The Many Ironies of Eating Disorders
Mahoney, Diana, Clinical Psychiatry News
The media are fascinated with eating disorders: Countless articles in consumer publications, made-for-television movies, and documentaries are devoted to the topic. But attention given to the problem rarely addresses some of the most troubling ironies.
For example, eating disorders are among the most prevalent and insidious mental illnesses in this country, with conservative estimates saying that 5 million to 10 million girls and women and 1 million boys and men meet the diagnostic criteria for one or more eating disorder at any given time. Yet eating disorders research spending pales compared with research funding for less prevalent mental health conditions.
In 2005, for instance, the National Institutes of Health poured $350 million into schizophrenia research, compared with $12 million for eating disorders. With an estimated national prevalence of 2.2 million people, schizophrenia research received an average of $159 per affected person, while eating disorder research got $1.20 per affected individual.
The discrepancy can hardly be justified based on potential disease-related consequences, given that anorexia nervosa alone has a mortality of nearly 10%. That percentage is higher than that of any other mental illness, according to the Alliance for Eating Disorders Awareness, a national nonprofit advocacy group based in North Palm Beach, Fla.
Another financial irony is that insurers will readily cover the costs associated with the medical complications of untreated eating disorders, including various cardiovascular conditions, hematologic illnesses, skeletal damage, and gastrointestinal damage. But rarely do they provide sufficient coverage for evidence-based behavioral and psychological interventions aimed at treating the underlying eating disorder.
In a study of health insurance claims for about 4 million people, Ruth Striegel-Moore, Ph.D., of Wesleyan University in Middletown, Conn., showed that insurance companies only provided coverage for 10% of people diagnosed with eating disorders. When treatment coverage was provided, the therapy typically failed to meet established physician-recommended standards of care (Int. J. Eating Disorders 2000;27:381-9).
Unfortunately, insurance providers often use recurrence of disease as a way to gauge the severity of eating disorders and mete out treatment dollars. Yet numerous studies have shown that the absence of early treatment leads to relapses. And at that point, patients have reached a disease stage requiring more intensive, expensive treatment with a lower likelihood of success.
Cultural ironies cannot be overlooked, either. When Hollywood personalities or other public figures reveal their own disordered eating battles, the "news" is often delivered by television journalists who typify the physical ideal that the media itself tells us is unrealistic for most people to achieve. Or articles decrying the nation's obsession with thinness are sandwiched in magazines between advertisements showcasing impossibly svelte models meant to appeal to that very obsession.
Perhaps the cruelest irony is that despite an awareness of risk factors that predispose people to disordered eating behaviors--body image dissatisfaction, low self-esteem, past trauma or abuse, and involvement in activities that pressure participants to attain a certain body size or shape--disturbed eating patterns are becoming more, not less, prevalent.
According to the federal Office on Women's Health, eating disorders are on the rise in the United States and worldwide, not only among adolescent white women, who are the primary victims, but also among all ethnic groups and among males. In addition, the average age of onset is getting younger, with girls and boys as young as 8 and 9 years old exhibiting pathologic body image concerns.
Advances in understanding the etiology of eating disorders have been significant, but the complexity of these conditions precludes quick fix, one-size-fits-all treatments. …