Many practitioners have their own eating disorder and mental health histories – yet stigma, shame, and fear of professional repercussions may prevent them from seeking supports in the workplace.
Consider this scenario. You are reviewing your patient with an eating disorder but also have your own eating disorder. Today, you find out your patient attends the clinic you are about to start attending – there is only one statewide specialist clinic available.
You worry about your patient finding out about your lived experience, and wonder whether your appearance impacts how your patient perceives you, and whether you will be perceived as a less competent doctor.
You want to seek guidance from your line manager, however, you worry about losing your AHPRA registration if you do, and how this might impact your professional reputation.
How do you take care of your wellbeing, so that you can provide the best level of care for your patients?
How common is mental illness among health practitioners?
The rates of depression, anxiety, and overall psychological distress are markedly higher among doctors compared to the general population. Female doctors are 2.27 times more likely than the general population to die by suicide. Among male doctors, this statistic is 1.41 times the general population.
Medical and health practitioners often encourage their patients to take care of their physical and mental health and wellbeing. Paradoxically, however, many practitioners may not practice what they preach. Practitioners can experience significant mental health difficulties, compounded by work-related burnout and stress.
Eating disorders among practitioners: a unique case
In the area of eating disorders, it is estimated that 24-47% of practitioners have a current or past eating disorder. This contrasts with the 2-8% lifetime prevalence rates in the general population.
The field of eating disorders brings unique challenges including:
- Eating disorders such as anorexia having the highest mortality rate of all psychiatric illnesses;
- The significant physical and psychological health impacts of eating disorders such as dizziness, fainting, impaired perception and thinking, which can impact on work;
- The need to consider patients’ perceptions of practitioner’s bodies in treatment, given that a key feature of eating disorders involves appearance comparisons to others;
- Relative lack of services available compared to other areas of mental health.
It is not uncommon for practitioners such as doctors to experience mental health difficulties such as an eating disorder. Currently, however, no guidelines exist to guide safe, ethical practice for practitioners with lived experience of an eating disorder despite the unique risks present.
There is a lack of discussion around the ethics of navigating practitioner and patient hats. This may be due to stigma and shame related to being a practitioner with mental health lived experience. Practitioners with eating disorder histories may also experience stigma and shame related to the eating disorder itself.
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Navigating being a practitioner and patient
It is up to individuals to decide whether they choose to disclose their mental health difficulties. If as practitioners, we decide not to discuss our lived experience, it can be helpful to use the following list of questions to help us gain awareness and understanding of whether our experiences are impacting on our professional practice, and if there are any blind spots:
- What is my professional role, and what are the responsibilities associated with this role?
- What mental health symptoms am I currently experiencing?
- Do the symptoms I am experiencing impact on my job responsibilities? Am I currently able to fulfil all my professional duties?
- Are there tasks related to my professional role that I tend to avoid or approach, because of my lived experience?
- What am I currently putting in place personally and professionally to stay well as a medical practitioner?
- Am I seeking regular supervision?
- Am I receiving my own mental health supports?
- Are there workplace supports I need?
- Do I need to temporarily take a break from work, or the field I work in?
Recognising ethical dilemmas—What can I do?
In addition to the ethical dilemmas that may arise from being a practitioner with mental health lived experience, there may be additional dilemmas associated with working in eating disorders specifically. It may be helpful to consider the following questions to guide ethical decision-making and professional practice, for the benefit of both practitioner and patient wellbeing:
As a practitioner with lived experience
- Should I disclose my lived experience to a line manager or supervisor in my workplace, and if so, how much do I disclose? What would be the reasons for my disclosure?
- How do I navigate dual relationships, if I am working alongside a previous treating practitioner in the same workplace I have received treatment at previously?
- How might meeting my own needs cloud my judgment about what would be best for the patient?
- When is it important for me to seek supervision to ensure my clinical decision-making is not being adversely impacted by my eating disorder?
- If I have a current eating disorder, should I continue practising? How would I navigate dual relationships if I sought treatment at a service my patient also attends?
- What if a patient comments directly on my appearance/body, and asks if I have had an eating disorder? How should I respond?
As a manager or supervisor
- What onboarding or employment processes could be implemented for a new employee who discusses they have lived (past) or living (current) experience?
- What workplace supports should be implemented for a practitioner with living experience, so that ethical obligations for safe work practices can be met? Are different supports needed for lived (past) experience?
- What supports can the workplace provide for an employee during leave related to management of their mental health symptoms? What would the employee’s return-to-work plan look like?
- How do I navigate dual relationships when an employee discloses that they are working alongside a current or past treating practitioner in the same workplace? Who should I seek advice from without breaching confidentiality?
- Do I understand fitness to practice and clinical impairment? Do I understand the scope of my obligations for mandatory reporting to AHPRA?
As a colleague
- How would I approach a colleague if I think they are unwell?
- I am aware that a colleague has an eating disorder. Does this knowledge affect how I perceive their performance?
It is encouraged that practitioners seek supervision and their own supports, whether that be through personal or workplace channels.
Building a mentally healthy, resilient eating disorder workforce
By better supporting eating disorder organisations, managers, supervisors, and colleagues to have supportive conversations and reflections, we can grow a mentally resilient, sustainable workforce in the area of eating disorders and mental health.
If you are interested in contributing to improving the wellbeing of practitioners with eating disorder lived experience, we invite you to participate in a nationwide anonymous 20-minute survey on stigma, shame, and mental health disclosure among eating disorder practitioners.
The study is led by Curtin University, with support from four peak eating disorder bodies (NEDC, InsideOut Institute, Butterfly Foundation, ANZAED). The survey is open to all medical and health practitioners who work with eating disorder patients.
Click here to learn more and participate.
If you have any questions about the study and/or your participation, contact Pheobe.Ho@postgrad.curtin.edu.au. This project has received ethics approval from Curtin University HREC (HRE2025-0168).
Practitioners are human too, and experience mental health difficulties such as eating disorders.
By coming together as a workforce, we can tackle stigma and shame among practitioners with eating disorder and broader mental health lived experience. Prioritising practitioner mental health will support patient wellbeing and safety, which can lead to improved patient outcomes.
As practitioners, we owe it to our patients to lead by example and role model helpful health and help-seeking behaviours.
Pheobe Ho is an WA-based clinical psychologist, lived experience advocate, and PhD candidate working in the field of eating disorders.
