Please Don’t Complain to Me About the Eating Disorder Patient. I Was One
A medical student reflects on their own experience of an eating disorder and mental illness to help medical professionals better understand how to treat their illness, as well as offer support for fellow medical students and doctors who also experience these conditions.
Please don’t complain to me about the eating disorder patient.
I was one.
I know how it appears. I know how frustrated you must be that they just won’t eat, that they just won’t comply, that they just won’t get better. I know, because I felt exactly the same way about myself.
I know you can’t fathom why they’re risking their lives and wellbeing for fear of eating and gaining weight. I know it doesn’t make any sense to your medically-informed mind because I couldn’t comprehend it myself. I was told, as a medical student, I “should know better.”
The patients seem sneaky, manipulative and ungrateful for the care. I promise I sat in my hospital room afraid of being a burden and wasting a bed. I felt guilty for having an illness warranting such distrust in those ailed by it. I felt guilty because I knew I would distrust myself too. I did distrust myself.
I promise that I felt as much a waste of resources and staffing time as you thought I was.
Sitting in my chair, eating my tenth biscuit and cheese, I could hear the conversations that occur about eating disorder patients before I was a part of them on the other side of the door as a medical student. The shame I felt for being in the position weighed as heavily in my stomach as the superhuman quantities of food which were saving my life.
I’m unsure if I’ll ever be able to truly articulate how I felt in the depths of my illness, or even how I feel on the tumultuous journey to recover. I’m unsure if I’ll ever help you to truly understand why many of us end up where we do. That it wasn’t a preoccupation with vanity or winning boys. Fitting into a dress wasn’t what shrunk my life down to a bare ability to survive. I didn’t land on the ward by choice - I didn’t even have the choice to leave.
It’s not an experience I endured for fun. Being in hospital with an eating disorder is a demeaning, vulnerable process, and continuing to see health professionals for ongoing treatment is a process drenched in stigma.
To have one half of you fighting so desperately against the other as you reprimand yourself for ending up where you are to begin with, it’s both comforting and distressing to know you’re not alone. A global systematic review showed the prevalence of eating disorders amongst medical students was 10.4%, compared to 7.8% amongst the general population. It’s a condition often underdiagnosed, undertreated and under taught in the medical field.
A preliminary report from the Melbourne University Centre for Mental Health suggests that stigma experienced within and from the medical profession could be improved by shifting from the “fundamentally discriminatory” biomedical paradigm which results in a lack of agency of those with lived experience. The report suggests:
- Incorporating more intensive training in mental health, including from those with lived experience and
- Incorporating reflective practice that allows us to understand our attitudes and the impact of these on those with mental illness, even if mental illness isn’t our “presenting complaint.”
Our attitudes (my own included) towards those with rarer or more stigmatised mental health conditions without a doubt can act as an obstacle to ourselves as health professionals, and to our patients in accessing equal and open healthcare that doesn’t label, but provides hope.
I’m a medical student and though you wouldn’t know it from meeting me, I have an eating disorder. I once sat in the room we’re talking outside, imagining the conversation we’re having. At the time, I wrote it off as me projecting. On one hand, I know I wasn’t wrong. On the other, I hate being so right.
I once sat in the room we’re talking outside, imagining the conversation we’re having. At the time, I wrote it off as me projecting. On one hand, I know I wasn’t wrong. On the other, I hate being so right.
Some practical tips:
I have put together these based on my own experience or the sources referenced. However, everyone’s experiences are different.
For current (or future) health professionals:
Health professionals are not immune to stereotypes or stigmatising beliefs found in the community and it’s completely okay to have biases - as long as you can identify and challenge these in your treatment of patients:
- Negative clinical encounters are marked by judgement, disregard or prejudice.
If you find yourself interacting with a patient who has an eating disorder, empathy can look like asking how they are truly feeling, the challenges they are facing and acknowledging that they didn’t choose to be in the position they are in, but that you will support them in their journey to recovery.
- Eating disorders are diverse and present in different ways.
To best detect and treat them, it is important to realise that the stereotype of the thin, affluent, young, white woman might not be the one in the room. Be cognizant of your bias, challenge it. Validate their concerns and that they deserve support and treatment. Even those who do present in the typical way will not be “fixed” once they reach a healthy weight, despite what the DSM-5 might tell you about the diagnosis.
- Treat them as you would any other “ill” patient.
Just like someone with pneumonia or heart failure, those with eating disorders didn’t choose to be sick and it can be difficult to “choose” to get better straight away. It might feel like it’s as simple as substituting a burger for a hospital bed from the outside eye, but eating disorders, particularly anorexia nervosa, have the highest mortality of all mental illnesses and need support during inpatient, intensive outpatient and then more ongoing treatment.
- You never know who has been impacted by an eating disorder.
Even if you take your stigma-soaked conversation away from a patient’s room, a member of the nursing staff, a medical student or doctor on the team might feel every word you say personally due to their own experiences, or you may prevent someone from seeking help. It is important for us to all be conscious of the way we talk about eating disorders and all mental illnesses and reflect on our practice regularly.
- Some further resources you might like to look at:
- National Eating Disorders Collaboration: www.nedc.com.au
- Centre of Excellence in Eating Disorders Victoria: https://ceed.org.au/
- The Butterfly Foundation: https://butterfly.org.au/
For those who identify with any of the content raised in this article:
Please know that you’re not alone and that it is never your fault, even IF you’re a medical student/junior doctor/on another health pathway. The most important step is to seek help from those who are close to you, and if those people don’t exist (either due to personal beliefs or geographical distance), there are many options available. I first reached out to the Butterfly Foundation webchat and they helped guide me to seek medical attention. I would recommend heading to their website for some more resources and/or someone to chat to: https://butterfly.org.au/get-support/helpline/
Following this stage, I was able to link in with a psychologist, dietitian and a GP who I now see either weekly or fortnightly via telehealth and in person for support.
I found it very useful to imagine myself as a patient or a friend and consider how I would treat them. I would treat them with compassion, validate their struggles and encourage them to seek help. I hope you do the same for yourself and if you do find it difficult (I know I did!), consider this for you - you don’t “know better” and you DO deserve help.
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