How many professionals that treat eating disorders have a personal history of struggling with an eating disorder? It is a crucial question to ask (and answer) because there are important implications for patient treatment and for the health of the afflicted professionals. It is true that many (or most?) individuals who go into mental health do so because of personal experiences–whether due to their own personal history or the experiences of a loved one–so it is useful to ask, just how common are eating disorders among ED treatment professionals?
This is the question that Nicole Barbarich asked in a survey mailed to 823 members of the Academy for Eating Disorders.
Barbarich developed a 14-item self-report questionnaire that assessed everything from basic demographics to personal eating disorder history and their employer’s hiring policies. Out of 823 potential participants, 399 completed the questionnaire.
I’ve summarized the main findings below:
Demographics of Survey Responders
- 81% were females, 19% were males
- Average age: 44 for females, 49 for males
- Primary employment area: 47%, individual therapy; 34% in outpatient programs; 11% in inpatient programs (smaller %ages in PHP/IOP, group therapy, nutrition, medication management, other)
- Lifetime prevalence of an eating disorder was 27%
- Among females: 33%
- Among males: 2%
- Type of eating disorder (~35% had more than one)
- Anorexia nervosa: 47%
- Bulimia nervosa: 50%
- Binge eating disorder: 24%
- Subclinical ED: 17%
- Duration of ED: from 4 – 372 months (31 years), average: 115.5 months (~9 1/2 years)
Treatment & Relapse
- 64% reported having received treatment
- 56% individual therapy; 30% group therapy; 18% medication; 12% outpatient; 11% nutrition therapy; 10% inpatient/residential; 7% PHP/IOP
- 27 (out of 97, as 12 didn’t answer) experienced relapse after entering the field as a professional; prior history of purging-type AN was associated with a significantly higher risk of relapse
- 39% reported that their employer was aware of their ED history (about the same number didn’t, and 23% were self-employed in private practice)
- 33% of those who reported their employer knew about their ED history experienced a relapse while working in the field (versus 16% of those whose employers didn’t know, though the difference is not significant)
- Hiring practices of participant employers: 33% hired recovered staff but history didn’t affect employment decisions; 6% actively hired recovered staff versus 9% that preferred NOT to hire recovered staff; 27% were either not aware of policy or their employer didn’t have a policy
The prevalence of anorexia nervosa and bulimia nervosa in adolescent and young adult females is about 0.5-1% and 1-2%, respectively. In this study, the prevalence was 13% and 14% for anorexia and bulimia, respectively. In total, 33% of female and 2% of male ED professionals surveyed had a prior history of eating disorders.
Of course, only 50% of AED members responded to the survey, and it was just a survey (not a validated questionnaire), so it is hard to know how applicable these findings are to ED professionals in general, but, there’s little doubt that eating disorders are overrepresented among professionals in the field.
These findings raise a lot of questions:
- What are the advantages and disadvantages of having clinicians who have a personal ED history?
- Are clinicians with an ED history better/worse (more/less effective) at treating patients, or the same? Does it even matter?
- What about self-disclosure? Good thing, bad thing, depends?
- How should treatment centres, for example, deal with relapses? What if relapses occur in a private practice setting?
- Is there a way to know which professionals are at a higher risk of relapse? (In this study, they were: longer duration of ED, AN-purging type, and history of more than one ED. But, in other studies found different predictors of relapse.)
Admittedly, some of these questions have been explored in studies since this paper was published, mostly using qualitative research methods (here, here, and here). I’ll do a post in the future about the possible advantages and disadvantages of ED clinicians with personal ED histories as it is definitely an important and interesting topic to think about.
As for now, I’m curious to hear what you think–as patients, parents, friends, clinicians, and researchers–about this issue and the implications. Thoughts?