Steering Committee Members
Danielle Colborn, PhD
Annette Kluck, PhD
Anne Kubal, PhD, CEDS-S
Riley Nickols, PhD, CEDS
Andrea Seefeldt, PsyD
Christine Selby, PhD, CEDS, CMPC-E
Leslie Sim, PhD, ABPP
We are proposing a new American Psychological Association (APA) Division, the Society of Eating Disorders and Body Image, that will support APA’s mission to advance the creation, communication and application of psychological knowledge to benefit society and improve peoples’ lives. More than 30 million Americans of all ages, genders, race and ethnicities suffer from eating disorders which are complex and difficult to treat illnesses. These individuals and their families will benefit from the collaboration of psychologists working towards the shared objective of advancing, communicating and disseminating the psychological science on eating disorders. This collaboration has the potential to improve outcomes and reduce suffering of patients with eating disorders and their family members, and to decrease the costs of these deadly disorders to society.
Eating disorders have the highest rate of mortality (1 in 5) (Arcelus, Mitchell, Wales, & Nielsen, 2011) and place some of the greatest costs on the health system of any psychiatric disorder (“The Social and Economic Costs of Eating Disorders in the United States,” 2020). Untreated eating disorders set in motion a cascade of acute and chronic medical complications, including but not limited to bone damage, neurological impairments, and cardiac abnormalities (Westmoreland, Krantz, & Mehler, 2016). These complications magnify the severity and chronicity of these conditions and by extension, the imposing cost of care.
In addition to the impact of these conditions on physical health, eating disorders represent a considerable threat to emotional functioning and well-being, with those affected showing high rates of psychiatric comorbidities such as depression, anxiety, personality disorders and substance abuse (Garcia et al., 2020; Martinussen et al., 2017). Not surprisingly, individuals with eating disorders experience an extremely poor quality of life and a high disease burden. This may explain why eating disorders have the highest risk of suicide (25 fold) of all forms of mental illness (Udo, Bitley, & Grilo, 2019). Even relatively low severity cases can have a chronic and relapsing course that can require lengthy and intensive treatments, including inpatient and day treatment programs.
Although health service utilization and hospitalizations among individuals with eating disorders are high, very few patients have access to evidence based assessment and treatment (Ágh et al., 2016; Striegel Weissman & Rosselli, 2017). Depending on the specific eating disorder, only one to two thirds of all individuals afflicted seek help for their condition, with even lower rates of help seeking among men, ethnic/racial minorities, and people in larger bodies (Coffino, Udo, & Grilo, 2019). This gap in treatment access puts these groups at risk of health complications, costly comorbidities and poor outcomes in a patient population already at high risk for poor outcomes (Coffino et al., 2019).
Contributing to the medical and psychological burden of these conditions are large scale systemic problems in research, training, and dissemination of evidence based treatments (Cooper & Bailey-Straebler, 2015; Von Ranson, Wallace, & Stevenson, 2013; Waller, 2016). Although most psychologists encounter patients with eating disorders in their practice, few have specialized training to detect, assess and treat these conditions (Von Ranson et al., 2013). This lack of training allows eating disorders to go unrecognized and untreated, particularly in those patients who do not meet the mistaken stereotype of a young, white, thin, affluent female. Even when eating disorders are identified, they can be misdirected into iatrogenic care and may struggle to obtain insurance coverage for their treatment.
Although empirically supported treatments are available, dissemination of these treatments are poor (Cooper & Bailey-Straebler, 2015; Von Ranson et al., 2013; Waller, 2016). Even clinicians who purportedly specialize in eating disorders often fail to utilize evidence based psychotherapies (Von Ranson et al., 2013). This may be due to limited dissemination efforts, coupled with a research base drawn almost exclusively from a homogenous patient population which does not resemble patients seen in real world practice.
Trials of evidence based treatments such as Cognitive Behavior Therapy-Enhanced (CBT-E) for adult anorexia nervosa, Cognitive Behavior Therapy for bulimia nervosa and binge eating disorder, and Family Based Treatment for adolescent anorexia nervosa demonstrate large effect sizes (Agras, Walsh, Fairburn, Wilson, & Kraemer, 2000; Ellison et al., 2012; Grilo & Masheb, 2005; Lock, Couturier, Bryson, & Agras, 2006; Nyman-Carlsson, Birgegård, Engström, Gustafsson, & Nevonen, 2019; Pike, 1998; Russell, Szmukler, Dare, & Eisler, 1987; Poulsen et al., 2014; Touyz et al., 2013). Yet, in light of high levels of attrition, relapse and non-remission, much work is still needed to improve outcomes (Frostad et al., 2018; Halmi et al., 2005; Lock et al., 2006; Pike, 1998). Unfortunately, efforts to improve treatments for these disorders are hampered by low rates of funding ($0.73 per individual with eating disorders compared with $86.65 per individual with schizophrenia)(Murray, Pila, Griffiths, & Le Grange, 2017). These low rates of research funding do not align with the severity of these conditions, life threatening medical and psychological complications, large scale disease burden, and pervasive costs to society inflicted by these disorders (Murray et al., 2017).
Psychologists play a unique role in addressing the systemic problems in adequately assessing and treating individuals with eating disorders. Psychologists are leaders in understanding social, developmental, cultural, and biobehavioral contexts that increase risk for eating disorders. Psychologists have expertise in conducting, evaluating and disseminating research on best practices for the assessment and treatment of psychological disorders. In addition, psychologists are in a unique position to correct disparities that are rampant in the research and clinical care of patients with eating disorders. Their role as scientists, clinicians and educators of psychological knowledge allows them to advocate for funding and policies at local, state and federal levels. Moreover, psychologists continue to play a central role in contributing to the basic science on eating disorders which serves to improve our understanding of these conditions and has implications for the prevention and treatment of these malignant conditions. As such, it is vital that psychologists have a home organization to unite the professionals in our field doing this work (e.g., role of psychologists in non-eating disorder specific environments (Farber, Ali, Van Sickle, & Kaslow, 2017; Kazak, Nash, Hiroto, & Kaslow, 2017; Wahass, 2005).
In light of the considerable challenges to address within the field of eating disorders, as well as the unique training and expertise of psychologists to confront these problems, we are proposing a new division of eating disorders and body image. The goal of this division is to join the resources of interested psychologists motivated by the shared goal of enhancing education and training in the area of eating disorders, as well as researching, summarizing and disseminating information on best practices for eating disorders. Last but not least, we aim to address the issues of social justice related to eating disorders and body image by working towards eliminating widespread health care disparities in the field, improving funding for the care and research on eating disorders, and decreasing stigma and discrimination towards people in larger bodies.
We believe that our objectives are congruent with the mission of APA to advance the creation, communication and application of psychological knowledge to benefit society and improve people’s lives. Although we envision this division to be spearheaded by psychologists, we support the mission of APA by building collaborations among other disciplines (e.g., registered dieticians, social workers, counselors, medical professionals) to enhance the understanding and care of individuals with eating disorders (APA, 2020).
References
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