How do these suboptimal medical outcomes challenge the recovery process?
Problems stemming from lack of medical awareness in eating disorder treatment affect patients, mental health clinicians and medical professionals alike.
For patients, ineffective treatment of their medical conditions, related to their eating disorder, can cause them to lose faith in the medical system. They know there is something seriously wrong, yet none of the medical professionals they see seem to know how to fix it. As a result, they often come to excessive testing, ineffective treatment and a dismissive attitude from medical encounters when they do seek treatment. Patients are less likely to seek additional care following bad experiences, and if they do, their resistance may be significantly heightened. But, most unfortunately these medical complications are imminently treatable.
For mental health clinicians, lack of medical understanding of eating disorder treatment often causes them to feel abandoned by the medical system. They’re doing the challenging emotional work of recovery with their patients, yet their patients continue to endure traumatic experiences when they seek medical care. This disconnect can cause the mental health clinician to lose credibility, which can challenge the sustainability of recovery progress (ie. “You said I would feel better if I…” ). Furthermore, ineffective medical treatment of serious complications will often cause patients to become too unstable to continue outpatient treatment. Mental health clinicians can sometimes feel as though they’re compromising their values as patients become increasingly ill during ongoing outpatient care. They realize their patients need a higher level of care, but they lack a trusted treatment provider with expertise in the medical complications of eating disorders to refer to. This is why it is so important for outpatient mental health clinicians to be able to identify reputable places of care and physicians to make timely referrals and get patients the medical support they need.
Medical professionals tend to lack training in and exposure to eating disorders, which prevents them from recognizing and addressing the cause of eating disorder patients’ uncomfortable and sometimes life threatening symptoms. They may also be uncomfortable with patients’ emotional overlay and resistance to care, which is common in eating disorder pathology. As a result, they can tend adopt the “someone else can do it” mentality, which contributes to the “revolving door phenomenon” in which patients move from provider to provider in community medical systems that lack the expertise to effectively manage a patient at a very low weight as well as those with other symptom acuity. The result is that patients continue to seek care but never get the treatment they need to alleviate their symptoms and achieve medical stability, or they stop seeking care altogether.
Because of this constellation of realities, Anorexia Nervosa continues to have a very high mortality rate; more than fifty percent of deaths in eating disordered patients are due to medical complications. This tells us that there is an impelling need for medical expertise in the continuum of excellent eating disorder care.
Philip Mehler, MD, FACP, FAED, CEDS
Dr. Mehler, founder and Medical Director of the ACUTE Center for Eating Disorders at Denver Health, is widely recognized as the world’s foremost expert in the medical treatment of eating disorders and is a noted administrator, researcher and author. He believes strongly in the important role of the outpatient treatment professional in advocating for effective and timely treatment of their patients’ medical complications related to eating disorders and malnutrition.