There was a study published this month that showed what many of us have been saying for a long time: eating disorder treatment is massively ineffective in many cases and the industry is badly in need of some sort of overhaul.
The study was published under the title Clinicians’ Attitudes, Concerns, Adherence and Difficulties Delivering Evidence-Based Psychological Interventions and it outlined the fact that many clinicians do not use evidence-based therapies when treating eating disorder patients. This, by the way, is despite the general consensus that these therapies are by far the most effective and have a high rate of success when compared to non-eveidence-based practices.
The report went on to very politely state the reasons as to why eating disorder treatment is in dire need of an overhaul. Here’s my blunt and opinionated interpretation:
One of the reasons stated in the study was that treatment centers have their own cultures and beliefs and that they don’t want to change—the majority of the resistance usually coming from staff.
The study also pointed out that clinicians have a delusional view of their own effectiveness. Fact.
Oh, and get this: as many as one-third are untrained in the the therapy that they are employed to deliver. If the bar is that low, why don’t we just allow car mechanics to operate on people? I mean, it’s similar, right? Replacing a car battery is pretty much the same as replacing a human heart. Same as treating someone for child abuse is roughly the same as treating someone for anorexia.
No, no, no, it’s not.
This might, however, explain why a number of doctors tried to convince me that my parents simply must have abused me in order for me to have an eating disorder. When in doubt, treat for trauma. That would be rather like going into the hospital with a stomach ache and being given chemotherapy just because the doctor that you saw was primarily trained to specialize in cancer.
Funnily enough, eating disorder patients often baulk at treatment that will work. Treatment centers therefore don’t push the issue, and here is where the problem lies. If given the option, most eating disorder patients will opt for a treatment less likely to help them put on weight and recover.
Wonder why? It is because the sufferer’s malnourished brain doesn’t want to recover. When under the influence of anorexia I didn’t want to recover either.
That’s a bit like asking a sufferer “Do you want to eat?” getting the answer “No” and responding with, “Ah well then, we tried our best, how about we take the easy option and you just pay me $100 an hour to file my nails. Best not to rock the boat eh?”
Then everyone is told that the patient has to want to recover and that’s why the treatment didn’t work.
I want to slam my head on my keyboard every time I hear the words “we have to wait until he/she wants to recover.” And, by the way, saying that immediately implies that you think the sufferer made the choice to have an eating disorder in the first place—which, ridiculously, many therapists still do.
Wanting to recover from an eating disorder is not the same as deciding that you are going to be better at organizing your closets, or that you want to be a brunette rather than a blonde.
It’s a disease, an illness. There is no “want” involved in taking treatment in order to recover from an illness, only must. Due to the nature of the disease, the sufferer’s mental condition usually doesn’t allow he or she to “want” to recover.
It’s like saying, “Let’s wait until Donald Trump realizes that he’s an asshole and steps down.” Not going to happen. If we want Trump to get off the podium someone will have to push him. Likewise if you want someone with Anorexia to get better, you usually have to force them to do it.
This is how the report ended:
“Our patients would benefit if clinicians and supervisors were to focus on clinical outcomes and the better implementation of protocols, to improve the level of patient improvement and recovery.”
I don’t know whether to clap, cheer, laugh, or cry. On the one hand: yes, this is absolutely what is needed.
On the other hand: How the heck did anyone ever survive an eating disorder already?
“Our patients would benefit if clinicians and supervisors were to focus on clinical outcomes …” Is a polite way of saying, “please, do things that work rather than your own bullshit ideas that obviously don’t.”
This is serious stuff—eating disorders are the most deadly of all psychiatric illnesses— yet treatment seems to be an utter free-for-all where anyone with a vague therapy qualification can glorify their own ego and offer “treatment.”
We need more reports like this. Then we need them to be taken seriously. Until then, we’ll we have to hope that each eating disorder patient falls in the hands of a therapist who is willing to follow evidence-based treatment.