High achievers overrepresented among patients
Attempting to treat patients using both therapy and magnetic stimulation aligns with the fact that anorexia is likely the result of biological, psychological and social factors.
“There is a familial prevalence, which means that even if a person doesn’t inherit an eating disorder, they inherit some sort of vulnerability. They carry something with them. And it’s those same qualities that make someone a high achiever. This group clearly has an overrepresentation of high achievers.”
Once the disease has developed, certain biological processes become disease-reinforcing in themselves. Starvation can lead to biological changes, making it difficult to break the pattern.
“Why can some people diet, while others succumb to an eating disorder? Perhaps this biological vulnerability makes some succumb.”
Care has improved
Ramklint believes that many patients who do not recover from their eating disorder are highly critical of healthcare. Therefore, in highly specialised care, they will try to pinpoint the type of help patients wish to receive.
“We have obtained ethical approval to interview adults with severe, persistent eating disorders about what they want. Many have emphasised the lack of a patient perspective.”
Even though not all patients can be helped, Ramklint believes there has been significant progress in eating disorder care.
“When I started working in the 1980s, there were no highly specialised units and healthcare was much worse. Patients became extremely ill and ended up in intensive care. Today, it is extremely rare. Deaths due to starvation are also very infrequent.”
Mortality is still elevated among patients with anorexia, but it occurs later and is associated with physical illness, suicide, and substance abuse. Significant progress has also been made in care of young adults. Many young people recover and do not need to seek treatment for eating disorders as adults.
Ramklint believes it is important to keep these advancements in mind and never lose hope, even when it comes to the sickest patients.
“When I worked clinically in eating disorder care, I used to tell my patients, ‘Maybe it didn’t work this time, or last time, but next time it will.’ Perhaps something changes biologically, or they get tired of their illness. You need to constantly think, ‘What haven’t we tried? Can we do something differently?’ Creativity is needed, because all of a sudden it works.”
Sandra Gunnarsson
