Palliative Approaches in Eating Disorders: Compassionate Care When Recovery Isn’t Linear

Eating disorder treatment has long been centered around full recovery—restoring weight, normalizing eating, and healing one’s relationship with food and body. For many, this is possible. But for a subset of individuals, particularly those with severe and enduring eating disorders (SE-ED) or complex medical and psychiatric comorbidities, traditional recovery-oriented treatment may not be sufficient, accessible, or aligned with their goals.

In these cases, a palliative approach to eating disorder care offers an alternative path—one focused not on cure, but on comfort, dignity, quality of life, and harm reduction.

This article explores what palliative care looks like in the context of eating disorders, why it matters, and how clinicians, patients, and families can engage in these conversations with compassion and clarity.

What Is a Palliative Approach?

Palliative care is often misunderstood as end-of-life care only. In truth, it is a broader medical philosophy focused on improving quality of life for individuals with serious, chronic, or life-limiting illnesses—at any stage of illness and alongside curative treatments when appropriate.

A palliative approach in eating disorder care does not mean giving up. It means shifting the focus from full recovery to meeting the patient where they are, supporting symptom relief, emotional comfort, autonomy, and dignity.

Source: World Health Organization (2020), National Institute for Health and Care Excellence (NICE)

When Might a Palliative Approach Be Appropriate in Eating Disorder Care?

While most individuals with eating disorders can and do recover, a small group experiences long-term, treatment-resistant illness despite multiple interventions. In these cases, ongoing aggressive treatment can sometimes cause more distress than relief.

Palliative approaches may be considered when:

• The individual has a severe and enduring eating disorder (SE-ED) lasting 7+ years with little response to standard treatment

• There are serious medical complications that make aggressive refeeding unsafe or undesired

• The individual has co-occurring conditions (e.g., trauma, severe OCD, autism) that complicate standard care

• Repeated hospitalization or weight restoration attempts result in functional or emotional decline

• The patient is refusing or unable to engage in full recovery-oriented treatment despite informed consent

• The focus is on harm reduction, comfort, and personal goals

It is essential that palliative care in eating disorders is never assumed based on body size, weight, age, or provider bias. It must be patient-centered and chosen with careful, collaborative discussion.

Core Elements of a Palliative Approach in Eating Disorders

1. Symptom Management

The focus shifts from achieving full symptom remission to reducing distress and improving daily function.

• Addressing pain, fatigue, GI discomfort, and anxiety

• Managing comorbid depression or insomnia

• Nutritional interventions may aim to prevent rapid deterioration rather than full restoration

2. Emotional and Existential Support

Palliative care embraces the reality that mental suffering may not be “fixed” by food alone.

• Providing trauma-informed therapy that validates complex grief, ambivalence, and identity

• Offering supportive psychotherapy focused on meaning-making, legacy, and autonomy

• Encouraging expression of goals, fears, and hopes in nonjudgmental space

Source: Geller et al., International Journal of Eating Disorders (2020)

3. Harm Reduction

A key aspect of palliative care is reducing the risk of death or further decline without requiring complete behavior change.

• Encouraging partial meals or safe foods rather than full meal plans

• Supporting hydration and electrolyte monitoring

• Reducing purging frequency or medical complications

• Avoiding triggers like forced weigh-ins or BMI targets when counterproductive

4. Family and Caregiver Support

Caregivers often need significant guidance and relief in these cases.

• Education on the nature of SE-ED and what palliative care entails

• Space to process grief and let go of rigid recovery expectations

• Support for maintaining boundaries and self-care

5. Advance Care Planning and Autonomy

Patients may want to make decisions about future care, hospitalizations, or DNR orders. These conversations require:

• Ethical sensitivity

• Medical clarity about risks and prognosis

• Respect for legal autonomy and dignity

Ethical Considerations

Palliative care in eating disorders is ethically complex and must be approached with:

• Informed consent and shared decision-making

• Avoidance of therapeutic nihilism (“nothing works” is not an excuse for inaction)

• Recognition of structural and systemic barriers (e.g., access to care, weight stigma, trauma)

• Regular re-evaluation of goals, as some patients may re-engage with recovery over time

Importantly, palliative care should never be used as a default for individuals in marginalized bodies, those with neurodivergence, or those who challenge normative treatment goals.

A Shift in Perspective

Moving to a palliative approach does not mean giving up on the person—it means acknowledging their full humanity beyond the illness. It prioritizes comfort over compliance, presence over pressure, and relationship over rigidity.

This model can be deeply healing for patients who have spent years being pathologized, medicalized, or misunderstood.

As one clinician wrote:
"Palliative care allows us to ask not, 'How do we fix you?' but 'How can we walk with you, as you are, with what time and life you have?'"

Final Thoughts

There is room in eating disorder care for both hope and honesty. For those who do recover, we celebrate. For those who cannot or choose not to pursue full recovery, we must still offer dignified, compassionate, and expert care.

A palliative approach invites us to broaden our definition of healing, making space for complexity, choice, and connection—even in the absence of cure.

References

• Geller, J., & Srikameswaran, S. (2020). The ethics and application of palliative care in eating disorders. International Journal of Eating Disorders, 53(5), 659–664.

• Tan, J. O. A., Hope, T., Stewart, A., & Fitzpatrick, R. (2003). Control and compulsory treatment in anorexia nervosa: the views of patients and parents. International Journal of Law and Psychiatry, 26(6), 627–645.

• Treasure, J., & Schmidt, U. (2013). The neuroscience of eating disorders: Implications for treatment and policy. European Eating Disorders Review, 21(2), 89–96.

• World Health Organization. (2020). Palliative Care: Key Facts. https://www.who.int

• National Institute for Health and Care Excellence (NICE). (2017). Eating disorders: recognition and treatment.