Why Standard Eating Disorder Treatment Doesn’t Work for Everyone

Understanding why some people feel unseen, stuck, or misunderstood in recovery

Many people seek help for eating disorders with hope and motivation, only to find that treatment does not work as expected. Some feel blamed for “not engaging properly”. Others leave treatment believing they are the problem.

In reality, standard eating disorder treatment does not work for everyone, and this is not a personal failure.

This article explains why this happens and what a more individualised approach can offer.

Eating disorders are not all driven by the same factors

Traditional eating disorder models often assume that difficulties are primarily driven by:

• Weight and shape concerns

• Fear of weight gain

• Distorted body image

While this is true for some people, many experience eating difficulties driven by:

• Anxiety and fear

• Sensory sensitivities

• Trauma

• Neurodivergence

• Emotional regulation difficulties

• A need for predictability or control

When treatment assumes a single driver, it may miss what is actually maintaining the difficulty.

One-size-fits-all approaches can miss complexity

Standard treatment pathways are often:

• Manualised

• Time-limited

• Built around diagnostic categories

These structures can be helpful, but they may struggle to accommodate:

• Neurodivergent thinking styles

• Fluctuating or subthreshold presentations

• Co-occurring anxiety, trauma, or ADHD

• People who do not relate to body image-focused narratives

When someone does not “fit the model”, treatment may feel misaligned.

Neurodiversity and treatment mismatch

Autistic individuals and people with ADHD often report that standard approaches:

• Rely heavily on abstract emotional language

• Assume cognitive flexibility

• Underestimate sensory distress

• Frame difficulty as resistance

Without adaptation, therapy can feel overwhelming or invalidating rather than supportive.

This does not mean the person is unwilling to recover. It means the approach needs adjusting.

Trauma-informed care matters

For some people, eating difficulties are closely linked to trauma, loss, or chronic stress.

In these cases:

• Food may function as safety or control

• Eating may trigger threat responses

• Exposure-based approaches may need careful pacing

When trauma is not recognised, treatment can feel unsafe or retraumatising.

The problem with focusing only on compliance

When treatment prioritises:

• Behavioural compliance

• Weight targets without context

• External measures of success

People may feel pressured to perform recovery rather than experience it.

This can lead to:

• Masking distress

• Dropout from services

• Shame and self-blame

Progress is not always linear or visible.

Why formulation matters more than labels

A formulation-based approach focuses on:

• How difficulties developed

• What maintains them

• What purpose behaviours serve

• What support fits this individual

This approach allows treatment to be:

• Flexible

• Neurodiversity-informed

• Trauma-aware

• Proportionate

Formulation supports understanding rather than correction.

When treatment “fails”, it is often a mismatch

If treatment has not worked, it may reflect:

• A mismatch between approach and need

• Insufficient adaptation

• Unrecognised complexity

It does not mean:

• You are unwilling

• You are not trying hard enough

• Recovery is impossible

Many people do better when support is adjusted.

What more tailored care looks like

Tailored care often includes:

• Assessment-led planning

• Flexible pacing

• Adapted communication styles

• Sensory and cognitive considerations

• Collaborative goal-setting

• A focus on safety and trust

Tailoring is not about lowering expectations. It is about increasing effectiveness.

How we approach treatment at The Eating Disorders Clinic

At The Eating Disorders Clinic, we work from the understanding that:

• Eating difficulties are heterogeneous

• Neurodiversity and trauma matter

• Diagnosis is not the whole story

• Understanding comes before intervention

Our approach is assessment-led, multidisciplinary, and adapted to the individual.

A gentle next step

If you have tried treatment before and felt misunderstood, stuck, or unseen, it may be worth exploring a different approach.

You are welcome to book a free initial call to talk through your experiences and consider whether assessment-led support may be helpful.

You can also review our website before making any decisions