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Guidance on Levels of Care for Eating Disorder Treatment: How & When to Refer

By Steven F. Crawford, MD

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Eating disorders affect more than 30 million Americans. Despite their prevalence and the reality that they have one of the highest mortality rates of all psychiatric illnesses, access to treatment remains challenging. Only one in three individuals with anorexia nervosa receives mental care, and for bulimia nervosa the numbers are much lower at approximately 6%. As a society, we still seem locked into the stereotype of who has an eating disorder, i.e., an adolescent, white, upper-middle-class female. And yet that stereotype is no longer valid. Eating disorders impact individuals of all ages, genders, races, sexual orientations and socioeconomic levels. More middle-aged individuals are requiring hospitalization than ever before and more men are being identified, with numbers now thought to be as high as 4 in 10 individuals with an eating disorder being male, compared to the historical statistic of 1 in 10.

In addition to the high mortality rate, eating disorders have a profound impact on the lives of individuals struggling with these illnesses. Without treatment, individuals can experience negative impact on their interpersonal relationships, lower rates of marriage and fertility, and inability to reach their potential. Despite these adverse consequences, individuals with eating disorders are frequently ambivalent at best about treatment as the eating disorder may play a role in their life, serving as a coping mechanism or even as an identity. Subsequently, they may be more reluctant to disclose their symptoms and less forthcoming with their medical provider, choosing to not reveal their behaviors.

Another factor is that eating disorders develop gradually. A person slowly begins to engage in these behaviors, and so the consequences develop over time and may not be recognized by family, friends and even providers. On top of this, many healthcare professionals are not trained to recognize, much less treat, eating disorders. The result is that many individuals miss out on the opportunity to access treatment. And yet, surveys have revealed that when asked directly by a healthcare provider about disordered eating, individuals tend to be open about their behaviors.

Written by

Steven F. Crawford, MD

Dr. Steven Crawford is Managing Director, Medical at Eating Recovery Center and Assistant Chief of Psychiatry at University of Maryland-St. Joseph Medical Center. Dr. Crawford attended University of…

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