Monday, 7 April 2014

ED and Medical Education

Throughout my studying, I noticed that very little information is available to students about ED. In elementary school, the focus of health teaching was on nutrition and how to avoid obesity. We hardly mentioned anorexia or bulimia. But what about in nursing or medical education in universities? Is it included? In my experience, not very much. Now, I know that obesity may seem to be more of an epidemic, but does that mean that we should not learn about ED and how to help our patients? Maybe it will be covered in a 'mental health' setting as opposed to general medical information. Bur I still feel that it should be given its time. As well, when ED is mentioned, I still believe that people are not getting the facts right. Let me explain...

One of my nursing textbooks (this is a paraphrase, not direct quote; nonetheless, the message is essentially the same) says that anorexia is a 'disease where young women feel overweight when they clearly not. They are irrational and perfectionist. Often dying from lack of body fat and nutrition, this girl typically is not engaged in sexual relationships and does not usually associate with others. She is preoccupied with food and weight, and this impairs her social life. Research shows that causes of anorexia nervosa are: having an unsteady relationship with one's mother, having overprotective parents, and not being permitted to express emotions in the family unit'. (I will not quote wher this is from out of respect to the authors, who honestly do a great job of explaining all other diseases - except for anorexia and eating disorders).

Do you spot the problem with the text? First, not all patients are 'irriational'. Yes, the fear of gaining weight may not seem proportional to the issue at hand, but it is a REAL fear because ED is a MENTAL illness. Calling patients irriational is, in my opinion, a bit harsh. Now, what about not being engaged in sexual or other relationships? There are MANY ED victims who are in a sexual relationship - it is not right to assume that their ED stops this from happening. And the social part? I was sick with ED and has lots of friends, and I spent a lot of time with them. Yes, ED may hinder some parts of our social lives, but it does not mean that we are loners. Lastly, the causes that they list are not supported by evidence. Maybe some people with ED have the above characteristics, but until now, no UPDATED and SUPPORTED research has shown that having overprotective parents or a bad mother causes ED. To blame a mental illness on such things is, in my opinon, unfair and biased.

What should we learn in medical school or nursing education? That ED is a MENTAL or psychological illness with many different causes and triggers, but no one thing solely causes it. In fact, a mix of genetics, brain chemistry, hormones, social amd personal factors interplay with one another. ED is also serious, and it is life-threatening. To characterize patients as perfectionist and irrational may be applicable to some patients, but maybe it would be more appropriate to say that patients with ED are usually perfectionist, and due to their mental illness (which they cannot control), they fear gaining weight and being fat. Finally, we need to focus on how ED should be treated and how we can help patients. Food is medicine, but so is therapy and expressing emotions. Helping the patient regain their lives that they lost due to ED is critical. Understanding and helping them see that they are victims and not the cause for their disorder is of the upmost importance. Not blaming the patient is NUMBER ONE.

Like with many mental illnesses, we still have a long way to go before medical education perfectly explains what ED is and how we can help our patients. We get so focussed on learning and teaching about other disorders like heart disease, kidney failure, diabetes, etc that we forget that mental health is deadly and serious as well. I think it's time that we put aside these wrong patterns of thinking and start to realize that as medical professionals, we need to learn about the other diseases that patients may present with - mental and emotional illnesses that require time, healing, trust, and empathy.


  1. This problem with education is am issue in the UK too, despite the work of charities to educate people, the stigma which ignorance creates is a big part of the problems I have had almost more than managing the symptoms of the ED. This included a GP when I was in the early stages of my ED, who atuly made the ED worse by insensitive comments.

    I was very fortunate going to my GP a few weeks ago when my ED came back, she got that there was a problem and looked up what to do. I did go armed with a better understanding this time and knowing more what to say, so as to get the response I wanted. I also sort my own help in counselling before going so I knew better what was going on in my head.


    1. I was told that majority of GPs do not know how to diagnose or treat or even refer appropriately.
      Some of them think ED is a choice or just a behaviour and they do not know the seriousness of Ed as fatal mental illness.
      Phoebe you armed yourself and you have GP who can look up info to help.
      Marina fed up from the care given by ED programs and she managed to empower herself and self treat and she did set an example
      Not every body able to do what you guys doing.


  2. That is why even many doctors are not familiar with ED and can not notice people even when their condition close to terminal. I had that experience with my daughter.
    You was able Marina to tell me where I can seek help.

    A thankful mother

  3. I learnt from you and your blog more that all programs I went to.
    I can understand how my family doctors was the last one to recognize that I was suffering from ED as no teaching about ED in med school


  4. This is a defect in our education system and should be fixed.

    I add my voice to yours Marina


  5. You are right Marina
    It was my initiative to do Psych elective and work at ED clinic ,otherwise I would only know very little info about ED that would not help as MD to identify ,early pick up of those at risk .

    Med student

  6. Is this a gap in med school and nursing school teaching ??


  7. Thank you for the 7 tips .
    This post is fantastic especially the pictures
    I am blaming doctors and nurses for not able to self educate when see a client with issues related to ED.


  8. Marina
    I want also to comment on the book you alluded to.
    Sounds like the authors do not know what ED really means and above all not respectful to ED victims.
    Good news ED is a past in our life and now We need awareness


  9. As you know I am a therapist and I treated many who has at least part of their life were struggling with ED and I can tell you ,how good quality they have .They are nice, polite ,hard worker ,love others ,able to accommodate others and love to share their experiences with others.
    You Marina ,showed all your reader what a responsible mature person can be and you set an example of altruism and caring person.
    May God bless you.
    Even if the majority of those suffer ED may have some of those symptoms' the author was talking about, but always there is exceptions to the rule.

    Kelly W

  10. One important skill I learnt from my long years of ED is one needs to differentiate between the disease and the person.
    ED can make victim to lie, cheat ,ignore ,be rude etc. but the real person is quiet different ..
    I urge every body to be supportive ,understanding and compassionate with any body who happen to have any mental illness.

    Thanks Marina

    Recovered ED survivor

  11. Let's put hand in hand to advocate for those who has or had ED or any mental illness to restore the life that is lost dealing with it and to compensate them for what they missed and help them catch up with what the illness denied them.


  12. ED hit the most talented youth who happen to come from educated caring family and can hit any one at any time.
    I recall Marina's post about ED does not discriminate .
    I remember Marina said doctors need to see what kind of person has the disease rather than only what kind of a disease a person has.

    I add my voice to you Marina ,please everybody be compassionate and sensitive to each others and especially to those who has or had any mental illness.

    With my humble respect


  13. The seven tips could be considered as the bible of helping those who suffer ED and their family.
    Excellent post Marina


  14. Med school and even our education need to change to meet our demand .
    Treating Ed if early diagnosed is possible and can be managed by family doctor if they have the skills.
    At least I want to see doctors to be compassionate and caring and act as a resourse for their clients


  15. I learn something new from every post I read.
    Thank you for defending all those who are ill and not only ED.


  16. No body agree with this author generalization.
    I know friends with Ed and despite they were very sick from it but none had any of those qualities the author talked about.
    I believe there we live in a free country with people from all walks of life and so you can see different characters among us .


  17. Most books I read and your blog Marina telling us ED victims are very smart, hard workers ,kind and friendly.
    The authors describing only the few fraction that could be exceptions rather than the norm.


  18. Thank you for this post Marina! I find the same thing in textbooks and it annoys me. Then my classmates talk about ED like they know everything from reading the textbook and it's all wrong. I sat through many lectures almost in tears hearing classmates talk about people with EDs and saying such hurtful things. I wish I had your courage to stand up. I'm just so scared for everyone to know.


    1. Cat
      You do have lots of courage too.
      Just mentioning this comment telling us that you identify an issue and you tried the best you could do.
      Marina off course is going way and beyond and We appreciate every single effort.
      Myself I got hurt badly from ED and now doing very well for myself but I am not doing any work for others as you guys.
      May God bless you

      Recovered ED survivor for 7 years

  19. Very helpful post.
    Well done


  20. ED is the same as depression or anxiety disorders. All are mental illnesses and all symptoms can range from mild to severe along a continuum from minimum to severe.
    So what can be right in one person may not match other person and so health care provider has be aware that need to look at every person as unique and ma

  21. Last comment was mine .
    To complete what I was saying

    No one size fits all.
    In Hospitals and clinics We work to gauge all guidelines so as to suit our client same as Taylors making shirts .All are shirts but different sizes and shape so that can meet the need of every body.

    Wonderful post Marina

    CJ(RN and CDE)

  22. I am hoping that any book author would do all what they can to quote the literature and when is possible mention the odd of a symptom or a behaviour ,say for example 10% of ED may have this etc. rather than generalization
    We all need to be sensitive to one another.
    No one is immune .
    Any of us or some one close to us can get hit with a disease at any time .

    I love you Marina

    Your Iraqi friend on line

  23. I iterate what Mays said .
    I like reading this blog and I will not forget reading all the comments .
    Positive views of this blog very helpful to me .



  24. I was hoping a published book to be fair and to be supportive of clients


  25. I agree with all reader this one of the most important post.


  26. Good post Marina


  27. Keep up the excellent Job Marina


  28. Ilove reading all your posts but this one is top


  29. I pray for people to be gentle and nice to each other as you are nice to all of your readers that you do not even know where they are.
    Thanks Marina


  30. This post has good information that is very helpful for every body.


  31. Yes I agree some even text books gives you sketchy information about mental health.
    You are the most reliable resource when it comes to ED and this is evident in this blog.


  32. Sandra D agrees with your views about writers of books being unfair

  33. I learnt to choose the book before I read as there are some authors you can not just trust.
    It hurt when an author forget the compassion in writing knowing that the book is about a disease and not atomic energy!!.
    If the writer uses your style of writing, would be a healing tool and informative as well

    Sam Ibrahim

  34. I wish all credible books about ED highlight that statement.
    It is possible to recover from Anorexia, even if you have been living with the illness for many years. The path to recovery can be long and challenging, however with the right team supporting you and a high level of commitment, recovery is achievable. Treatment for Anorexia is available; seek help from a professional with specialised knowledge in eating disorders. .
    I urge every body whether has or had Ed read your blog and take you Marina as a guide to recover and maintain recovery.
    Sometimes reading books like that author is not helpful


  35. wonderful blog


  36. This post explain a lot of confusion when We read an article and feel something not right.
    Even authors of a published book can be off sometimes.


  37. WOW Marina
    That is a well written post.


  38. I wish you the best during Easter Week


  39. Any post you write ,I see benefit in some way or another ,even though I had no ED or I am not working in medical career
    Thanks Marina


  40. I think our educational systems needs to be reviewed .


  41. I agree with you ,all readers need to have the analytical ability and able to criticize what they read and not take every thing as face value or fact


  42. Amazing post.


  43. I agree books should be read with caution as when we watch media or press .There may some biases some how .
    We need to know about the author before We read the book

    I love your blog


  44. Amazing Marina ,not only you are a respected writer but I noted also your readers are very resposnbile and knowledgible and I read all the comments as well as the post.


  45. The author of that book Marina may have genarlized a rare manifestaon and this confirm what I learnt during univesrity that We have to have the analytical thinking and be able to choose and analyze what is read or heard..


  46. I thought one can trust what is written in a published book.


  47. We do trust all published books ,however some authors looked at things from one angel,highlight one issue ,you know .


  48. I LOVE that everyone here had a comment or experience to share - I am so thankful for this blog! Your experiences, advice, and motivation are very precious and important to me and to this blog. THANK YOU all!

  49. Wonderful discussion.
    Excellent post



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