As a research assistant at the Columbia Center for Eating Disorders, I am one of the voices you may hear when you call us to ask about research, treatment, or referrals. I have learned so much from fielding these calls in the last couple of years, but as I reflect on my time at the Center, I am most struck by the challenges patients face when seeking treatment for anorexia nervosa.
The disorder can make you think you don’t have a problem, that it’s “not that bad,” or that you can “get over it” on your own.
I have spoken with many patients who, even after calling us and initiating an evaluation, continue to question whether they are “thin enough” to receive treatment for an eating disorder. Some people continue to question their need for treatment even when family and outpatient clinicians are urging them to seek care, and others question the need for treatment as they engage in it.
Of course, I only hear from the patients who are interested in seeking help—many struggling with anorexia nervosa will not pursue treatment at all. A recent study of college students estimated that approximately about 42% of those with untreated eating disorder symptoms did not seek treatment because they felt they did not need counseling or therapy and 20% did not feel their symptoms were “serious” enough to warrant treatment.
Why keep trying to seek treatment?
Anorexia nervosa is associated with serious medical complications (implicating the cardiovascular system, hormones, and beyond), and ignoring or diminishing the severity of the illness can have profound physical and psychiatric consequences. Early intervention is associated with better outcomes—waiting years, months, or sometimes even weeks to look into treatment can get you stuck even deeper in unhealthy behaviors. Also, “not that bad” does not sound particularly good. Consider how much better you might feel, or how much better you might be able to handle particular stressors or enjoy experiences if you were less in the grip of the disorder.
To those who wonder if they are “thin enough,” I offer the reminder that there is simply no one weight at which someone “should” seek treatment. Although low body weight is traditionally a distinctive characteristic of the illness, people of all weights may struggle with thoughts and behaviors associated with anorexia nervosa (e.g., restricting caloric intake, over-exercising, vomiting, taking laxatives). Others may have lost a considerable amount of weight and be underweight for their body’s needs, even if their body mass index (BMI) suggests otherwise. Clinicians are trained to pay attention to those who may not yet meet full diagnostic criteria for anorexia nervosa but are on a worrisome weight loss trajectory. Whether you have been struggling with anorexia nervosa for a long time or these behaviors began recently, you can seek and receive treatment for disordered eating behaviors no matter what your weight is.
The eating disorders treatment landscape is unfamiliar and overwhelming.
We try – on the phone and on this blog – to answer questions about treatment, from clarifying the levels of care to how to decode the letter’s after a clinician’s name or how to assemble a multi-disciplinary team to support you in all areas of recovery. But it can still be difficult to understand what kind of treatment is right for your eating problems.
What to do about it?
Before starting treatment, learn about the evidence-based options. While there is still a lot to be learned about how best to treat anorexia nervosa, for example, the value of behavioral interventions that aim for full weight restoration and full normalization of eating is clear. For adolescents with anorexia nervosa, family-based therapy is a well-studied, effective form of treatment. In general, there is little scientific support for the use of medication to treat anorexia nervosa. (Individuals with anorexia nervosa may be on medication for other psychiatric concerns, such as depression or anxiety, but at low weight, these may not be as effective as when weight-restored).
For specific specialized eating disorders treatment referrals in your local area, consultation with your primary care physician or pediatrician is a good place to start, as is the National Eating Disorders Association (NEDA) Helpline (1-800-931-2237) and treatment database.
Accessibility and affordability of care present another challenge.
At the Center, I have spoken with people from all over the country seeking specialized care. If you live in an area far from major hospital centers or if your resources are limited due to insurance coverage, it may be necessary to travel out of your town, city, or state to access the care that professionals recommend for you.
How to navigate this?
- Call your insurance company to see what eating disorders treatment services are covered under your plan.
- Investigate outpatient treatment providers who offer care on a “sliding scale,” typically based on need (which means they are able to provide discounted treatment) or look into training clinics through academic medical centers, or psychology graduate program centers in your local area.
- Consider applying for a grant to get help pay for treatment through Project Heal’s scholarship assistance program.
- Participate in eating disorders research studies to receive treatment while making a scientific contribution.
The journey to recovery may not be linear.
Anorexia nervosa is a tough and persistent illness. Patients who leave intensive treatment may find themselves challenged by the thoughts, feelings, and behaviors they experienced before they started treatment in the first place. Relapse can occur, with the greatest risk of relapse occurring during the first year after structured treatment. I have spoken to many patients who, after leaving our treatment program at a healthy weight, call back months later seeking help again. Rather than interpret a relapse as a failure, use it as an opportunity to better understand the persistence of the disorder and brainstorm with your support system about how to approach treatment differently this time.
How to feel optimistic about getting better?
At the Columbia Center for Eating Disorders, though we know that those who develop anorexia nervosa are vulnerable to a recurrence, we believe (1) that recovery is always possible and (2) that the path to wellness looks different for everyone. Work with a mental health team to navigate any possible lapses (and relapses) that might come up and continue to ask for help when you feel like you need it.