"ED services rely heavily on Western diagnostics, rigid triage thresholds, and manualised psychosocial packages rooted in CBT; this architecture privileges low body mass index and acute medical risk and tends to overlook binge-spectrum, night-eating or sensory-driven presentations that may be more common in structurally disadvantaged or culturally distinct populations."
Yes, because ED services of this nature are those at HLOCs where there is an emergent medical component. Am I going to admit the night-eating patient with no issues in their lab values to RTC? Yeah, we need rigid triage thresholds and to privilege "acute medical risk" because we need to know where to place an ED patient to best address their medical component, psychiatric component, or both. It's almost like if you're physically ill, you need treatment (and the dx that gets you treatment) more than the person who is not in acute medical distress.
"CBT approaches for EDs assumes the primacy of maladaptive cognitions and avoidance behaviours as maintenance processes, and that modifying these intra-individual processes is sufficient for recovery. Lived experience-led research, especially among neurodivergent people, show that sensory processing differences, gastrointestinal disorders, systemic discrimination, and experiences of iatrogenic harm can be proximal drivers of restrictive and binge behaviours. When the primary illness drivers are somatic, sensory, or socio-politically mediated, cognitive techniques may not only fail but also exacerbate iatrogenesis, shame, and disengagement from care."
Good sir, no. There is significant emphasis in ED treatment, CBT included, that emphasizes interpersonal and social factors in the recovery process. Furthermore, if we're going to talk about actual implementation in practice, every ED company that I have worked for, visited, or referred patients to, does not do CBT in a vacuum. It is always supplemented with other modalities like DBT, ACT, exposure therapy, family therapy, etc. They're not doing cognitive restructuring worksheets all day. Furthermore, if a physical illness is the primary driver of the "eating disorder", the patient likely does not have an eating disorder, and it becomes a feeding concern that we move over to the internal med/OT folks.
I get what the author is trying to say. But the articles he cites are questionable, there is a lot of lived-experience and phenomenological accounts and some of the claims are straight up wrong or unreasonable. Asking us to remove the "privilege" afforded by acute medical risk is to ask us to not triage...
