I’ve been in an outpatient eating disorders group for awhile now. There’s nothing special about it — it’s just a weekly / bi-weekly group at a treatment center, with women of all ages and ED diagnoses Everyone either has to be in outpatient therapy at the center or have done some kind of intense treatment there. The latter is definitely the norm — most patients have stepped done from day treatment or IOP.
What’s weird right now is the make-up of the group: 5 restricting-anorexics and 2 binge eaters. I don’t know where all the patients in between these two groups are. I guess most of the women struggling with AN-R technically fall into the EDNOS-AN-R category, but you know what I mean. There are no bulimics, and way more restricting anorexics than there should be–statistically.
There are three issues that I have with this:
- There are too many anorexics in one room.
- Since there really isn’t any middle-ground, the group feels very divided by diagnosis.
- One of the girls is really really really underweight. Really.
Issue #1: betta fish
I think that anorexics are like betta fish — you’re not supposed to put several of them in the same bowl. I could expand this to all individuals with eating disorders, but I think that there is something especially competitive about anorexia. Even when they are doing well in their recovery, putting too many of them in a group is just not a good idea.
Issue #2: no grey
I definitely believe that eating disorders are on a continuum and that we all have similar struggles despite the different diagnoses. However… we seem to be missing all the people in the middle of that continuum. It sucks to have BED and be in a group with all anorexics. Heck, I think it’s triggering for anyone to be in that group (see issue #1). With such a polarity, it feels a little them vs. us.
Issue #3: too sick
I don’t care how great you’re doing mentally — if you’re that underweight, you shouldn’t be in outpatient group. You could be drinking boost like it’s water, and I still wouldn’t be okay with it. It’s just too triggering. I think it’s an especially bad combination in the current group, because the majority of girls have gone through refeeding in the last year and are struggling with body image now that they are at healthy weights. Plus, personally, my whole “I don’t need to be here because I’m not that sick” complex starts creeping up on me.
Issues #2 and #3 are definitely elephants in the room. Everyone feels weird about the divide and triggered by said sick patient. No one will say anything (myself included).
I think you have to be so careful when putting together outpatient eating disorder groups… and I think that a certain level of physical health is necessary — even if someone is 100% gung-ho, yay-recovery-is-awesome.