What are eating disorders?
For a long time, popular culture has portrayed eating disorders as predominantly affecting white, affluent young girls, characterised by extreme thinness. However, this belies the reality of the situation: anyone, regardless of age, gender, ethnicity or background, can develop an eating disorder. While some people with an eating disorder are of low weight, a disorder can be present at any weight. It is the way in which thoughts and feelings about food affect your life that matters, not the weight that you are on a given day.
Anorexia nervosa and bulimia nervosa are probably the best-known eating disorders, but others include binge eating disorder, avoidant restrictive food intake disorder and other specified feeding or eating disorders. They appear to be connected to other complex conditions, including depression, obsessive compulsive disorder, anxiety and autism.
What is the problem with how eating disorders are currently treated?
Eating disorders have the highest mortality rate of any mental illness. This is due to the severe physical effects of sustained malnutrition (affecting people of all weights), as well as the elevated risk of suicidal thoughts and attempts. Despite these serious consequences, many people do not receive treatment until they have deteriorated significantly, often over several years. In the UK, waiting lists are long and have doubled during the COVID-19 pandemic.
Of course, you will only be on a waiting list if your eating disorder is recognised, and this is far from a given. Research from 2016 showed that only around a third of cases in Europe are detected by healthcare professionals. This is further complicated by the fact that many people with eating disorders are ambivalent towards treatment, if not actively resistant to it. One of the many distressing facets of these diseases is their tendency to convince you that you do not need or deserve help. For many people, that feeling is further strengthened when they pluck up the courage to ask for help, only to be told by medical professionals that their weight is not low enough to require treatment.
Even if you can access treatment, what is offered in the first instance is not sufficiently intensive for many people’s needs. When food is the source of your distress, you are going to face your fear multiple times every day. Weekly or twice-weekly appointments with a therapist are often not enough, especially if the illness has already spent years infiltrating your life. The sooner effective, appropriate treatment begins, the more likely a person is to make a sustainable recovery.
What is early intervention?
Early intervention pathways for the treatment of eating disorders are supported by the Royal College of Psychiatrists and have been adopted as one of the programmes of work by the Academic Health Science Networks in England. The thinking behind early intervention is that the longer a brain operates in a certain way, the more entrenched those ways of thinking become. Bringing early intervention into eating disorder treatment was initially proposed following the success of similar models in psychosis care.
In recent years, researchers and clinicians have established a staged model of eating disorder progression and severity. This moves from ‘high eating disorder risk’, characterised by body dissatisfaction and dieting, through ‘early stage illness’, where symptoms have been present for less than three years and changes to the brain, body and behaviour are still thought to be highly malleable. The last two stages, ‘full-stage illness’ and ‘severe and enduring illness’, are when the condition is more resistant to treatment, and disability and mortality become more likely.
Any treatment before the three-year point falls under the category of early intervention.