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Eating disorders are complex and debilitating mental illnesses affecting millions worldwide. Despite the significant advances in psychiatric treatment over the past several decades, eating disorders remain challenging to diagnose and treat effectively. 

This post will explore the current challenges of clinical terms for eating disorders and why a language change is needed. We will also discuss alternative language suggestions, ways to implement more compassionate language when working with individuals with eating disorders, and resources for those interested in this area. We will also provide an overview of the history of psychiatric treatment of eating disorders, including significant developments in psychiatric research in eating disorders and how psychiatric treatment should consider changing in the future.

Challenges of clinical terms for eating disorders

One of the significant challenges of medical terms for eating disorders is the associated stigma. The most commonly recognized eating disorders are anorexia nervosa, bulimia nervosa, and binge eating disorder. However, many individuals with eating disorders do not fit neatly into these categories and are often diagnosed with other specified feeding or eating disorders (OSFED).

This categorization perpetuates the idea that these experiences are undeserving of crucial treatment options and attention from providers. Individuals with OSFED often feel invalidated and dismissed, leading to delays in treatment and a sense of hopelessness.

Alternative language suggestions

Alternative language suggestions have been proposed by various individuals and organizations within the mental health and eating disorder communities to address the stigma associated with current terms for eating disorders. These suggestions aim to focus on the emotional and psychological experiences of individuals with eating disorders rather than the physical symptoms.

For example, the term “body distress disorder”, was proposed by a group of Australian researchers in a 2019 study published in the Journal of Eating Disorders as an alternative to anorexia nervosa. This term highlights the distressing feelings that individuals with anorexia nervosa experience about their bodies and avoids focusing on weight loss as the defining feature of the illness.

Similarly, “binge eating disorder” has been suggested by individuals suffering with eating disorders to be replaced with “emotional eating disorder” to emphasize the emotional and psychological experiences that contribute to the disorder.

Implementing compassionate language

In addition to alternative language suggestions, it is essential to implement compassionate language when working with individuals with eating disorders. This includes mirroring language, listening without judgement, and avoiding language that may cause harm to or invalidate the individual’s experiences.

Mirroring language involves reflecting back to the individual the language they use to describe their experiences. This helps the individual feel heard,validated and fosters a sense of trust and connection with their healthcare provider.

Listening without judgment involves actively listening to the individual’s experiences without making assumptions or judgments about them. This helps create a safe and supportive environment for individuals to express their feelings and experiences.

Trying to avoid language that may trigger or invalidate the individual’s experiences is crucial. This includes terms that reinforce stigma or perpetuates stereotypes about eating disorders. Examples of triggering language include phrases such as “just eat” or “you’re so skinny.”

History of psychiatric treatment of eating disorders

The history of psychiatric treatment of eating disorders is complex and reflects the broader societal attitudes toward mental illness over time. In the early 20th century, eating disorders were often seen as physical ailments, and treatment focused on physical symptoms such as weight gain or loss. However, as psychiatry developed, eating disorders began to be seen as psychological conditions.

The first formal description of anorexia nervosa came in 1873 from Sir William Gull, who described the condition as a mental illness. However, it was not until the 20th century that anorexia nervosa became recognized as a distinct psychiatric diagnosis. Similarly, bulimia nervosa was not formally recognized as a diagnosis until the 1980s.

The early treatments for eating disorders were often ineffective and harmful. For example, insulin coma therapy, a treatment used in the 1930s and 1940s, involved inducing a coma in individuals with anorexia nervosa to promote weight gain. This treatment was dangerous and often resulted in serious harm, including death.

In the 1950s and 1960s, psychoanalytic approaches to treating eating disorders became popular. These approaches focused on exploring the underlying psychological issues that contributed to the development of the disorder. However, psychoanalytic approaches were criticized for being time-consuming, expensive, and ineffective for some individuals.

In the 1970s, cognitive-behavioural therapy (CBT) emerged as a treatment for eating disorders. CBT focuses on identifying and changing negative thought patterns and behaviours contributing to the disorder. CBT has been shown to be effective in the treatment of bulimia nervosa and binge eating disorder but has had limited success in the treatment of anorexia nervosa.

In recent years, other forms of psychotherapy, such as dialectical behaviour therapy (DBT), have been developed specifically for treating eating disorders. DBT focuses on helping individuals regulate their emotions and behaviours, and has been shown to be effective in treating bulimia nervosa and binge eating disorder.

The role of medications

Certain medications have also been used to treat eating disorders, although their role is often limited. Antidepressant medications have been used to treat bulimia nervosa and binge eating disorder, and some studies have suggested that they may be effective in reducing binge eating behaviours. However, their effectiveness in the treatment of anorexia nervosa is limited.

Atypical antipsychotic medications have also been used to treat eating disorders, particularly in the treatment of anorexia nervosa. These medications have been shown to be effective in promoting weight gain, but their use is controversial due to their potential side effects.

The future of psychiatric treatment for eating disorders

Despite the advances in psychiatric treatment for eating disorders, many areas of work remain. One of the significant challenges in the treatment of eating disorders is the lack of access to effective treatment. Many individuals with eating disorders do not  any treatment or receive insufficient treatment due to the high cost of care, a shortage of trained healthcare providers, and limited insurance coverage.

To address these issues, there needs to be a greater emphasis on early detection and intervention. This includes increased awareness of the signs and symptoms of eating disorders among healthcare providers, educators, and the general public, as well as increased funding for research into developing effective and accessible treatments.

Another area that requires further development is the treatment of anorexia nervosa. While there have been significant advances in treating bulimia nervosa and binge eating disorder, the treatment of anorexia nervosa remains challenging. There is a need for more research into effective treatments for anorexia nervosa, as well as increased awareness of the unique challenges associated with this disorder.

Finally, there needs to be a greater emphasis on individualized and compassionate treatment of eating disorders. This includes providing care tailored to the individual’s specific needs and experiences and avoiding stigmatizing language and attitudes.

Individualized approaches to treatment

An individualized approach to treatment for eating disorders is crucial because these disorders can manifest differently in each person. Treatment should focus on addressing the specific needs and concerns of each individual, rather than applying a one-size-fits-all approach. This requires healthcare providers to be trained in recognizing the unique needs of patients and adapting treatment accordingly. It is also essential to involve patients in the treatment planning process, ensuring that they feel heard and that their concerns are addressed.

A comprehensive approach to treatment may include a combination of psychotherapy, nutritional counseling, medication, and other supportive interventions. Therapy should focus on addressing the psychological factors that contribute to the development and maintenance of the disorder, such as distorted body image and low self-esteem. Nutritional counseling should provide patients with the knowledge and tools necessary to establish healthy eating habits, and medication may be used to address co-occurring mental health conditions.

Training staff who work with individuals is crucial to implementing an individualized approach to treatment. This includes providing education on the symptoms and diagnostic criteria of eating disorders, as well as training on evidence-based treatment approaches. Ongoing supervision and support are also essential to ensure that staff members are equipped to provide effective and compassionate care.

To achieve this goal, there needs to be a greater emphasis on training clinicians and key community members, such as school counselors and social workers, on the signs and symptoms of eating disorders. This training should include information on evidence-based treatments for eating disorders and the importance of early intervention.

Additionally, it is essential to ensure that healthcare providers in community-based settings have access to resources such as screening tools, treatment manuals, and consultation with specialists in eating disorders. This may involve developing partnerships between primary care clinics, community mental health centers, and specialized eating disorder clinics.

Holistic approach to treatment

A holistic approach to treatment for eating disorders recognizes that these disorders are complex and multifaceted. It involves addressing not only the physical symptoms of the disorder but also the underlying psychological and social factors that contribute to its development and maintenance. This may include addressing issues such as low self-esteem, perfectionism, and trauma.

To prioritize a holistic approach in the overburdened and privatized healthcare system in the US, several steps can be taken. First, increased funding for research is needed to develop a better understanding of the causes and maintenance of eating disorders. This can inform the development of more effective treatments that address the underlying psychological and social factors that contribute to the disorder.

Second, there needs to be a broader societal shift towards body positivity, diversity, and acceptance. This involves challenging societal norms around beauty and promoting a more inclusive and accepting culture. Healthcare providers can play a role in this shift by promoting body positivity and providing patients with resources to challenge negative self-talk and improve self-esteem.

Third, healthcare providers need to be trained in a range of evidence-based treatment approaches that address the complex needs of patients with eating disorders. This includes training in cognitive-behavioral therapy, interpersonal therapy, and other modalities that have been shown to be effective in treating eating disorders.

Finally, there needs to be a greater focus on prevention and early intervention. This includes educating healthcare providers, teachers, and parents on the warning signs of eating disorders and providing resources for early intervention. It also involves promoting healthy body image and self-esteem in children and adolescents to reduce the risk of developing an eating disorder.

Conclusion

Eating disorders are complex and challenging mental illnesses that require a compassionate and individualized approach to treatment. While there have been significant advances in psychiatric treatment over the past several decades, much work must be done to improve access to care and develop effective treatments. By focusing on early detection and intervention, increasing funding for research, and providing individualized and compassionate care, we can work towards destigmatizing eating disorders and providing better outcomes for individuals with these illnesses.

It is also essential to recognize the role of social and cultural factors in developing eating disorders. Research has shown that societal pressures to conform to unrealistic beauty standards, trauma, and abuse can contribute to the development of eating disorders. Addressing these underlying factors requires a broader societal shift towards body positivity, diversity, and acceptance.

Ultimately, the goal of psychiatric treatment for eating disorders should be to promote physical health and weight gain and address the underlying psychological and social factors that contribute to the development and maintenance of the disorder. This requires a holistic approach that recognizes the complexity of eating disorders and the individual needs of those living with these illnesses.

References

American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders, 5th edition.
Bulik, C. M., Marcus, M. D., & Zerwas, S. (2012). Eating disorders in the twenty-first century.

In M. Blouin & L. Goldstein (Eds.), Mental illness in popular culture (pp. 185-196). Praeger.

Crow, S. J., Peterson, C. B., Swanson, S. A., Raymond, N. C., Specker, S., Eckert, E. D., & Mitchell, J. E. (2009). Increased mortality in bulimia nervosa and other eating disorders. American Journal of Psychiatry, 166(12), 1342-1346.

National Eating Disorders Association. (2021). Statistics and research on eating disorders.

Schmidt, U., & Treasure, J. (2006). Anorexia nervosa: Valued and visible. A cognitive-interpersonal maintenance model and its implications for research and practice. British Journal of Clinical Psychology, 45(3), 343-366.

Stice, E., Marti, C. N., & Rohde, P. (2013). Prevalence, incidence, impairment, and course of the proposed DSM-5 eating disorder diagnoses in an 8-year prospective community study of young women. Journal of Abnormal Psychology, 122(2), 445-457.

Wonderlich, S. A., Gordon, K. H., Mitchell, J. E., Crosby, R. D., Engel, S. G., & Simonich, H. (2009). The validity and clinical utility of binge eating disorder. International Journal of Eating Disorders, 42(8), 687-705.

Yager, J., Devlin, M. J., Halmi, K. A., Herzog, D. B., Mitchell, J. E., Powers, P., … & Zerbe, K. J. (2014). Guideline Watch (August 2012): Practice Guideline for the Treatment of Patients With Eating Disorders. Focus, 12(4), 416-431.

Hay, P., Chinn, D., Forbes, D., Madden, S., Newton, R., Sugenor, L., … & Ward, W. (2014). Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of eating disorders. Australian & New Zealand Journal of Psychiatry, 48(11), 977-1008.

Lock, J., & Le Grange, D. (2015). Treatment manual for anorexia nervosa: A family-based approach. Guilford Publications.

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