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Why Eating Disorders Are so Difficult to Treat

Though eating disorder treatments have greatly improved in recent years, many diagnosed patients move in and out of treatment programs.

By Alexis Schofield
Jan 11, 2023 4:00 PM
Stylized eating disorder concept
(Credit: 13Smile/Shutterstock)


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A common misconception about eating disorders is that they aren’t serious illnesses. In part because of this, roughly 9 in 10 people with eating disorders either never receive treatment or go completely undetected.

Even among those who do seek professional help and make a full recovery, about a third will experience one or multiple relapses. Below, let’s dive into the complexities and psychology behind eating disorders, what eating disorder treatment looks like, and why the disorders are so difficult to treat.

A Complex Picture

While there isn’t an exact cause for eating disorders, researchers have found that they can arise from a variety of factors, including mental health, body image, biological factors and genetics. Likewise, they can affect any person — regardless of weight, age, gender, race or other demographic. However, they are most commonly diagnosed in adolescence and young adulthood.

Why? For adolescents and young adults, body changes happen rapidly and can trigger a plethora of negative thoughts and emotions. In fact, studies have shown that when it comes to body image, weight is one of the biggest concerns among adolescents and young adults.

Therefore, body image is a huge part of the psychology behind eating disorders. For many people, this can also lead to body dysmorphia — a separate mental health condition in which a person fixates on their body and their perceived flaws.

Digging Into the Psychology

Another common misconception about eating disorders is that they’re only about food; while some individuals do obsess over food, calories and weight, disordered behaviors such as self-starvation, purging, binging and over-exercising are often derived from deeper psychological factors such as a sense of powerlessness.

Read More: Eating Disorders Have Spiked Amid the Pandemic

People who feel a general lack of control in their lives may use these disordered eating habits to gain back a semblance of control. In turn, this can create a fear of losing control that only serves to heighten the severity of the disordered behaviors.

Because many people who have an eating disorder also have a distorted self-image, negative body image or intense fear of gaining weight, a lot of eating disorder treatment programs revolve around different types of therapy.

Eating Disorder Treatments

Currently, the most established methods of therapy in eating disorder treatment are cognitive behavioral therapy (CBT), interpersonal psychotherapy (IPT) and acceptance commitment therapy (ACT).

Particularly for adolescent patients, many treatment plans will also incorporate family-based treatment (FBT), which includes the patient’s parents and immediate family members. In some cases, parents of children with eating disorders can feel at a loss as to how to help their child; therefore, this method of therapy is often hugely beneficial to a successful recovery.

There are also different levels of treatment, including outpatient services, intensive outpatient programs, partial hospitalization, residential treatment and inpatient hospitalization. Depending on the severity of a person’s eating disorder, these programs are customized to best support them and put them on the track to a full recovery.

Why Treatment Is Difficult

Still, many of those who undergo an eating disorder recovery program remain resistant to treatment. There are many reasons this may be the case, but a common one has to do with meal plans.

Most eating disorder treatment centers have a nutritionist or dietician on their team to create meal plans based on the patient’s needs. This can be highly triggering for people with an eating disorder — especially at the beginning of treatment — because their whole mindset is still centered around food.

Unfortunately, once patients are discharged from treatment centers, there’s a great risk of relapsing. Because weight gain can cause an intense amount of anxiety, many of those who have undergone weight restoration during treatment will ultimately engage in disordered eating behaviors again.

It’s important to remember that lapsing and relapsing is a part of the recovery process. Knowing the signs of a relapse and how to get help are some of the most important things to remember while in recovery.

New Approaches to Treatment

Considering both resistance to treatment and the rate of relapsing patients, treatment centers are pivoting their approaches to focus on harm reduction and the minimization of how much the illness affects the patient. This has been shown to improve how patients function in their everyday lives, and it better allows them to “see the bigger picture.”

Most treatment centers still incorporate multiple types of therapy depending on the patient’s needs, as this has been shown to be the most successful method. And as mental health medications and therapies advance, so will the ability to create treatment plans customized to each patient individually.

More programs now focus on more fundamental methods such as harm reduction, living with an eating disorder, and maintaining a healthy and happy lifestyle after treatment. While many people with eating disorders will still be resistant to getting help, finding the right treatment plan and a provider that matches your needs is the first step to a successful recovery.

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