- Iatrogenic harm in psychotherapy for eating disorders is under-recognised despite evidence, worsened by intensive, prolonged treatment and power asymmetries.
- Structural system features produce harm: rigid diagnostics, manualised protocols, limited accountability, and marginalisation of lived experiential knowledge.
- Urgent reforms required: epistemic pluralism, routine monitoring and reporting of iatrogenesis, and meaningful co-production to ensure ethical, accountable care.
Int J Ment Health Nurs. 2026 Aug;35(4):e70318. doi: 10.1111/inm.70318.
ABSTRACT
Iatrogenic harm in psychotherapy remains under-recognised, despite longstanding evidence that psychological treatments can produce adverse effects. This omission is consequential in eating disorder care, where treatment is often intensive, prolonged and characterised by significant power asymmetries alongside poor long-term outcomes. This article examines iatrogenic harm in the context of eating disorders through an epistemic justice and intersectional framework. Drawing on qualitative and lived-experience-led scholarship, it argues that iatrogenesis is produced through structural features of mental health systems, including rigid diagnostic practices and manualised treatment models, limited professional accountability and the marginalisation of experiential knowledge. Treatment dropout and the attribution of treatment failure to patients are examined as mechanisms that obscure harm and inflate perceptions of treatment safety and effectiveness. Rather than rejecting evidence-based psychotherapy, the article calls for epistemic pluralism, routine monitoring and reporting of iatrogenesis and meaningful co-production as prerequisites for ethical, accountable and humane eating disorder care.
PMID:42473701 | DOI:10.1111/inm.70318
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