I think one of the challenges is even considering that it might be an eating disorder. There is this misperception that it happens to white upper middle-class teenage girls, and it's actually an equal opportunity illness. It can happen to new immigrants. It can happen in all races and ethnicities. Often if you don't look like the typical case, people don't even think about it as a possibility. That's related to a lack of training and myths that revolve around eating disorders.
We also have to deal with the shame and stigma issue. It's still a very stigmatized illness. Patients often are ashamed. It's also an illness where, particularly in kids, they want to keep it a secret because they want to keep doing it. The patients in children and adolescent programs often come unwillingly as it is their parents who are concerned.
The first step I think is recognizing it's an equal opportunity illness and training people to look at what the signs are.
The other issue is knowing when you need to get more help. The idea that it's just a phase, or that we'll just watch it or, “Come here next week and I want to see that you've gained weight”, and doing that for months and months without actually providing adequate mental health treatment, because it exists, really just leads to chronicity. There's an interesting study that came out of the U.K. which shows that if you get a child into specialized mental health care quickly, you can really prevent the beginnings of an eating disorder from turning into something more chronic. The longer a child is sick, the more difficult the illness is to treat.
