Peer support and eating disorders

We are going to be straight with you, because this is the one topic on this site where being vague could do real harm.

Eating disorders have the highest mortality rate of any psychiatric illness. They also respond well to specialist treatment, and they respond better the earlier that treatment starts. A general anonymous peer-support app — ours included — is not treatment, is not part of a treatment plan, and should not be the thing you try instead of getting assessed.

Where to start instead

• Your GP or primary care doctor. Unglamorous, and still the fastest route to bloods, an ECG, and a referral. The physical assessment matters even when you feel physically fine.
• ANAD (National Association of Anorexia Nervosa and Associated Disorders) runs free, structured peer support groups specifically for eating disorders, with trained facilitators. That is a different thing from an open feed, and for this condition the structure is the point.
• NEDA (National Eating Disorders Association) maintains a screening tool and a treatment-provider directory.
• F.E.A.S.T. supports parents and carers, who frequently need their own resources and rarely get offered any.

The specific risk in general peer spaces

This is not a generic disclaimer. Eating disorders are unusual among mental illnesses in that contact with other sufferers can actively feed the illness. Specific numbers — weights, calories, clothing sizes, durations — function as competitive targets rather than information, and comparison is a core mechanism of the disorder rather than an unfortunate side effect of talking to people.

That is why specialist ED groups are facilitated and have explicit rules about numbers, and why an open anonymous feed is a worse environment for this condition than it is for, say, loneliness or burnout. If you do use general peer spaces, the practical version of this is: do not post numbers, do not ask for them, and leave any space where they circulate freely.

What peer support can honestly offer here

Alongside treatment, not instead of it, the useful part is the ordinary one: the isolation, the shame, the exhausting business of explaining yourself to people who have never experienced it. Peer support has reasonable evidence behind it for that kind of burden — a randomised trial of trained peer volunteers supporting new mothers at high risk of postnatal depression cut depression rates at 12 weeks from 25% to 14% (our summary of that trial) — though note that trial was about depression, in a different population, with trained volunteers and a structured protocol. We have no evidence that peer support treats an eating disorder, and we are not going to imply otherwise.

Keep reading, with the citations: peer support vs therapy — where the line sits.