Yes, eating disorders are very difficult to deal with, especially in adults, and many clinicians will not treat clients with EDs. Adults with non-purging AN have a hard time finding anyone to treat them, since even CEDS often exclude them from their practice. (Although a lot of the same practitioners won't treat BN with BPD symptomology, either. Kinda makes you wonder why they got the certification in the first place?)
There are a lot of reasons these pts are so frustrating. One is that they tend to be very intelligent, they do tend to recognize that they're sick -- but there's still that disconnect between intellectually knowing that they're sick, and actually recognizing the sickness in themselves. Add in the physical changes that take place, such as the loss of hunger/satiety sensations, gastroparesis, etc, (and the atrophy of the brain), and it's a very hard thing to treat. And frustrating because -- again -- these tend to be very intelligent young women, many of whom could be very likeable. (Many are likeable, but many are just so isolated within their pathology that it's hard to feel much connection.)
Walter Kaye at UPMC has done some studies showing disorders of the 5HT system that might shed some light on EDs. It may be that the 5HT anomolies are premorbid, and the EDs are attempts at self-medication. If so, that would also explain some of why ED pts hold on to their disorders so closely. On the purely psychological side, though, my own ED made me feel special, somehow. I was doing something right, finally -- I was in control of myself, my impulses, I wasn't indulging myself with food, I only ate enough to "satisfy my hunger," etc. And every commercial for diet products triggered me to lose more weight, so that I wouldn't have to face the shame of obesity; comments from others that I looked great (!), etc. Even those who knew that I was sick still gave mixed messages -- "You're sick -- how can I do it just a little?"
Well, I've said way too much. I hope someone found it helpful.
