disordered eating: 'even if the journey is incredibly hard, recovery is possible'

eating disorders have a huge impact on canadians. the national initiative for eating disorders (nied) reports that approximately 1,000,000 canadians have been diagnosed with an eating disorder, and that closer to 2,000,000 have sufficient symptoms for an eating disorder diagnosis. eating disorders are mental health illnesses, with a reported 10 to 15 per cent mortality rate, the highest overall mortality rate of any mental illness. children and adolescents are increasingly at risk for eating disorders, and in canada, between 12 and 30 per cent of girls and nine and 25 per cent of boys aged 10 to 14 report restricting nutritional intake in order to lose weight. most people with eating disorders suffer from additional, anxiety and mood disorders .

finding help can be difficult, not only in childhood, but also in adulthood when getting support in recovery is something that an eating disorders sufferer has to fund alone. with the outbreak of covid-19, the situation has become dire . waiting lists have become frighteningly longer, and hospitals are at more than capacity with eating disorders patients.

kaitlyn axelrod is a social worker and psychotherapist, as well as the program and outreach coordinator at sheena’s place , a not-for-profit group where people aged 17 years old and up can go for support.

what is the biggest challenge in treating eating disorders?
eating disorders are often overlooked by healthcare providers due to a lack of knowledge, limited education and the enduring prevalence of several myths.

why do so few free or subsidized options exist? and why are eating disorders so underfunded and unrecognized by the government?
i believe that the myths about eating disorders listed above play a part in this. our health systems are also not equipped to capture accurate data regarding the prevalence of eating disorders due to both data collection and the capacity of health care providers. the latest eating disorder prevalence data was collected via census survey in 2012 and excludes several eating disorders, including binge eating disorder, which is actually the most common diagnosis. this means that our prevalence estimates are likely an underrepresentation. additionally, doctors in ontario use outdated billing codes when seeing patients — eating disorders are not accurately captured in these billing codes, so even if doctors are accurately diagnosing patients with eating disorders, this information is not relayed to the government.

what is the key to therapy when it comes to addressing childhood trauma as it relates to eating disorders, and coping with staying in recovery past adolescence?
when seeking therapy for an eating disorder and childhood trauma, finding a therapist who you trust is key. therapists (and all practitioners, for that matter) should be trauma-informed and eating disorder-informed if they are going to support someone with both. understanding that eating disorder symptoms serve as coping strategies is also critical. a therapist must support someone in developing alternative coping strategies before expecting that eating disorder symptoms will subside. harm reduction is an important consideration here. how can we support people in minimizing the harm associated with certain behaviours, while acknowledging that food is critical to physical, emotional, social, and cultural well-being? unlike certain substances, we cannot abstain from food.

what direction do we need to go in, when seeking to merge clinical diagnoses, mental health management through therapy, and advocacy?
it’s crucial that all of these worlds listen to each other and learn from each other. this work often happens in silos, which is not the most productive way to make change. clinicians and advocates must be open to communicating and open to changing how things have ‘traditionally’ been done. it’s especially important that people with lived experience are heard and involved in decision-making. in order to work towards eating disorder treatment and recovery for all, we also must recognize eating disorders as social justice issues — people are impacted differently due to systemic oppression.

what can we tell people who are struggling with maintaining their recovery, but who are “too old” to benefit from the infrastructure of places like sick kids?
adult treatment and support options exist too! unfortunately wait lists are long, but there are several hospital-based eating disorder treatment programs for adults in ontario. there are also a few community-based eating disorder organizations in ontario that provide free treatment and support. for example, sheena’s place provides free group-based support to people age 17-plus in ontario affected by eating disorders.

while support groups are not a replacement for therapy or treatment, they can decrease feelings of loneliness and isolation, which often perpetuate eating disorder symptoms. group members can also build community and learn skills for managing symptoms. another community organization called body brave offers ohip-covered eating disorder treatment. there are also private treatment and therapy options, although these are inaccessible to most individuals. the national eating disorder information centre (nedic) is a great place to start for information and referrals — its toll-free helpline and anonymous chat service can help connect individuals to eating disorder services across canada.