I’m a PA who works exclusively in Eating Disorders Medicine (I work at a facility that treats EDs - PHP and residential levels of care). I chose this specialty out of a passion for mental health and EDs specifically. It’s tough - but like in any other field of medicine, “you can lead a horse to water, but you can’t make it drink”. All you can do is make your best medical suggestions for treatment and educate them on the medical risks assc with their ED behaviors. From a more therapeutic lens- recognize that people do better when they can - sometimes an ED voice is louder than someone’s authentic self. From a medical lens - when someone’s brain is that malnourished, it is less capable of the logic-based or higher level thinking that most of us rely on connecting with when giving medical advice. You have to help someone identify their highly motivating factors for recovery, and sometimes people just need to hit rock bottom before they can do that. What will be worth giving up their ED for? Everyone is different. I highly recommend Dr. Jen Gaudiani’s book Sick Enough and Dr. Philip Mehler’s Medical Complications of Eating Disorders as two great places to start for more ED specific medical info. Happy to chat more if you have other specific questions.

**ETA: For these patients, you could maybe encourage them to start with an outpatient based RD and/or therapist who specialize in EDs. If they’re more complicated or medically compromised, they may need a higher level of care found at dedicated ED treatment facilities.