I was reading an online opinion piece by one of my colleagues, Dr Ovidio Bermudez, who like me is an adolescent medicine physician and eating disorder doctor. This one sentence jumped out at me since it reflects what I have said in many ways before, only Ovidio said it better and more succinctly: “Families like to hear that care is tailored to their loved one’s unique recovery need, but core principles of treatment, including symptom interruption and weight restoration, should not be individualized but rather normalized.”
Part of acknowledging that anorexia nervosa and other eating disorders are brain disorders -- as Dr Tom Insel, formerly the head of the National Institute of Mental health (NIMH), reinforced in his position letter -- is recognizing that they are like other medical illnesses and should be treated similarly.
“Of course,” you might say. Well, it’s not “of course.”
No one likes to be seen as a cipher or to be treated as if our individuality is invisible. And as much as we might hate this treatment for ourselves, we really hate it for our children. No matter what we think of ourselves, we almost always regard our own children as special. Very special. And we want them treated that way.
Each one of our children is special and individual and should be seen as such. But their ear infection, their rash, their acne is not really unique itself and responds to treatment pretty predictably. We do not struggle to accept the wide-spread protocols used in the treatment of other medical conditions, which have been the harvest of evidence-based medicine. One streptococcal skin infection is pretty much like another, whether the child is talented, shy, outgoing or sings like an angel. And anorexia nervosa, as the prototype of an eating disorder, is like that too.
As Dr Bermudez said: “core principles of treatment, including symptom interruption and weight restoration, should not be individualized but rather normalized.” In other words, every patient with the symptom constellation we call anorexia nervosa needs the same underlying treatment: interruption of restricting, exercising, bingeing (where present) or purging (where present) and every one needs complete weight restoration regardless of their feelings about it.
Now, let’s get to it.