Does Residential Eating Disorder Treatment Create Barriers to Care?

Eating disorders are complex illnesses that affect a person both mentally and physically. Due to their complexity, these disorders are among the deadliest mental illnesses, making earlier intervention and effective treatment options crucial. A commonly recommended option for severe eating disorders is to attend a private residential treatment program.

Individuals with marginalized identities report higher incident rates of eating disorders. However, these individuals face many barriers to receiving identity-affirming, accessible care within the current eating disorder treatment model. For this reason, the explosion of residential treatment facilities creates a gap in marginalized individuals' ability to receive care.

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Residential Treatment Outcomes

In 2006, there were 22 residential eating disorder treatment facilities in the United States. By 2014, that number had risen to 75, and this number has only been rising since. However, despite the drastic increase in treatment facilities, little data are proving the effectiveness of these programs.

With the little data available, it is estimated that even after completing an eating disorder program, about 30 percent of eating-disorder patients will remain sick for 10 to 20 years and that many sufferers would only ever reach partial recovery from their eating disorder.

From the few treatment facilities that have published their readmission rates, it is shown that about 45 to 77 percent of their patients are readmitted. This means that more than half of the patients who participate in an eating disorder program will be recommended to return either to that facility or to another.

Now, even these sparse statistics are skewed because the majority of individuals noted in these studies are white, cis-gender women from affluent backgrounds, which eliminates a large portion of individuals who are suffering from eating disorders in the first place.

Groups of Underrepresented Individuals That Report Higher Rates of Eating Disorders

• Members of the LGBTQIA+ community
• Members of the Latinx community
• Black people
• Members of Jewish communities
• Neurodivergent people

Even though these individuals report higher rates of eating disorders, there are nearly no outcome data regarding their time in residential treatment because these individuals face increased barriers to even receiving residential care to begin with.

Barriers to Receiving Eating Disorder Treatment

There could be many reasons why individuals with marginalized identities who suffer from a severe eating disorder may face more barriers to receiving treatment:

1. Lack of Detection

One may be the various reasons eating disorders go undetected.

Some reasons include the following:

• Stereotypes surrounding what an eating disorder does or doesn’t look like
• Shame associated with needing/asking for help
• Limited access to treatment
• Uneducated health care professionals who are unable to spot the disorders due to their own assumptions on how eating disorders appear

2. Financial Burden

Residential treatment facilities almost exclusively take private health insurance. If an individual doesn’t have private health insurance, the out-of-pocket cost of these facilities averages about $1,000 a day, which is wildly inaccessible to anyone without insurance or on government-funded insurance.

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Not to mention residential facilities are commonly located in white, affluent neighborhoods, which makes getting to these facilities expensive and challenging for individuals of diverse ethnic, racial, and economic backgrounds.

Now, even if someone does have health insurance that a facility takes, there are still barriers to receiving care. First, many health insurance plans don’t cover residential programs. Second, if someone’s plan does cover residential care, they will still be required to meet their deductible as well as pay co-pays until their out-of-pocket max is reached. The cost of these can reach thousands of dollars.

Third, even if someone’s insurance was going to cover the cost of the program and they were able to meet their deductible, insurance companies rarely agree to cover the recommended length of stay for individuals who don’t meet certain stereotypical diagnostic criteria, such as low body mass index (BMI), medical complications, etc. This results in early discharge and poor follow-up care.

3. Lack of Individualized Care

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) clearly states the symptoms associated with the eight recognized feeding and eating disorders. However, behind those eight diagnoses is a human being, and human beings each have a unique identity that determines their experience of the world. A key element missing in eating disorder treatment is a recognition of the interplay of a person’s identity and their mental health recovery.

The reality is that current models of eating disorder treatment don’t fully consider a person’s unique lived experience. Many facilities are genderized and don’t have options for gender-expansive individuals. Many facilities are unable or unwilling to offer resources to individuals who cannot afford treatment. And, many facilities are unprepared to support neurodivergent individuals' needs.

What Can Be Done?

There has been an explosion of residential treatment facilities resulting in these programs becoming the leading model for eating disorder treatment. However, that doesn’t mean there aren’t other potentially more effective ways to treat eating disorders.

• It starts with education. If mental health professionals can begin to educate themselves on the nuances of eating disorders and the gaps in research regarding marginalized populations, then there could be an added awareness among providers about individuals whose struggle has remained unnamed and untreated.
• After education comes advocacy. Mental health professionals can begin to get creative about finding alternative approaches when treating individuals who don’t have access to residential treatment.
• With advocacy comes change. The more professionals advocate for alternative approaches to eating disorder treatment, the louder the conversation surrounding treatment barriers becomes. When more people are talking, more people are aware, and this awareness can move the mental health profession toward changes that result in more accessible, identity-affirming care.