The "perfect patient"

Eating disorder treatment presents with a lot of ironies. They are often disorders of perfection, yet treatment sometimes demands perfection to save the person's life. For example, you need to eat exactly this, nothing more, nothing less, to make sure that we can keep you safe and out of the hospital. Ironic, huh? Never mind that the eating disorder is about over-focus on food and weight, yet what must (good) treatment focus on initially? Food and weight. I'm not sure there could be a more ironic field. Well, I guess sometimes in medicine, a similar thing happens. With cancer; here, take this lethal medication in an effort to save your life. Let's kill off all your body's defenses so it can defend itself better. So, I guess it's not just eating disorders, but it certainly is not the norm.

So, if eating disorders are about perfection, and some level of precision is needed at times during the process, what do you do with the "perfect patient?" These are the patients who come in and they want help on some level, but more so, perhaps, they want you to like them, accept them, approve of them. So, they tell you what they think you want to hear. Often times, they actually do the behaviors perfectly. For instance, they follow their meal plan perfectly, but they are not telling you that it is killing them inside. The outcome, in my experience, is that they gain weight, for example, or they stop bingeing and purging, or they stop whatever ED symptom, but the psychological parts of the disorder go unaddressed because they are showing you they are perfect, and are handling things perfectly. They are at high risk of relapse, as a result. And then they can't tell you about the relapse, because a relapse isn't perfect.

On the surface, it sure is nice to have a compliant patient. What a relief, right? Well, not so much. Because eating disorders are terribly painful diseases; they are hell to live with and to overcome. So, the process should not look perfect. Now, in that, I'm not saying that we should expect and accept non-compliance, because that won't help anything either. No, I'm saying that we need compliance, but honesty about horribly painful and difficult that compliance is. That is treatment. That is recovery. If your patient or your loved one is smiling at you about recovery from his/her ED, look deeper. Help him/her to talk about how it really feels to do what needs to be done in order to recover. In doing that, he/she relearns how to talk about all that he/she used her ED to avoid. As the ability to communicate returns, the need for the eating disorder decreases.

That is treatment. That is recovery.