When alarms are ignored: clinical reflections on ignorance culture in eating disorder care.

In his analysis of 'ignorance culture' in eating disorder services, Downs describes how repeated alarms raised by patients, carers and clinicians are routinely ignored, deflected or reframed as individual pathology. In this Opinion piece, I reflect on the clinical implications of that analysis, arguing that ignorance culture is enacted through everyday treatment structures that misread multi-layered presentations, invalidate advocacy and displace responsibility. Drawing on dialectical theory and biosocial frameworks, and using multidiagnostic eating disorder-dialectical behaviour therapy as an illustrative example, I suggest that addressing ignorance culture requires treatment models that operationalise responsibility rather than merely espouse it.