Iatrogenic harm (sometimes specialist SD treatment can actually do harm)
There is a persistent bias in eating disorders that you were sicker, butter or more deserving or recovery if you receive professional treatment. I used to be desperate to be “ill enough” to warrant referral to the ED service. Whilst I accept that often people are very unwell by the time they receive treatment, it’s simply not true in thinking that professionals offer some sort of panacea.
Firstly - and I don’t think this will come as a surprise to anyone - ED treatment, particularly in the UK and other resource scarce countries, relies heavily on weight as a signifier of illness. By the time people are able to access Specialist ED treatment, they are often feeling entrenched in ED thinking. Imagine then how this is reinforced by teams focusing on arbitrary weight cut offs. There’s a real cognitive dissonance, as professionals know weight doesn’t signify healthy status, and yet they still massively focus on it, with weekly weigh ins and over reliance on goal weights.
For those of us with a history of trauma, or simply a longstanding eating disorder, psychodynamic elements of ED treatment can also be challenging. The sickest patients are often treated in coercive ways. “Force Feeding” may occasionally be necessary to save a person’s life, but the physical fear loss of control over one’s body that that entails is huge.
Similarly, even if you’re not being restrained to eat, in an outpatient setting, there may be bargains and persuasion techniques in place. If you have been ill for several years, the eating disorder can feel like your only identity. You currency of self worth is based entirely on how you behave to your treatment team, and focus on just meeting treatment goals can actually hold you back from developing your life away from ED (with friends, family and career etc.
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