much change in the larger picture other than trying to do the right thing on an individual basis. For now, I am very judicious about who is a reasonable candidate for inpatient or residential care, and then I track those patients carefully as a form of protection.

It’s hard to stay hopeful when access to care has led to seemingly widespread abuse. In the years I hoped for more access to care, I could never have imagined such a horrifying result.