Even as researchers discover more effective treatments for anorexia nervosa and bulimia nervosa, psychologists are working on the policy front to ensure that people with the disorders receive enough insurance coverage to benefit from such interventions.
Among them is social psychologist Jeanine Cogan, PhD, director of the Eating Disorders Coalition for Research Policy and Action, whose mission is to educate Congress and the federal government about the growing public health threat posed by eating disorders.
One of its main policy priorities, Cogan says, is urging Congress to pass legislation that would mandate appropriate coverage for these serious conditions. "We theorize that one reason anorexia has such a high mortality rate is because people with eating disorders have such a hard time getting coverage for long-term care," Cogan says.
Data show that health insurers provide an average of 10 to 15 sessions for people with eating disorders when at least 40 may be needed.
To address the treatment gap and to promote sound policy on eating disorders, the coalition is working to:
Pass the Mental Health Equitable Treatment Act, which would require insurers to cover mental illnesses in the same way as physical illnesses. (The coalition is working with APA on this goal.) The current law allows insurers to set limits on the number of sessions covered, and APA and the coalition want to change that, Cogan says.
Procure congressional and agency funding for research, education, prevention and improved training on eating disorders.
Urge the Centers for Disease Control and Prevention to develop accurate statistics on mortality rates for eating disorders. Those figures are underreported, Cogan says, in part because death certificates don't cite eating disorders as a cause of death.
A study reported in the May 2000 International Journal of Eating Disorders (Vol. 27, No. 4) underscores the importance of these efforts. Analyzing the health-insurance claims of 4 million people, psychologist Ruth Striegel-Moore, PhD, of Wesleyan University and colleagues found that the incidence of patients given an eating disorder diagnosis was only about a 10th of that seen in epidemiological samples of the general population. The finding suggests that many people who need treatment aren't getting it, Striegel-Moore says.
The team also found that the average length of treatment--26 inpatient and 16 outpatient days per year for anorexia nervosa and 12 days for bulimia nervosa--is much lower than the American Psychiatric Association's recommended standards of care for these disorders, says Striegel-Moore, who received the coalition's Research Award at the group's first annual gala event, "Honoring Our Innovators," which at Monitor press time was scheduled to be held Feb. 27 in Washington, D.C. Sen. Hillary Rodham Clinton (D-N.Y.), who has become an outspoken advocate for those affected by eating disorders, is this year's recipient of the coalition's Policy Award.
Tori DeAngelis is a writer in Syracuse, N.Y.