Eating Disorders: When Outpatient Treatment Is Not Enough - Hospital Treatment for Eating Disorders

Written by HealthyPlace.com Staff Writer

SUMMARY OF REASONS FOR HOSPITALIZATION

• Postural hypotension (low blood pressure).
• Cardiac dysfunctions such as irregular heartbeat, prolonged QT interval, ventricular ectopy.
• Pulse less than 45 beats/minute (BPM) or greater than 100 BPM (with emaciation).
• Dehydration/electrolyte abnormalities such as a serum potassium level less than 2 milligrams equivalents per liter, fasting blood glucose level less than 50 milligrams per 100 milliliters, creating a level greater than 2 milligrams per 100 milliliters.
• Weight loss of more than 25 percent of ideal body weight or rapid, progressive weight loss (1 to 2 pounds per week) in spite of competent psychotherapy.
• Binge/purge behaviors are happening multiple times per day with no or little reduction.
• Outpatient treatment failure: (a) patient is unable to complete an outpatient trial, for example, can't physically drive to or remember sessions, or (b) treatment has lasted six months with no substantial improvement (e.g., weight gain, reduction of binge eating or purging, etc.).
• Observation for diagnosis and/or medication trial.
• Suicidal thoughts or gestures (e.g., self-cutting).
• Chaotic or abusive family situation, in which the family sabotages treatment.
• Inability to perform activities of daily living.

By Carolyn Costin, MA, M.Ed., MFCC
- Medical Reference from "The Eating Disorders Sourcebook"

Hospitalization should not be regarded as an easy or final solution to an eating disorder. Minimally, hospitalization should provide a structured environment to control behavior, supervise feeding, observe patient after meals to reduce purging, provide close medical monitoring if needed, and, if necessary to save a life, provide invasive medical treatment. Ideally, treatment programs for eating disorders should offer an established protocol and a trained staff and milieu that provide empathy, understanding, education, and support, facilitating cessation or dramatic reduction of eating disorder symptoms, thoughts and behaviors. For this reason, hospitalization does not have to be a last resort. In fact, professionals should avoid the connotation that indicates, "If you get too bad, or if you don't improve, I'm going to have to hospitalize you, and I know you don't want that." Hospitalization should not be feared nor should it be seen as a punishment. It is better for individuals to understand that if they are unable to battle their eating disorders with outpatient therapy alone, then more help for them will be sought in a treatment program where they will be provided the care, nurturing, and added strength they need to overcome their oppression by their eating disorders. When framed to the patients as "an opportunity to take the necessary time out from other responsibilities to focus on recovery in a setting where your thoughts and behaviors are understood," hospitalization or some other round-the-clock treatment option can be viewed as a welcomed, albeit scary, choice individuals make from the healthy part of them that wants to get better.

Letting eating disordered individuals be included in all of their treatment decisions, including when to go to a treatment program, is valuable. Control issues are a consistent theme seen in individuals with eating disorders. It is important not to let a "me against them" relationship develop between the therapist or treatment team and the person with the eating disorder. The more control individuals have in their treatment, the less they will need to act out other means of control (e.g., lying to the therapist, sneaking food, or purging when not being observed). Furthermore, if an individual has been included in the decision-making process regarding hospitalization or residential treatment, there is less trouble getting compliance when admission is necessary. Consider the following example.