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.