Navigating Resistance: How to Support Families Who Want to Postpone Eating Disorder Treatment
“My patient received a recommendation for a higher level of eating disorder care, but their family wants to hold off until a ‘better time.’ How do I help them understand the risks of waiting?”
Eating disorder clinicians frequently face the challenge of resistance to care. This resistance stems from various factors, such as a fear of the unknown, difficulty acknowledging the severity of the illness, and ambivalence toward the recovery process. The prospect of interrupting life for treatment often only adds to the anxiety.
The reality is that there is rarely a “perfect time” to enter treatment. School and work conflicts, social obligations, seasonal celebrations, and vacation plans will always be there – and they will always conflict with the stressors and disruptions of treatment.
Underlying the reasons for delaying care is often a layer of denial and feelings of overwhelm, leading an individual or their support system to question whether getting better is truly worth it, or whether it’s the best time to start on the journey to recovery. Regardless of the length of one’s list of obstacles, timely treatment is essential – even when it’s not convenient.
Referring providers like you are essential to patients’ recovery, as you can kick-start the process. At Veritas Collaborative, we work to maintain a level of collaboration with you throughout your patients’ treatment progression. We are in this together, involving you in the process so you become educated and empowered about these insidious illnesses, helping you ultimately do best by your patients.
If one of your patients or their family is questioning a recommended higher level of care, and you find yourself a little stuck as to what to do next, we encourage you to consider the following to advocate for your patient’s recovery.
Understanding Level of Care Recommendations
The right level of care sets a patient up for sustained, lifelong recovery with a lower likelihood of relapse or recurrence. Determining a level of care is not just a box we check at random; there is a breadth of expertise and training behind our recommendations. Our personalized assessments allow us to tailor care recommendations to each patient’s clinical needs, our understanding of their relationship with food and body, their symptoms, and their family needs, while also considering the standard of care guidelines for eating disorders.
Years of research support the fact that individuals who adhere to level of care guidelines see the best outcomes. For patients and their families who want to delay a recommended higher level of care, we suggest sitting down with them and reviewing the facts of the case. Our Determining Levels of Care brochure outlines an assortment of factors we consider when making a level of care decision. Reviewing this resource with your patient could provide clarity about why the treatment recommended is the best fit for them right now.
It’s worth noting that a higher level of care corresponds with more intensive treatment. In delaying care, there is the possibility that your patient will no longer be suited to their initial recommendation and will require more intensive programming, thus contributing to greater life disruptions.
Ultimately, urging your patients and their families to seek the appropriate level of care at the time they receive the recommendation is the optimal way to ensure success in treatment.
Understanding the Long-Term Health Risks of Eating Disorders
Every 52 minutes, an individual dies as a direct result of an eating disorder. Eating disorders carry an increased risk of death from both suicide and medical complications that are a direct result of eating disorder behaviors. This statistic is grim but imparts a sense of urgency and necessity for championing early intervention. We cannot afford to wait. Honoring the treatment recommended based on a patient’s symptomatology may prevent them from being part of this frightening statistic.
Each type of eating disorder – anorexia, bulimia, binge eating disorder, ARFID, and OSFED – carries serious emotional and physical consequences, with countless studies confirming the reach of this impact. The longer treatment is delayed, the more time an individual’s brain adapts to the distorted behavioral patterns of the illness. By starting treatment early, we can cut through and shift patterns of behavior and thinking before they become more entrenched and pronounced.
Eating disorders can impact virtually every organ system of the body. While the changes to these systems are not always permanent, the longer proper renourishment and vital medical care are postponed, the greater the likelihood is for irreversible complications.
For example:
- Inadequate nutritional intake with Avoidant/Restrictive Food Intake Disorder (ARFID) comes with a risk of inadequate growth in height, and patients may not be able to catch up to their genetic potential
- Purging behaviors deplete the body of electrolytes, which can lead to a seizure or heart attack
- Recurrent binge eating episodes may lead to diabetes, irritable bowel syndrome, or sleep apnea
- Restrictive eating disorders such as anorexia nervosa can result in impaired bone density and strength, causing early-onset osteoporosis
Bottom line: Make it clear that timely eating disorder treatment will protect an individual and their support system from a host of potentially dire health outcomes.
A Harder Road to Recovery
Understanding resistance to care is a natural part of the eating disorder puzzle. In many eating disorders – especially ego-syntonic disorders like anorexia – resistance is often reinforced by the illness itself, as well as by our culture. We live in a society that praises restriction, weight loss, and body fixation, adding barriers to engaging in the recovery process.
Tapping into a patient’s values outside of their eating disorder and understanding their future plans and goals can help with decreasing resistance. The longer an eating disorder persists, the greater its impact on quality of life. An eating disorder’s range of physical, mental, and social impairments may make living in accordance with one’s values and achieving their goals significantly more challenging, if not impossible.
Your patient deserves to engage with life meaningfully and in accordance with their values. Leverage your therapeutic relationship to help your patient and their family understand the consequences that putting off treatment will have on their future. The trade-off of inconvenience for a harder road to recovery is simply not worth it.
For more information about the detection and management of eating disorders in children and adolescents, as well as the medical risks posed in delaying care, consider attending Dr. Anna B. Tanner’s upcoming webinar titled “Not Just a Phase: Eating Disorders in Children and Adolescents” on Thursday, April 13. Learn more and register here.
About the Author
Dr. Anna B. Tanner is Vice President of Child and Adolescent Medicine for Accanto Health, the parent company of Veritas Collaborative and The Emily Program. She is a board-certified Pediatrician who has specialized in the care of complicated adolescent patients, in particular patients with eating disorders, for over 20 years.
Dr. Tanner completed medical school and residency at Vanderbilt University, and then remained there to serve on the Pediatrics faculty in the Division of Young Adult and Adolescent Medicine. Dr. Tanner has been very involved in advocacy and education efforts and serves on national and international committees for eating disorders education. She speaks frequently across the United States on the Medical Complications of Eating Disorders, especially as they affect children and young adolescents, and contributed a book chapter on that topic in the 4th edition of Dr. Philip S. Mehler’s Eating Disorders: A Comprehensive Guide to Medical Care and Complications.
Dr. Tanner currently serves as an Adjunct Assistant Professor of Pediatrics for Emory University School of Medicine and as an Adjunct Assistant Professor of Pediatrics for Morehouse School of Medicine. She is co-chair of the Academy of Eating Disorders (AED) Medical Care Standards Committee and a member of the International Association of Eating Disorders Professionals (IAEDP) Certification Committee Task Force.
Dr. Tanner is a Fellow in the Society for Adolescent Health and Medicine (SAHM), a Certified Eating Disorder Specialist, and a Certified Eating Disorders Supervisor. She has been named by Atlanta magazine as a “Top Doctor” every year from 2013 to 2022 and named by Castle Connelly as an Exceptional Woman in Medicine and one of America’s Most Honored Doctors.