The Eating Disorder Industrial Complex (EDIC)

There is only one way to receive any treatment for an eating disorder. Once a patient sees a new provider, they enter a strict, rigid system that provides only one avenue for care. Stick with outpatient help and get better or get thrown into the finance-driven world of one size fits all outpatient or residential programs. All providers now work around this system and assume the industry can back up any clinician by giving supposedly adequate care and saving any clinician stuck with a difficult case.

The once overlooked eating disorder field is now a boon for the finance world, what I call the Eating Disorder Industrial Complex (EDIC).

The introduction of private equity into the marketplace led to an explosion of residential and outpatient treatment centers aimed at exploiting the insurance market for profit. Programs did not further or improve treatment at all but instead doubled down on existing, largely ineffective models. By expanding access across the country, the EDIC made treatment more palatable to providers who now can opt out when the going gets too tough by saying go to a program or treatment ends.

Although widespread availability of treatment is the new norm, the EDIC provides cookie cutter care by a largely inexperienced staff. It’s no surprise that the EDIC is failing a large percentage of patients.

The current protocol is a combination of one meal plan fits all, standardized residential care and generic therapy often run by a rotating group of new clinicians. There is no real evidence this treatment plan works, and many patients end up in a revolving door of various programs until either insurance won’t pay or they give up.

Programs ignore new information about coexisting ADHD, autism or MCAS with eating disorders. Where are the programs with a different learning style for people with ADHD or that are less chaotic for people with autism? Why aren’t programs considering and treating other medical issues that make recovery harder like MCAS?

Since there is no accredited degree or certificate to treat people with eating disorders, clinicians have to learn on their own and do so in the shadow of treatment programs. When patients aren’t doing well, providers can decide not to see someone and insist they go to a “higher level of care.” The EDIC allows independent therapists and doctors to sign off on a patient who gets too sick and trust the programs will make things better. Even clinicians in private practice have no incentive to try to improve care since they can rely on the EDIC to bail them out.

What happens to the patients who cycle through programs for one, two or three years? They desperately want to get back to their lives. For some that means stopping all treatment since all roads lead to residential care. Others beg surgeons for feeding tubes in their stomach to have enough nutrition to stay out of treatment. Many just give up and turn to social media for solace and new ideas about how to get well.

Medicine and the psychology world have abandoned a desire to meaningfully help eating disorder patients to the EDIC. Financial gain has become the driving force for eating disorder care, not improved treatment and outcomes.

It’s due to this sad and frustrating situation that I and other likeminded providers are looking for answers. Part of this new line of treatment involves taking social media concepts seriously and creating outpatient teams which can treat the concurrent illnesses and psychiatric disorders that complicate eating disorder recovery.

Just as important, patients need people to believe in them. The traumatic experiences of a revolving door of treatment combined with a series of providers who give up on them, blame them for their disorder and condemn them to a life of chronic illness causes an enormous amount of pain, trauma and hopelessness. Therapy for these people is as much about undoing the trauma of endless treatment as it is about recovery.

Just the act of having a provider believe in true recovery, that people with eating disorders can get well and that there is a chance to live a full life goes a long way towards helping people truly get better. That sense of humanity and lack of judgment is sorely missing in the EDIC.

Reassessing eating disorder treatment needs to start from the ground up. Focusing on people and their healing has to be paramount, not financial gain and capitalism.