A big part of my job both as a science writer and as a blogger here for ED Bites is to read news articles. For ED Bites, not surprisingly, those articles are generally about eating disorders.
The problem with regularly perusing media coverage of eating disorders is that I am left wanting to stab out my own eyeballs in frustration and despair.
Cases in point:
Anorexia and bulimia are “dramatically” on the rise.
Anorexia and bulimia are also dramatically on the increase: official figures for hospital admissions released last October pinpointed a 16 per cent rise in hospital admissions for eating disorders, and showed that one in every 10 of these admissions was a 15-year-old girl.
“There’s plenty to be concerned about,” Biddulph says. “Everyone who has a teenage daughter right now sees this, in their child and among their child’s friends.” The people they blame, he says, are the advertising industry and the media. “They are driving girls’ sensibilities and making them miserable. The corporate world has identified them as a new market for products, and is preying on them.”
The article also talked about the “epidemic” of self-harm in the same population. Although I can’t talk as much about self-harm prevalence, I can tell you that the interpretation of the official figures for hospital admissions tell us nothing more than that there was an increase in hospital admissions.
Here’s what it doesn’t mean:
- There’s an increase in the number of cases of eating disorders. Nope. Overall number of cases could have remained the same or even gone down. We don’t know, truthfully. It could be that the cases are more severe, or that people are actually being hospitalized more frequently. It doesn’t indicate how many ED cases there are that don’t actually end up in the hospital.
- An increase in hospitalization is a terrible thing. If more people being in the hospital means that more people are getting the care that they need, then this is a good thing.
- The world has it out for 15-year-old girls. Considering that peak onset for anorexia is puberty (and, at least in the UK, anorexia is the ED that is most frequently hospitalized), it’s not surprising that a high number of hospitalized people are aged 15. Neither surprising, nor shocking, if the reporter had done her background research.
- There is an epidemic of eating disorders. To get really technical, an epidemic occurs “when new cases of a certain disease, in a given human population, and during a given period, substantially exceed what is expected based on recent experience.” (Thanks, Wikipedia). Here’s the rub: we don’t have any data on the current number of new or existing EDs in the community, so we absolutely CANNOT accurately say if there are more cases than we would expect. Because we don’t know how many cases to expect. It’s all smoke and mirrors to say there’s an epidemic. As far as we know, there’s not.
When all else fails, blame the patient.
The results of a coroner’s inquest into the death of a young woman from anorexia were reported
, and here is what the medical examiner concluded:
Issuing a narrative verdict, Mr Hinchliff said: “She never fully complied with the treatment regime which had a major impact on her physical health and caused her death.”
Because, yes, it was the patient’s fault she died, wasn’t it?
It wasn’t that she didn’t comply, it was that she couldn’t comply. When you are underweight and malnourished and frightened, facing the thing that scares you more than anything (food) six times a day is often more than a person can tolerate. Most of the time, ED patients do want to get well, they just can’t handle the fear and anxiety. The disorder, then, becomes preferable.
The problem is that too many of the organizations that pay for ED treatment (whether it’s insurance companies, the NHS, whatever) see weight restoration as the “cure” for anorexia. Nutritional rehabilitation is crucial and needs to happen for recovery, but just because a patient has gained weight doesn’t mean that their eating disorder is gone. So people relapse, again and again and again, and everyone barks at them that they can’t be helped.
This behavior isn’t a choice. We need to stop expecting compliance from ED patients in the beginning of recovery. Treatment providers need to comply with the patient’s abilities at his/her particular stage of recovery. That’s where compliance needs to happen. It’s not–and can’t be–the patient’s job.