I received a call last night from a doctor that I know asking for a referral for an eating disorder therapist for a 13-year-old patient of his. I started giving him information on eating disorder clinics and he stopped me right away, telling me that the patient was really just starting to show signs of an eating disorder, that it was just the very beginning stage, and that she didn’t need serious treatment. She didn’t need the services of a clinic with a multidisciplinary team, she just needed a therapist for now, and the more local the better.
After our conversation, I started thinking–suppose that same child had a lump on her neck that the doctor suspected may be a tumor. I can’t imagine in a million years that he would have the attitude of “it’s only a small lump, just the beginning stages of cancer, no need for serious treatment.” I also presume that location of treatment would be far less of an issue; the only consideration would be who is the best-qualified person to diagnose and treat this girl.
And then I started thinking–why is there such a disparity between the way that primary care physicians view and treat eating disorders and the way that they view and treat other life-threatening illnesses? When it comes to eating disorders, many doctors don’t want to recommend what they consider to be aggressive treatment, and it baffles me as to why any medical professional would take this laid-back attitude toward an illness that has such potential for physical and mental harm, toward an illness where the term “highest mortality rate” is frequently used. Too many doctors, good doctors, would rather take a “wait and see” approach based on a series of “maybes”—maybe it’s just a phase, maybe he/she will snap out of it, maybe it’s just some type of teen rebellion, maybe it’s not really an eating disorder it’s just some mild disordered eating. After the maybes, in some cases, there is measure of weight bias thrown in as well, especially, but not only, with higher weight eating disorders. It’s favorable to lose weight, it’s beneficial to exercise, so it’s hard for a doctor who is supposed to promote health to come down on those medically encouraged behaviors and to tell patients that what is supposed to be an indicator of good health is in effect making them sick. This is not a consideration with all doctors, but I think that it may be an issue with some of them.
Most doctors that I know are not the slightest bit apathetic about the health of their patients. They are professional, competent, and caring. Given that this is the case, the only answer that I can come up with to the question of why eating disorders are not treated as the potentially life-threatening illnesses that they are is because so many doctors do not understand the nature, the consequences, the ramifications, the severity, and the impact of eating disorders. They don’t understand the degree to which they violently threaten not only the body, but the mind and the soul as well. They don’t understand how pervasively eating disorders operate, and on how many levels they spread their poison. They don’t understand that eating disorders attack at the speed of lightning, with the severity of a savage tornado, and with the damage of a category 5 hurricane, bringing with it total and utter destruction.
I understand all of this far too well, having seen what an eating disorder has done to my own daughter over the last 10 years. My daughter was not diagnosed early enough, and she wasn’t initially treated aggressively enough. I am not laying blame here, I am sharing my experience as a mother in the hopes that it won’t happen to anyone else. Ten years after my daughter was diagnosed, doctors are no better trained to spot eating disorders and no better educated to know that where there is smoke, there is the potential for a raging fire that can rapidly (so rapidly!) spread and escalate in scale, and can ravage and destroy everything in its path. Identify where the smoke is coming from and stop it from spreading into a full blown inferno. Early diagnosis is crucial, as is referring to a specialized eating disorder team. Any course of action less than that is like calling a guy with a garden hose to put out a serious fire and expecting him to succeed.
One of most fundamental concepts in the medical profession is that early intervention greatly decreases the level of suffering and greatly improves the chance of recovery from any illness; and yet, once again, there is a disparity in diagnosis and intervention between other life-threatening illnesses and eating disorders.
There are so many things that we don’t know about successfully treating eating disorders, but early intervention = better outcome is a no-brainer, which makes it that much more difficult for me to accept that too many doctors are missing the boat on early eating disorder diagnosis and immediate treatment referrals. There are a lot of things about eating disorders that I have grudgingly been forced to accept; but I cannot, nor will I ever, accept that.