Why Doctors and Psychiatrists are Reluctant to Treat People with Eating Disorders

I have a strange experience any time I tell another doctor, especially another psychiatrist, that I specialize in seeing people with eating disorders. The reaction is typically surprise, incredulity and admiration. On the whole, doctors across the board are shocked to know a colleague would choose to build a practice seeing primarily these patients.

My first thought about this reality is that no wonder patients with eating disorders struggle to find adequate, compassionate care. Doctors don’t appear to want to treat this group of patients.

My second thought is what are these colleagues trying to say through their reactions.

I believe there are several aspects of treating patients with eating disorders that scare off many doctors.

First, this cohort of patients is often medically sick, sometimes very ill. When the symptoms of the disorder itself are often intractable, seeing people with eating disorders means ongoing care for people who are chronically medically ill. Even with adequate medical care, which is very hard to find since primary care doctors often reject these patients, psychiatrists are held somewhat responsible for the concomitant medical and psychiatric effects of these illnesses. Recovery is long and slow so psychiatrists end up overseeing a medically ill patient for years. That’s an unusual burden for a psychiatrist.

Second, the family dynamic around these patients is typically complicated. As many books have discussed, patients with eating disorders tend to come from families with challenging emotional structures, poor communication and little room for the patient to express thoughts and feelings. The way they are heard and seen is most often through the eating disorder—a reason why recovery often seems so out of reach. Psychiatrists are then challenged to work on the emotional struggle and dysregulation with a patient reluctant to improve eating and their overall health, specifically due to that family dynamic. Very often this situation applies to adult children in their 20’s and 30’s and even older. The potential consequences are serious.

Last, the families and patients are also typically desperate for the person to just get better. Since eating seems like the most basic human task, it’s hard to explain what makes recovery so hard. Failure is often not tolerated, and psychiatrists can get caught up in the whirlwind of desperation even when the course of recovery is laid out clearly. The emotional needs of the family don’t match the data that getting better is no guarantee, and that situation makes it easy to include the doctor as part of the failure.

These mainstay issues in treating people with eating disorders lands a lot of blame and responsibility, often erroneously or at least in an exaggerated way, on the doctor. These are hard to treat illnesses. People can get better, but recovery is often long and hard. Some people don’t get well. Circumstances around treatment make this population challenging, often more challenging than many doctors and psychiatrists are willing to take on.