A friend of mine (who also has an eating disorder) called me a couple of days ago and said, “I just did something kind of crazy and I need to tell someone.” And while I run through all the worst case scenarios simultaneously in my brain she says, “I called [our old treatment center] and scheduled an assessment.”
We were roommates in treatment last summer and since we discharged, we call each other every week or so to check in. I knew she wasn’t doing well and was really struggling, even in her day program. “That’s not crazy,” I told her. “That’s amazing. I am so proud of you.”
Even considering inpatient treatment for your eating disorder is a big step. On the whole, we don’t like to admit how bad things have gotten. Considering inpatient or residential treatment means that you have to recognize that your behaviors, your thoughts, your eating disorder is out of control.
It’s nearly inconceivable at some points to think this – after all, isn’t your eating disorder what gives you control?
I’ve been trying to avoid the “inpatient” conversation with my dietitian for weeks, and finally got cornered by my therapist on Monday.
Knowing that my team (and my family) think that it would be appropriate for me to go back into treatment made me think stop and think seriously about what whether or not another [hopefully short] stay in treatment would be beneficial.
So I had to run my current experience of my eating disorder against my ideas of when to seek treatment.
When Should I Seek Inpatient Treatment?
First of all, let me begin by saying that I’m not a professional. (I know, I know. You’re shocked by this.) This advice should never supersede your treatment team’s suggestions as to what would be best for you. However, this can be a great place to start a conversation with your team.
Also, a disclaimer. I use “inpatient” and “residential” fairly synonymously in this article. Inpatient usually refers to a hospital setting, while residential is slightly less structured and less medically-based. Some insurances will cover inpatient but not residential and vice versa. Use these guidelines to consider inpatient and/or residential – don’t let the word “inpatient” trick you into thinking that these guidelines aren’t for you, too.
- Other levels of care have been ineffective: Perhaps you’ve been doing outpatient for long time. Maybe you’ve tried partial hospitalization programs. If your eating disorder symptoms are continuing to worsen despite this type of care, you may want to consider inpatient treatment.
- There are secondary behaviors to consider: Self harm is not at all uncommon among patients with eating disorders. If you have a history of self harm or are concerned that you might begin to self harm as you get treatment, inpatient or residential treatment is a great way to keep yourself safe. This also goes for alcohol abuse or overexercise or any other behavior that might interfere with your healing.
- You need psychiatric stabilization: If you are extremely depressed or suicidal or have other comorbid psychiatric illnesses, it might be best for you to begin treatment for your eating disorder somewhere that can also monitor your mood and make adjustments to your medications as necessary.
- You are medically compromised or could become so during refeeding: A friend once put it beautifully: “Eating disorders are a mental illness with very serious physical side effects.” If you are currently experiencing physical symptoms due to your eating disorder, you may want to consider getting treatment in an environment that can keep close tabs on your physical well-being and act immediately should you experience worsening conditions. (This is particularly a concern for anorexics during the refeeding process – prolonged starvation followed by “sudden” eating can cause extreme electrolyte imbalances, among other things, that need to be closely watched by a doctor.)
- You are not able to gain weight/stop bingeing/stop purging at home: Sure, this probably falls under all the above categories already, but I need to make it very clear – not just for you, but for me. The first step to a full recovery from an eating disorder is nutritional restoration – this means no starving, no bingeing, no purging. If you’re unable to do this in your current situation, inpatient treatment could give you the head start you need to continue on your own at home.
Do I think this is an extensive list? Certainly not. I would love to hear any other thoughts or suggestions that you might have. These are simply guidelines that I’ve used in the past to help determine if I need to step up the level of care.
Oh, and guidelines that I’m using in the present. I’ve got an assessment with an inpatient facility next week.