Interview. Anorexia, bulimia: "very significant disparities" in treatment, warns a psychiatrist

Are healthcare professionals sufficiently trained in identifying eating disorders?

"No, certainly not. Identification, early detection, and support are absolutely essential. Frontline workers—school and university medicine, general practitioners, and psychologists—are insufficiently trained in these disorders, probably because their frequency is underestimated."

What is the appropriate support?

"It must be age-appropriate, as early as possible, and multidisciplinary from the outset. Often, there is a real tripod of physical, psychological, and nutritional/dietary care. It is necessary, when possible, especially during adolescence, to involve loved ones in the support. In some cases, hospitalization is necessary, based on emergency physical, psychological, or environmental criteria (if the person is very isolated)."

Is prescription medication necessary?

"It will depend on the eating disorders. In bulimia and binge eating disorder, there are a few medications, notably antidepressants, that have shown benefit as a second-line treatment, that is, once a therapy has not worked or has worked insufficiently. In binge eating disorder, there are other treatments that exist, but they are either unavailable in France or contraindicated in women of childbearing age. For anorexia nervosa, there is currently no validated drug treatment, so it will be reserved for nutritional support (correction of a deficit, a deficiency) and the treatment of a psychiatric comorbidity (anxiety disorder, fairly severe depression). Drug treatment is not a first-line treatment, even if there are therapeutic avenues."

Are there enough specialized structures, and how are they distributed across the territory?

"There are not enough of them, and there are very significant regional disparities. There is no region where we are in a situation where the provision of care is sufficient. If you take full-time hospitalization for the most severe forms, there are few facilities in France. There is also a disparity between public and private sectors. Patients with significant financial means can find private facilities relatively expensive. In the public sector, facilities are even rarer and not so easy to access, with waiting lists."

What support is offered to loved ones?

"There is an anonymous helpline*, run by the TCA-Ile-de-France network. You can call for help, ask for information, or contact a family association, doctor, or psychologist on the phone. You need to find out more, not stay alone, contact a local support group, talk to a psychologist, and so on. You need to be able to receive support in your caregiving work. You shouldn't feel guilty. These are real illnesses. Learning about the illness to better understand it is absolutely essential."

*Anorexia bulimia information listening: 09 69 325 900. Monday, Tuesday, Thursday and Friday from 4 p.m. to 6 p.m.