People are still dying from eating disorders. This means that people are dying of malnutrition. Yes, in the West, in our world of abundant food, people are dying of malnutrition. And they are doing so right under their doctors, dietician, and therapist’s noses.

There are so many ways in which the eating disorder treatment field has to change. I think it is time that we recognize that for people in malnutrition, sometimes a therapist should not be the first port of call. Rather, we need specialized medical doctors trained in eating disorders and the physical and psychological aspects of malnutrition.

An eating disorder is a medical emergency. Malnutrition has to be treated like a deadly serious, physical, medical condition.

In what other serious, physical, deadly medical condition, are people referred to a talk therapist alone?

I just had to spend half an hour explaining gastroparesis (delayed gastric emptying) to a therapist. A therapist who considers himself sufficiently educated in eating disorder treatment. Gastroparesis is common in malnutrition. It happens when the body attempts to sustain basic life functions by lowering metabolism. It blows my mind that a therapist who considers themself an eating disorder specialist would not know what this is.

This is dangerous. Therapists treating eating disorders have to be educated in the signs, symptoms, and implications of malnutrition, because malnutrition can kill.

I’ll take that a step further. I don’t think that talk therapists should not be the first and only referral for people with restrictive eating disorders. A person in malnutrition needs to be seeing a medical doctor who is specialized in the complications associated with malnutrition.

If you got diagnosed with cancer tomorrow and your doctor referred you only to a talk therapist rather than a cancer specialist you may consider that to be medical misconduct. Can we stop pretending that eating disorders are flights of fancy and start treating them as serious medical illnesses? Yeah, just as serious as cancer. Yeah, just as serious as heart disease.


Therapy can be an important tool … as can family and peer support

I agree that with all illnesses there is a psychological component a patient may want to seek help with, but this is as true for an illness such as cancer as it is for anorexia. If one was diagnosed with cancer I am sure that it would have a traumatic affect. It would also affect career, family and relationships and there are many people with such illnesses who should also see a therapist. But they would not only see a therapist. A therapist would not be the first and only referral. A therapist would be an addition to specialist medical treatment.

People in a state of malnutrition need to be referred to people educated and equipped to deal with the condition of malnutrition. I think that we vastly underestimate people with eating disorders when we assume that they absolutely have to go to talk to a therapist about their feelings before they will be able to cope with weight restoration. A person with anorexia is never ready for weight restoration. That is what anorexia is! It’s going to be hard on us either way. But guess what? We are tough and we will deal with it if we are given as much support as possible. A once weekly meeting with a therapist alone doesn’t cut the mustard as support. We’ll need support on the ground — in the home. For many, online support groups that can offer around the clock company are worth much more than that $200 per hour appointment — and they are free. For others, therapy is a crucial part of their eating disorder support and worth every penny. This tends to be especially true for people who have suffered trauma. The decision whether to see a therapist or not should be entirely based on whether or not the patient feels that is beneficial to them.

I’m tried of therapy being the assumed course of action for all people with anorexia to take. I’m also sick of the stories of those of us (and there are plenty) who have reached full nutritional rehabilitation without stepping foot in a therapist’s office not being considered.

Every therapist I’ve worked with has tried to sort out my head before sorting out my body. This, to me, shows a clear lack of understanding of the basic principles of malnutrition – anon, adult in recovery from anorexia


Doctors need more training in eating disorders

Unfortunately, most doctors don’t know much about malnutrition, either. Last week one of my clients had her MD tell her that her heart rate of 40 bpm means she is “very fit.” The girl is underweight, in malnutrition, has been for years, and went in complaining of heart rate abnormalities. Seeing as heart problems are one of the ways eating disorders can be fatal then this is incredibly concerning. Malnutrition causes hypotension and often bradycardia and a multitude of other complications. This is serious shit.

I presented at my GP with symptoms of what I now know was severe electrolyte imbalance, and he told me I should drink some salty cup-a-soup. – anon, adult in recovery from anorexia

In what other medical situations are you treated like a complete idiot to the point where it is not explained to you what is going on?

Doctors need to treating adults with eating disorders as if they are infants. We have a right to know what is happening with our bodies.

My current dr has been good in explaining the effects of malnutrition. Several dietitians just focused on the food aspect, meal plans and no consideration to my lack of insight into my illness therefore my inability to follow meal plan or understanding of my dire health. In hospital, they dealt with the immediate dangerous symptoms (electrolyte imbalance etc) however nothing was explained to me, I just thought it was a foolish mistake from drinking too much…. I’m not a fan of dr Google, but my inquiring mind has led me to acutely understand malnutrition lately. However, this was once I finally understood my ed – anon, adult in recovery from anorexia


Therapists have a place

There is certainly an important place for therapy in eating disorder treatment. There are plenty of people with eating disorders who will want the support of a therapist for one thing or another. There is room for many different forms of support.

I have been in therapy (+ seeing a consultant / dietician) since the age of 18 (I’m now 36). For years I was told I had underlying issues that I needed to resolve. My anorexia loved this because it meant I could focus on something other than food and weight gain (consequently I never reached a non-anorexic weight).

Yes I’ve had great therapists who I’ve felt understood by emotionally but they knew very little about malnutrition and never gave me the clear information I needed to eat my way out of anorexia.

There are some wonderfully educated eating disorder therapists out there, but they are few and far between. These are people who have gone above and beyond and have educated themselves out of dedication and commitment. One cannot assume that all therapists who tick the box saying that they want eating disorder referrals are educated on the effects of malnutrition. But maybe we should be able to assume that? Maybe there needs to be some checks in place and therapists treating eating disorders need to be formally assessed for competency before they can start taking those types of referrals?


We need more eating disorder specialist medical doctors

Should dealing with such medical information like that be a therapist’s job anyway? Maybe this only comes up because there is a real lack of eating disorder specialist medical doctors. I would love to see therapists be able to specialize and stick to being wonderful therapists, and the medical side of eating disorder treatment being left to specialized medical doctors. There are doctors (Dr Gaudiani as an example) who do focus only on eating disorders and do an incredible job at this. We need to develop this field of medicine so that specialist eating disorder doctors are abundant rather than few and far between as they are now.

The fact that eating disorder specialist medical doctors are few and far between illustrates that the world of medicine does not take eating disorders seriously enough.


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