Why are eating disorders so hard to treat? – Anees Bahji
Globally, about 10% of people will experience an eating disorder
during their lifetime. And yet, eating disorders are
profoundly misunderstood. Misconceptions about everything
from symptoms to treatment, make it difficult to navigate
an eating disorder or support someone you love as they do so. So let’s walk through what is—
and isn’t— true about eating disorders. First, what is an eating disorder? Eating disorders are a range
of psychiatric conditions characterized by these main patterns
of behavior: restricting food intake, bingeing, or
rapidly consuming large amounts of food, and purging or eliminating calories through vomiting, laxatives, excessive
exercise, and other harmful means. An eating disorder can involve any one
or any combination of these behaviors. For example, people living with anorexia usually restrict the amount
of food they eat, while bulimia nervosa
is an eating disorder characterized by recurrent binges
and purges. Importantly, these behaviors determine
whether someone has an eating disorder. You can’t tell whether someone has
an eating disorder from their weight alone. People who weigh what medical
professionals might consider a healthy range
can have eating disorders, including severe ones that damage
their long-term health in invisible ways, including osteoporosis, anemia,
heart damage, and kidney damage.
Just as we can’t tell whether someone
has an eating disorder based on their weight alone, we can’t get rid of these disorders
simply by eating differently. That’s because eating disorders are,
at their core, psychiatric illnesses. From what we understand, they involve a disruption
to someone’s self-perception. Most people who experience them
are severely critical of themselves and report many self-perceived flaws. They may use eating to try to regain
some control over an internal sense of chaos. We still don’t know exactly
what causes eating disorders. There likely isn’t a single cause,
but a combination of genetic and environmental
risk factors that contribute. Sometimes, other mental illnesses—
like depression or anxiety— can cause symptoms of eating disorders.
In addition,
certain psychological factors, such as perfectionism
and body image dissatisfaction, are risk factors for eating disorders. Several social factors contribute, too, including internalized weight stigma,
exposure to bullying, racial and ethnic assimilation,
and limited social networks. Although there is a common misconception
that only women experience eating disorders, people of all genders can be affected. As these disorders intimately affect
the development of one’s identity and self-esteem, people are particularly vulnerable
to developing them during adolescence. Although these are among the most
challenging psychiatric disorders to treat, effective therapies
and interventions exist, and many people who receive treatment
make a full recovery. Treatment has a higher chance of success
the earlier it starts after someone develops
disordered eating behaviors. But unfortunately, less than half
of people with an eating disorder will seek and receive treatment. Because of the complex effects
of eating disorders on both the body and the mind, treatment usually includes a combination
of nutritional counseling and monitoring, psychotherapy, and in some cases,
medications. Evidence-based psychotherapies exist
as treatments for most eating disorders, including cognitive-behavioral therapy
and family-based therapy.
These are talk-therapies
that help people gain the skills to deal with underlying psychological
problems that drive eating disorder symptoms. Because not all patients will respond
to these treatments, researchers are also investigating
treatments outside of psychotherapy, such as transcranial magnetic stimulation. Proper treatment can reduce the chances
of dying from a severe eating disorder. Eating disorders can provoke
a powerful sense of powerlessness, but education for individuals,
families, and communities helps erode the stigma
and improve access to treatment..
