Eating Disorders Anonymous: Could this fill the gap of peer support in anorexia nervosa?

To the Editor

Anorexia nervosa in adults is associated with significant morbidity and mortality, with significant proportions experiencing delayed or partial recovery (Hay et al., 2014). Treatment constitutes therapeutic engagement, medical stabilisation and nutritional rehabilitation to reverse the cognitive effects of starvation, and then structured psychological therapies (Hay et al., 2014).

We observe that it is a common occurrence in the psychiatry inpatient wards for people with eating disorders to collude in resisting treatment, especially in the initial stages. They may form group chats or social media groups to discuss ways to evade nutrition or alter weights. We have also observed that these same people can turn to allies in recovery when they emerge from the grips of their eating disorder, assisting the ones still struggling on the ward or who have relapsed in positive ways.

Recovery-oriented practice embraces and supports partnerships with consumer organisations and the development of new models of peer-run programmes and services (Cook and Gill, 2019; Hay et al., 2014), but this is inconsistently available. Peer support groups have potential to offer validation, the wisdom of lived experience, hope for and modelling of recovery and the non-judgemental approach of group members suffering with similar illnesses.

Eating disorders have features that are compatible with 12-step programmes, originally designed for alcohol dependence, such as a problematic relationship with a substance or behaviour (food and eating), preoccupation, erosion of other roles and relationships, powerlessness over the problem, ambivalence about change, stigma, and a need for peer support. Advantages of 12-step programmes are that they are usually easily accessible (not requiring referral or formal diagnosis), confidential and free of charge. The availability of meetings via videoconference is an added advantage. There is a successful model for binge-eating disorder, called Overeaters Anonymous (Bray et al., 2021).

Eating Disorders Anonymous (EDA) is a non-denominational ‘Twelve-Step fellowship of individuals who share their experience, strength, and hope with each other that they may solve their common problems and help others recover from their eating disorders’. EDA focuses on balance rather than abstinence and defines recovery as living without obsessing on food, weight and body image. EDA is supportive of professional medical, dietary, psychiatric and psychological support in the recovery process.

Limitations for recommending such programmes include the lack of high-quality research, limited availability of groups and sponsors, and potential for negative interactions with peers who are not in an adequate stage of recovery.