'Non-compliance' with ED treatment

I have heard from many patients that they were kicked out of treatment because they were 'non-compliant' with their treatment. For some, this was what they wanted because they did not want treatment anymore. But for others, this wrecked their recovery and left them hopeless.

First, what does 'non-compliant' mean? Technically, it means that you are unwilling to do what your treatment plan/team says you should do to get better. In ED treatment, doctors refer to a patient as being non-compliant if she/he does not eat enough, does not gain weight, or does not suddenyl have amazing thoughts and high self-esteem. But, is this non-compliance? Or is just part of the illness?

My first time in therapy was when I was in grade 12. Let me tell you - I hated it. It was with some therapist that my father found because 'she was the best with EDs'. I won't get into that part much, but I will just say that I absolutely hated it. No offense. Anyways, this therapist worked with me for a while. But after my weight started to plateau, she brought me in for a serious talk. Basically, she told me that since I was not trying hard enough to gain weight, I was being non-compliant with treatment. If I did not gain weight and get back into recovery mode, she said that I could not see her for therapy anymore.

That really hit me hard. I was not trying to NOT gain weight. I was just scared of it. And I felt so weak and tired of gaining and eating. I was frightened, and I felt as though I did not have enough support and love around me. And now this therapist was telling me that I was being NON-COMPLIANT?! I'd prefer to call it scared. I was sick with ED, an illness that despises food and weight gain. Of course I would have moments when I would not want to gain and eat! But this therapist was acting as though as a consequence for my illness, she was letting me go.

Let's rephrase the situation: what if I had cancer, and chemotherapy did not stop the tumour from growing? What if, even after chemo, my cancer continued to grow. Would my doctors kick me out of chemo because I was being non-compliant? No. Of course not. Because it woud not be my fault. The same thing goes for patients with ED. While some people believe that patients with ED are purposefully being non-compliant, we need to realize that they are scared of what recovery will bring and that this is a symptom of their illness. Would a doctor who was treating a patient with chemotherapy blame the patient for their cancer? No. Then why do we blame ED victims for ED?

Maybe 'non-compliance' is actually used in the ED treatment world for 'not going as I had hoped'. For example, maybe therapists tell their patients that they are being non-complaint when really, it is the therapy that is not working out so well. Or maybe the treatment approach needs to change. Or perhpas the patient needs to realize that recovery is really what they want. Helping patients stick to recovery is important - they need support, love, and motivation. They need to realize that even though eating and gaining weight is hard, recovery is worth it and it will get easier. So, perhaps, we need to stop using the word 'non-compliant' as an excuse for failure of treatment and start seeing where the real problem is. It could be motivation, treatment approaches, or something else. But blaming the patient and calling them non-compliant is unfair and unacceptable. My message to treatment providers is this: stop blaming the patient and calling them non-compliant simply because your treatment plan and strategies are not working as you had planned. Start acting like a real professional and find out where the real problem is. Then, make a new plan with the patient. Do not be harsh and treat the patient as if it is their fault that they are not improving. This is part of the illness. ED is tough to treat - ED will not go away quickly. So let's stop blaming the patient for failure of treatment and therapy and srtart finding new and better ways to help the patient overcome this illness.

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