Seeking help for an eating disorder or other mental health condition can be incredibly difficult. Between societal stigma, financial barriers, and the challenging nature of vulnerability inherent in therapy, treatment avoidance is incredibly common across many diagnoses. However, consistently avoiding care for any significant health concern–including mental health and eating disorders–almost always leads to worsening of symptoms over time.
At Galen Hope, we come across patient hesitation and treatment avoidance frequently. That’s why we strive to meet people where they are, build trust through compassion, and help guide people toward the idea that investing in mental healthcare leads to improved health and quality of life when done thoroughly and consistently.
Let’s explore the reasons that people may avoid getting the help they need, how to navigate agency when supporting a loved one, and actionable solutions to help those hesitant about treatment buy into the immense value of investing in specialized, evidence-based mental healthcare. Understanding the nuances behind treatment avoidance can help us create an inclusive care environment where people feel safe, heard, and empowered to take the vulnerable steps toward healing.
Treatment Avoidance vs Treatment Resistance: What’s the Difference?
Before we get too much further, it’s important to understand the distinction we’re making between “treatment avoidance” and “treatment resistance” when discussing barriers to eating disorder recovery.
Treatment resistance refers to when a standard, protocolled eating disorder treatment is not adequately or effectively alleviating symptoms and restoring healthy functioning. A person could be fully engaged in the therapeutic process but find that their disordered behaviors, physiological issues, and psychological distress persist despite sincere efforts to implement skills taught across settings. Treatment resistance signifies that the current treatment approach or level of care may not be the right fit despite both the patient and provider’s best collaborative efforts.
Treatment avoidance is how we refer to consciously evading or refusing recommended treatment for an eating disorder, even when appropriate, evidence-based care is available. This could look like repeatedly missing intake appointments, denying having symptoms or need for help when concerns are raised, stopping therapy or treatment prematurely against medical advice, or refusing step-down care after higher levels of care like residential or inpatient treatment. Motivations behind avoidance vary greatly, but the end result is rejecting care that could help alleviate suffering.
The key differentiation comes down to the conscious rejection of potentially helpful care in the case of avoidance. There are many seemingly valid reasons someone may hesitate to get care, including:
- Fear, denial, lack of awareness of diagnosis/risks
- Scheduling conflicts with school, work, sports, family obligations
- The stigma around mental healthcare
- Lack of culturally competent or inclusive treatment options
Identifying whether avoidance or resistance is occurring allows providers and loved ones to tailor support. Enhancing motivation and addressing reluctance is crucial in avoidance, while adjusting treatment plans to find optimal fit is the priority with resistance even with willing participation. Understanding these distinctions creates pathways to personalized care.
Why Is Avoidance a Problem?
In most cases, untreated mental illness leads to more severe symptoms, lower functioning, strained relationships, and a greater risk of disability or health complications over time. While distress is part of life, consistently dysfunctional patterns that disrupt functioning likely need professional support.
As we said above, in most cases, not addressing a significant mental health concern (like an eating disorder) will generally lead to worsening symptoms, decreased functioning, and a greater risk of
- disruption of normal developmental milestones
- disrupted relationships (all the things) over time
Remember, though, that not all distress is mental illness. We may be situationally anxious for example, or we may experience sadness, grief, anger, or even mood swings as part of the normal range of human experience. But when symptoms and circumstances warrant a diagnosis of a disorder, then intervention and treatment can be crucial despite the fears and inconveniences that may cause avoidance.
How Can We Overcome Avoidance?
It can be a challenge to move a client (and often their families, as well) past their avoidance of treatment. Here are a few things that can help in that process.
Navigating Agency and Support
It’s difficult balancing patients’ agency with providing support, especially for parents of children avoiding care. Parents must weigh respecting developing autonomy against the duty to protect safety and health when judgment is impaired.
Using coercion risks straining the parent-child bond vital for wellbeing, but refusing to intervene enables deterioration. Involuntary adolescent commitment, though complex emotionally, may become essential as a last resort. At Galen Hope, we work closely with our clients to create individualized treatment plans that allow for as much freedom and agency as possible.
Open communication about motivations behind avoidance promotes trust. But compassionately upholding boundaries demonstrates loving guidance. This nuanced tightrope walk requires empathy on all sides as families make gut-wrenching decisions, trying to give voice to the child while ensuring access to life-preserving treatment.
Gaining Buy-In and Trust
Building strong therapeutic relationships promotes trust and buy-in. At Galen Hope, our pillar values center on creating a sense of belonging, both during and after treatment. Consistent messaging from supportive loved ones also helps. Psychoeducation, family therapy, and collaborative goal setting give clients more stake in their care.
From Avoidance to Hope
The reality is that any mental health struggle significant enough to warrant a diagnosis will only worsen over time without proper treatment and support. Symptoms left unchecked become more disruptive, risks increase, and the cycle of shame can fuel further avoidance. Not prioritizing trust-building and motivational work early on contributes to negative outcomes like hospitalization trauma or false labeling of someone as treatment-resistant when unaddressed avoidance is the core barrier.
Reframing the issue from noncompliance to hesitation opens doors to meeting people where they are while compassionately challenging what fuels reluctance. True informed consent requires awareness – of diagnosis, the evidence behind treatment options, and the risks of non-intervention.
We’re working to create a model that keeps people safe while offering agency whenever possible. We do this through
- Informed consent.
- Cultural humility and a treatment landscape that is demographically reflective of those seeking care
- Collaboration on treatment goals and on life goals.
- Emphasis on relationships
Collaboratively building this knowledge foundation prevents avoidance stemming from misinformation and empowers agency in choosing pathways towards healing. Our role is to plant seeds of hope that recovery is possible while providing resources to make the idea of investing in mental health treatment compelling rather than intimidating. Removing shame, listening without judgment, and tirelessly establishing safety ultimately help people take the vulnerable steps to say yes to the support they deserve.
the road to wellness starts by seeking help. today.
Built on the principles of assertive community treatment, Galen Hope is an eating disorder and mental health treatment center offering individualized treatment options that include Intensive Outpatient (IOP), supported housing, and Partial Hospitalization Programs (PHP). As a “Community of Integrated Wellness,” we pride ourselves in fostering a thoughtful and meaningful care experience that can guide our clients on their road to recovery and increased quality of life, regardless of diagnosis. Galen Hope currently offers separate, age-specific programming for adolescents ages 12-17 and adults 18 and up, of all genders.
To learn more, or to join our community for integrated wellness, please contact us today.
Belong. Heal. Grow.