Eating disorder treatment

Why Eating Disorder Treatment Needs an Overhaul 15

Eating disorder treatment

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:

Therapist’s Ego.

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.

Patient’s Refusal.

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.

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About Tabitha Farrar

I work as Head of Marketing for a software startup in Boulder. As a recovered Anorexia sufferer, I advocate for proper understanding of eating disorders in my spare time. On that note, I wrote a book about my own journey into eating again called Love Fat.

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15 thoughts on “Why Eating Disorder Treatment Needs an Overhaul

  • Julia

    “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.” ~ in my opinion this is why insurance companies are hesitant to pay…Not enough outcome studies. The ED world just expects treatment to be paid for whether evidenced based or not while the rest of the medical world is busting their asses doing studies to get stuff paid for. The world of physical therapy has been doing studies for two years to get insurers to pay for dry needling. Why should payment be expected if you can’t prove what your doing works? I get that research funding is poor but why are the for profit centers not donating money to research institutes or universities to study this? Just my two cents.

  • Sarah

    Great write up Tabitha – wish all the folk in our disbelieving world would read and think about think long and hard, then do their best to do better…

  • Jess

    I don’t know which kinds of “evidence-based” treatments” this article is referring to but it seems to me like you’re just suggesting swapping out one cookie-cutter solution for another. Like you’ve said, each individual case is complex and every person has their own reasons for having the eating disorder and for wanting or not wanting to recover. Speaking as both someone who has struggled with anorexia and a future therapist, all my experiences (and the research I’ve read) have taught me that the number one factor in recovery is not the type of treatment but the therapeutic relationship. In order to build a strong therapeutic relationship a counsellor has to be respectful of where their client is at and work toward THEIR goals – not to impose their own agenda when someone is not at the point of being willing to change

  • Meghan Kacmarcik

    Tabitha- I recently heard your interview on the Recovery Warriors podcast and was so touched by your story. I enjoy your site and I LOVED this article- and I have to say the line about Donald Trump made me laugh out loud. I shared it on my blog today in the hopes that more people can understand that the treatment for eating disorder recovery is still far from ideal. Thank you for speaking up and for doing what you do!

    • Tabitha Farrar Post author

      Hi Meghan

      Thank you for those kind words! It’s so important that we change the way that treatment is offered as soon as possible! Too many people are suffering without proper care. I really appreciate you sharing. I’ll check out your blog!

  • Tina Klaus

    A fabulous article. I too get encenced about this topic as I can speak from my personal experience had a patient living in recovery. This topic needs so much attention that it makes me want to cry. Unfortunately, as you so clearly state, “treatment centers have their own culture and don’t want to change”. In short, when organizations such as eating disorder treatment centers and the ego of “know it all” clinicians don’t want to take a close look at where they may be broken results in growth and movement being stunted. More importantly those struggling , suffering and needing help get lost in the ineffective revolving door syndrome of treatment centers.

    I’m grateful that I fell into the hands of the right therapist. Dr. Michael Maley was able to guide and help me through all the chaos within the treatment system.

    Thanks for writing this article.

  • Rachael

    Hi Tabitha,
    I strongly agree with your post in why treatment of eating disorders needs a overhaul. I would like to add that society and the medical world needs to stop associating mental illness to drug addiction and treating the two as similar issues. Sure, drug abuse can lead to mental illness and vise versa. However, this is not always the case and for someone like me who has never touched drugs in my life, I do not require the same medical treatment, as a drug addict.

    • Tabitha Farrar Post author

      Hi Rachael

      That is a really good point and I too have experience of being treated as if my eating disorder is an addiction. For me, this was another experience that created distrust in those who were supposed to be helping me. It made me feel very alone every time I did try and reach out to someone in the medical profession that they never seemed to understand my eating disorder.

  • Brit

    I LOVE this Tabitha. LOVE it. As someone who has dealt with EDNOS for years, I always used to wonder whether or not it was just me feeling that ED treatment, though largely necessary, is extremely ineffective. It seems that no one really knows how to treat them, centers included, but no one wants to admit it. There’s got to be some dramatic change soon, and I hope that ppl like you will continue writing to spur it!

  • Laura Collins Lyster-Mensh

    Thank you so much for spotlighting the article, the issue, and what so many feel but are afraid to say. I have never met anyone who treated eating disorders who didn’t care or didn’t want to do better. But that, unfortunately, doesn’t mean everyone is willing or interested in doing things based on effectiveness, which of course it has to be. To treat in ways that feel better, or fit someone’s past training, or fit into their passions or skill set…. well, that’s about the treater and not the treated. And patients deserve better.