Traditional care for anorexia nervosa focuses on weight restoration as the core aim of treatment and measure of recovery. It reduces recovery to numbers: when a young person reaches a certain weight, they are considered well. These programs prioritise weight restoration during the treatment process, often overlooking the psychological factors that underpin eating disorders.
We now know, however, that eating disorders are not only about body shape, weight, or eating behaviours. Research suggests that psychosocial factors like cognitive traits and interpersonal relationships play a key role in the development and maintenance of anorexia nervosa. Treatment should take a whole-person approach, addressing experiences of trauma and other underlying factors to promote lasting recovery.
This blog explores the potential harm caused by outdated, traditional models of treatment for anorexia nervosa and how trauma-focused care represents a transformative alternative.
Stigmatising and Excluding
Traditional eating disorder care often requires a person to fit within a specific box of diagnostic criteria to be considered unwell. The diagnostic criteria for anorexia nervosa still include the requirement of a ‘significant low body weight’, despite evidence that most people who severely restrict their diet are in normal or higher weight bodies.
Young people who do not fit this diagnostic criterion may be denied treatment or coverage from insurance providers.
Unfortunately, this often leads to the shaming and exclusion of people living in larger bodies or bodies that don’t reach the lows that healthcare and insurance providers force them to be at in order to get well. People denied treatment on the basis of their weight may engage in escalated disordered eating behaviours and other harmful behaviours.
These policies also prevent young people from receiving support in earlier stages of their illnesses, when they are easier to treat.
‘Not Unwell Enough’
Weight-based admissions criteria – and denials of care and support – can also reinforce a young person’s perception that they are ‘not unwell enough’. These feelings not only perpetuate the illness but may also lead to further destructive behaviours, including self-harm, substance abuse, and suicidality.
As a result, their well-being and mental health continue to get worse, and treating their conditions becomes more complex.
Equating Physical and Psychological
Recovery programs that focus on weight restoration, measuring recovery with numbers, are based on a misconception of the illness. These programs equate physical recovery with full recovery, assuming that when a young person reaches a certain weight, the psychosocial difficulties that underpin disordered eating behaviours will somehow disappear.
Of course, in reality, these unaddressed thoughts, feelings, and experiences often cause disordered eating behaviours to reappear some time later. Without whole-person, trauma-focused care, young people may enter cycles of recovery and relapse. As their illness endures, it becomes more and more difficult to treat. Some young people ultimately develop severe and enduring eating disorders.
Numbers and Perfectionism
Perfectionism is common among people with eating disorders. Young people with anorexia may have exceptionally high self-standards and experience distress when they make mistakes. In the context of eating disorder symptoms, perfectionist traits can contribute to body dissatisfaction and distress.
Traditional anorexia treatment programs typically provide young people with a number: a certain weight where they will be considered well and recovered. But people with unaddressed perfectionist traits are unlikely to ever feel okay with that number. This can cause relapses soon after the end of a treatment program.
A Chronically Relapsing Condition?
Unfortunately, the current healthcare system that surrounds eating disorder care often prevents young people from reaching full recovery. The consequent cycles of recovery and relapse cause many people to believe that anorexia is a chronically relapsing condition. Speaking about continual relapse takes hope away from the young person and their family.
In reality, anorexia nervosa isn’t chronically relapsing, and lasting recovery is possible with effective treatment that addresses the psychological and social experiences underpinning eating disorders.
The Causes and Maintenance of Eating Disorders
Traditional models of anorexia treatment assume that the illness is primarily related to eating, weight, and/or body shape. For example, family-based treatment is based on the idea that young people with anorexia are unable to make good decisions about the way they eat, handing responsibility to family members. It assumes that as physical symptoms improve, so will co-occurring disorders and psychological distress.
Equally, standard enhanced cognitive-behavioural therapy addresses the thought patterns that underpin disordered eating behaviours, but still emphasises concerns about shape and weight as a core factor maintaining the disorder.
However, research now suggests that for many young people, anorexia is caused and maintained by other psychological and social experiences, such as interpersonal difficulties and perfectionist traits. Drawing on various studies, the cognitive interpersonal model of anorexia nervosa identifies cognitive traits, such as rigid thinking, and interpersonal difficulties, such as sensitivity to rejection, as key factors that cause and maintain the disorder. It also recognises how the reactions of other people to a young person’s illness can exacerbate interpersonal difficulties and help to maintain the disorder.
As a result, newer treatment approaches, such as MANTRA, centre around the core psychosocial factors that underpin eating disorders. During MANTRA sessions, young people address interpersonal issues, learn healthier thinking styles, learn to regulate their emotions, develop a positive sense of self and form an identity aside from their eating disorder.
The ‘broad’ version of CBT-e also considers wider psychological issues that may underlie disordered eating behaviours, including low self-esteem, perfectionism, and interpersonal difficulties.
Embracing Trauma-Focused Care for Anorexia
Traditional eating disorder care doesn’t provide the trauma-informed approach that young people need to get well. Most young people with anorexia have experienced at least one form of childhood trauma. These traumas affect their relationships, their trust in other people, their perceptions of danger, and the way they process emotions. All of these patterns can contribute to and maintain disordered eating behaviours.
Unfortunately, traditional treatment for anorexia focuses on weight restoration and numbers, rather than a person’s life experiences. These outdated ways of working with eating disorders are not only counter-productive but inherently overlook experiences of trauma and its permeative consequences.
On the other hand, trauma-focused care addresses the experiences, feelings, and thought patterns that cause and maintain anorexia, enabling whole-person healing. This helps prevent relapse and underpins lasting mental and physical well-being.
The Wave Clinic: Trauma-focused Eating Disorder Support
The Wave Clinic offers mental health treatment spaces for young people in Kuala Lumpur and Dubai. We’re specialists in the treatment of eating disorders for children, adolescents, and young adults.
Our eating disorder programs are inclusive for all young people with eating problems, regardless of the body they are living in or the different symptoms they experience.
We offer trauma-focused eating disorder treatment that addresses the past experiences that affect how young people think, feel, and behave. We integrate trauma treatment into our programs from the very beginning, encouraging a process of whole-person healing.
We also recognise the fundamental role of interpersonal relationships in causing and maintaining eating disorders. Our programs emphasise interpersonal skills, friendships, and families, fully involving family members in the treatment process.
If you’re interested in finding out more about our programs, get in touch today.
