A psychiatrist’s words carry weight. There’s an unspoken trust that they won’t say anything that could damage your mental health further. That trust doesn’t always hold.
It’s easy to assume a psychiatrist will have knowledge of eating disorders. Often, that assumption is wrong – and the gap can produce comments that do real damage. In my case, it was “you don’t look anorexic anyway,” said to me at fifteen, the first time I asked for help.
Later, a psychiatrist told me I didn’t need to gain weight – directly contradicting my eating disorder team, who had spent weeks helping me acknowledge, rightly, that I had a significant amount of weight to regain. One sentence undid weeks of careful work. And it had come from a psychiatrist.
It’s tempting to assume that once you’re sitting across from a psychiatrist, the training gap previously mentioned in our GPs post, is behind you. It isn’t. It’s just a different shape.
Specialist doesn’t mean specialised in this
Psychiatry is a specialty. Eating disorders, within psychiatry, are a sub-specialty – and the difference matters more than it sounds like it should.
Core psychiatric training in the UK covers eating disorders in outline: trainees need to know the prevalence, presentation, and treatment of anorexia and bulimia well enough to pass the MRCPsych exam. But knowing the syllabus definition of an illness and knowing how to manage a acutely unwell patient in front of you are not the same skill, and the gap between them is where a lot of the difficulty lives.
A 2024 survey of psychiatry trainees in Wales put a number on it. Over 60% rated their own confidence in describing eating disorders, their prevalence, and their risk profiles as low. Only half of higher trainees – doctors further into specialist training – felt confident diagnosing an eating disorder at all, and three-quarters felt unsure about the stages of treatment.
More than 80% said they were dissatisfied with the training they’d been given. Most had never had a dedicated placement; what exposure they got came mostly through child and adolescent placements, almost by chance.
To actually specialise in eating disorders as a psychiatrist, you need to pursue a separate credential on top of core training – extra assessment and physical-health competencies that aren’t guaranteed as part of the standard path. Which means the psychiatrist you’re referred to isn’t automatically an eating disorder specialist. They might be. They might also be a general adult psychiatrist doing their best with a syllabus-level understanding.
Where the gap bites hardest
The evidence base for eating disorders has historically centred on women, which means presentations that don’t fit that pattern – including in men, where the illness burden is substantial and consistently under-recognised – are more likely to be missed or delayed.
Diagnostic overshadowing is a real, documented risk: co-occurring conditions get treated while the eating disorder underneath goes unnamed, sometimes for years.
What this means if you’re the one in the room
If a psychiatrist has struggled to understand what you’re describing, or has focused on something adjacent to the eating disorder rather than the eating disorder itself, that isn’t proof you weren’t clear enough. It’s a training pipeline that funnels genuine specialism into an optional extra rather than the default.
You’re entitled to ask directly whether the person treating you has specific eating disorder training, and to ask for referral to a dedicated eating disorder service if what you’re getting doesn’t feel like it’s built for this illness. Wanting a specialist isn’t difficult or demanding. It’s asking for the qualification the system is supposed to guarantee, and often doesn’t.
Sources: Royal College of Psychiatrists core psychiatry curriculum and eating disorders credential curriculum; service evaluation of eating disorder training among psychiatry trainees in Wales (2024); British Journal of Psychiatry (2025) on training deficiencies related to male eating disorders; NICE eating disorders quality standard briefing.
