Her description of the dark bout of bulimia during her 20s will come as a surprise to many who saw Nicole Scherzinger's bright onstage persona. Yet, her message that people can and do recover from eating disorders offers hope to those who still struggle.
Much is at stake, particularly for girls and women, because eating disorders have the ultimate endgame--and it's not weight loss. Eating disorders kill. Women ages 15-24 are 12 times more likely to die from anorexia than from all other causes of death combined.
A killer illness deserves the best care.
Unfortunately, inadequate insurance coverage causes those with eating disorders untold pain.
For the past 29 years I have been an eating disorders therapist, with 14 of those as the founding director of an outpatient treatment program. I've participated in a growing understanding of how best to treat these disorders. We now know a team composed of a physician, a therapist and a dietitian is the most effective approach. Without this team, the odds of recovery drop substantially.
Insurance companies don't get this, choosing to cover physical care, such as medical monitoring and stabilization, but limiting psychotherapy or nutritional counseling. While the Affordable Care Act increases insurance access and adds consumer protection by eliminating pre-existing conditions, its failure to bolster the 2008 Mental Health Parity Act may continue to keep insurance coverage for eating disorders treatment out of reach.
Eating disorders have been excluded from what can be treated, according to the
Washington-based Eating Disorders Coalition. They report that treatment centers and patients say that coverage for eating disorder treatment has gotten more difficult since parity passed.
More is Needed
New mandates in the works could also help achieve mental health parity, but given the poor track record of eating disorders coverage by insurance companies, something more is needed.
The Federal Response to Eliminate Eating Disorders (FREED) Act is intended to address this lack of parity by including treatment in medical coverage. This little-known act was first introduced in 2009, and it has been reintroduced every year since. If passed, this legislation could clear up gaps that have allowed insurance companies to provide inadequate coverage.
Here are some stories from my practice where adequate insurance might have made a difference:
- A suicidal client's insurance company sent her to a general psychiatric hospital. She became frustrated with care that did not address her eating disorder and left against medical advice. The hospital didn't notify me of her discharge, and she killed herself the next day. An eating disorder treatment facility would have understood that patients with anorexia are 57 times more likely to die of suicide than their peers. Other providers tell me similar stories.
- A 20-year-old client contacted her insurance company because her bulimia was out of control. She was sent to a facility in another state that accepted her insurance. Her symptoms improved two weeks after she began treatment, only an initial step toward recovery. Sadly, her insurance company didn't support her journey: They terminated coverage and ordered her discharge. Her relapse was immediate. On the plane ride home, she went to the bathroom and made herself vomit.
- One family did not pre-authorize their daughter's treatment in another state, so their insurance company refused to cover her care. The girl's desperate family paid the $250,000 bill with a second mortgage on their home.
Lack of Specialized Care
Beyond inadequate coverage, insurance companies often send patients to generalists who have seen a few eating disorder cases but who lack specialized knowledge to treat them successfully. Only 35 percent of those who get help get specialized treatment, finds a study cited by the National Association of Anorexia Nervosa and Associated Disorders.
Twenty million American women suffer from some type of eating disorder at some time in their life, according to the Textbook of Psychiatric Epidemiology. Estimating how many people die from eating disorders is difficult because most die from complications, such as heart or organ failure.
One crude estimate from the National Institute of Health is 150,000 people die each year from eating disorders, representing 10 percent to 20 percent of those who suffer. These figures may climb higher because binge eating was only officially recognized as a disorder in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, the go-to guide for medical professionals published in 2013.
In fairness to insurance companies, eating disorders are complex, time consuming and expensive to treat. But the lives of people suffering from eating disorders must be considered just as important as those of anyone else with any form of a serious illness.
Annetta Ramsay, Ph.D., a public voices fellow of The OpEd Project at Texas Woman's University, is a nationally certified and licensed counselor who has specialized in the treatment of eating disorders for 29 years. She directs the Chrysalis Treatment Program in Denton, Texas.
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