Judy Krasna
Eating Disorders Parent Advocate

Do no harm: Who should not be treating anorexia

If you are a therapist, dietitian, or psychiatrist without solid training or experience in the field of eating disorders, I don’t want you treating my daughter. I don’t care how noble your intentions are, how proficient you are at your job, how many letters you have after your name, or which prestigious university you attended; if you are not an eating disorder specialist, for the love of G-d, please don’t just presume that you can treat patients with anorexia.

I know that the above statement is not going to win me any friends in the mental health profession. I’m sorry, I mean no disrespect. However, I was taken aback when I learned of a discussion that took place online last week between mental health professionals about treating anorexia. One therapist claimed that there is no such thing as an anorexia expert and that more or less anyone qualified as a therapist can treat patients with anorexia. If that was the end of the story, I would chalk it up to one person’s misguided opinion. What pushed me over the edge is that other professionals offered their validation. So all therapists are equally qualified to treat patients with anorexia, right?

WRONG. As the mother of a daughter with anorexia, I vehemently disagree. I am genuinely horrified by the thought that a therapist or a dietitian would try to treat anorexia without the proper qualification, tools, or experience.

I am happy to report that anorexia experts do indeed exist. They are called eating disorder professionals. What makes them eating disorder professionals is the same thing that differentiates a family doctor from a neurologist– training in a specific area of the field and a specialized skill set. Just like you would not expect your family doctor to give brain surgery a whirl, I would not expect a therapist or a dietitian who has no significant eating disorder training to take on a patient with anorexia. If you are going to treat patients with anorexia, you need to know what the hell you are doing. You can’t just “wing it” or use your intuition, you have to fully and deeply understand what anorexia is and what anorexia does before you can contemplate treating it. Even the most experienced and qualified professionals find anorexia extremely difficult to treat. The wrong treatment can cause tremendous and potentially irreparable harm, despite the best of intentions. There is no room for the type of trial and error that stems from inexperience. Because what may represent a challenge to a well meaning therapist or dietitian who wants to try her hand at treating anorexia is my child, the most precious thing in my universe. So if you are not qualified to treat anorexia, hands off.

I am not holding anyone to a higher standard than I hold myself. I could not begin to parent a daughter with anorexia until I became educated about the illness and how it affects the people who suffer with it. I had to understand how my daughter can perceive the anorexia, which we see as such a negative entity, as a positive source of strength and comfort. I had to learn to separate the eating disorder’s voice from my daughter’s. I had to understand how deeply rooted anorexia is in a person’s head and how it affects way more than eating. I had to learn about how starvation affects the human brain. I had to become well versed on re-feeding philosophies, on treatments methods, and on the workings of an anorexic mind.

Whatever I thought that I knew about parenting didn’t apply to parenting an anorexic daughter, so I re-trained as a parent. My husband and I took a parenting course and participated in family therapy at the center where our daughter was being treated. I became an amateur anorexia expert. I read eating disorder books, research papers, academic journals, articles, and blogs. I joined eating disorder online forums, both parent groups and professional groups. I found a mentor specializing in eating disorders who helps me be the best mother to my daughter that I can possibly be under the circumstances.

I want the professionals who treat my daughter to be rock stars. I want them to have the maximum possible understanding of anorexia that a person can have. I want them to be well versed in every evidence based treatment that exists. I want them to be current on research, studies, and trends in the eating disorder field. I want them to have a proven treatment track record; not necessarily in healing the people whom they treat, but at the very least in helping their patients to function. I want them to make room for my family in my daughter’s treatment, because we very much want to help her in every possible way.

So here’s my plea–if you’re not an eating disorder specialist, don’t treat patients with anorexia. Just don’t. It is your professional obligation, if not your moral one, to do no harm. If you want to invest yourself and become an eating disorder professional, that’s terrific. We need more of you out there. Get specialized training, gain valuable experience, master the skills needed to competently treat anorexia. But until then, please leave the care of eating disorder patients to those who are truly qualified to treat them.

About the Author
Judy Krasna is an event planner in Israel. She is also the mother of four children, including a daughter with an eating disorder, and is an eating disorders parent advocate. She offers free advice and coaching to parents of kids with eating disorders. Judy is an active member of the Academy for Eating Disorders and advocates both in Israel and globally. She can be reached at parentinganorexia@gmail.com.
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