"But our patients are more ill."
"I see older patients."
"So many have been traumatized."
"It's a very complicated illness"
I think it is time to re-frame eating disorders. Let's separate the illness - a temporary brain condition - with the consequences of failed treatment.
I'd like us to look at an eating disorder as a problem that happens to certain people under certain circumstances and is, in itself, quite treatable. This problem we're talking about presents very much the same way in most patients: a drive to treat food in a disordered way, a distorted relationship with one's body and feelings, a distorted relationship with others, and certain fixed beliefs around food and the body.
The problem I'm describing is treatable. If caught early and brain restored and behaviors normalized the symptoms abate and can be addressed in a rational way.
The rest are complications
Pre-existing or co-morbid mood or personality disorders
An environment - social or personal - that complicates efforts toward recovery
The medical consequences of restricting, binging, and compensatory behaviors
The traumatic effects of treatment
The traumatic effects of one's illness on one's family and friends
The consequences of the illness on one's development and life
The first two require intervention even without an eating disorder, period. The rest are dependent on how well others respond to the illness - personally and professionally.
Why separate the illness from the complications? Primarily because this confusion has led to generations of misunderstanding the illness itself, but also because it is the complications that are unique to each patient. The illness doesn't change much person to person, but the effects and RESOURCES do. No two patients have the same resources or complications.
Separating the core illness means truly individualizing treatment.
If we saw each new patient and their family with a clean slate - and with optimism - with a pretty simple if dangerous illness - that's a start. From there we build resources and skills to fight the illness. If, along the way, there are complications revealed, we deal with them. That is a very different stance, I know. But I'm more and more confident that most cases of eating disorders could, if identified early and treated for what they are, be approached in a way that prevents most of the complications that we now tend to think of as the core illness - and offers the person with the illness help for real issues that need addressing in order for that person to live a satisfying life, even without an eating disorder to complicate the picture.