New clients consistently say what they want is hope. "I feel so isolated. No one knows the battle I face, the voices in my head telling me I am disgusting and I don't deserve to eat. I hate the body I am trapped in. I have been to treatment centers, but there is nothing in Alaska to help me."
Ignoring an eating disorder does not contribute to its resolution, but ignoring the symptoms and treatment has been standard protocol in Alaska until recently. National statistics extrapolate an estimated 26,000 Alaskans are living with an eating disorder. This figure, based on 2012 data, may be much higher in actuality, since eating disorders are heavily associated with trauma experiences, military history, and Native or marginalized populations — all of which are concentrated in Alaska above national averages.
The fifth edition of the Diagnostic and Statistical Manual (DSM-5) recognizes eating disorders as mental health issues; eating disorder behaviors create neurochemical changes similar to those induced by substance abuse. Current diagnoses include: anorexia nervosa, bulimia nervosa, binge eating disorder, avoidant/restrictive food intake disorder, and other specified feeding and eating disorders.
While the causes of eating disorders remain largely unknown, behaviors are easier to identify, though they often masquerade as an attempt at healthful eating and exercise or body weight management. Parents or caregivers (often called carers to be inclusive of parents of adult children, spouses, siblings and friends of the person living with an eating disorder) may be the first to recognize new eating behaviors, such as sudden interest in restrictive diets, including vegetarianism, picky eating, eating more or less, and weight changes. Minimizing behaviors may be a first-line response, a "you'll be okay" anticipation that the "phase" will be outgrown. Behaviors may raise intuitive concern, and that uncertainty creates a need for medical assessment.
Medical professionals are underprepared for this task. Nationally, fewer than 20 percent of medical residency programs offer as much as an elective in eating disorders. The field of eating disorders is considered a specialty, and is therefore deemed to be extraneous training. This means that a physician may have had only a passing mention of eating disorders during eight to 12 years of medical training. As a result of this lack of training for health professionals, eating disorders may go undiagnosed and a patient may erroneously be assessed as "medically stable" based on interpretation of testing that is not specific for eating disorder conditions. While individuals may appear healthy or even athletic, they may be severely ill.
Anxiety, depression and PTSD are often co-existing with eating problems, and this may prompt seeking assistance from a behavioral health therapist. Similar to medical training, those in psychology professions do not receive specific education regarding assessment or treatment of eating disorders without additional training. This means that when an individual or their family is at the proverbial end of the rope and in need of specific directions on how to regain control of feeding issues, the response they receive from a professional may well be, "I am sorry, I don't know how to help you." Further, clinicians are not well-informed of treatment availability and have little time for assisting in treatment referrals or navigating the highly individualized treatment process through various levels of care.
This is exactly the crux of why eating disorders assessment and treatment is complicated: They are recognized as mental health issues with serious medical complications. Both issues need to be addressed in a collaborative approach while neither profession is equipped to handle the task.
Although treatable at any stage, early intervention is believed to lead to better treatment outcomes. Eating disorder behavior can progress rapidly to costly, time consuming, and life-threatening illnesses. The burden of care is enormous, but often felt individually. Students may fall behind in courses, withdrawing from school or dropping out of college. Parents may be forced to quit a job to care for a child. Adults must choose between employment to keep their insurance benefits or getting the treatment they need. In Alaska, this is exacerbated by a lack of specialized clinicians and complete unavailability for in-patient hospitalization or step-down care.
Eating disorders have the highest mortality rate of any psychological illness. Every 62 minutes, at least one person dies as a direct result of an eating disorder. Although eating disorders wreak havoc on body systems and create medical complexities, suicide is the most common cause of death. Lack of appropriate treatment for the eating disorder and co-occurring conditions is a likely reason.
In honor of World Eating Disorders Action Day this weekend and the more than 30 million Americans living today who will suffer from an eating disorder at some point in their lives, consider joining the newly drafted Alaska State Chapter of the International Association of Eating Disorder Professionals. It invites community participation for eating disorders awareness, prevention and advocacy, and encourages professional competency by providing access to professional resources and specialty training. The organization helps improve statewide treatment referral processes and paves the way for professional collaboration and improved patient care.
Grace Ray Schumacher is a behavioral health registered dietitian nutritionist in Alaska, currently working toward specialized credentialing through the International Association of Eating Disorders Professionals. She provides therapeutic medical nutrition and nutrition counseling through her private practice, Nutrition Partnership, with offices in Anchorage and Palmer, and state-wide telehealth. She is founder and soon-to-be president of the upcoming Alaska State Chapter of the International Association of Eating Disorders Professionals.
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