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

Written by HealthyPlace.com Staff Writer

C. OFFERS SUPPORT FROM PEERS AND A HEALING ENVIRONMENT

• Patients in a treatment program are there with other individuals with similar issues, problems, and feelings. The camaraderie, support, and understanding of others are well-documented healing factors.
• A good treatment team in a hospital also provides a healing environment. Its members can be positive role models for self-care and can be an example of a healthy "family" system. The treatment team can provide a good experience of the balance between rules, responsibility, and freedom.

The duration of time spent in a treatment program will depend on the severity of the eating disorder, any complications, and the treatment goals. Inpatient treatment dealing with the eating disorder should include family and/or significant others throughout its course unless the treatment team determines there is good reason not to do so. Prior to discharge, family members can work with the treatment program staff to establish treatment goals and realistic expectations for the entire family.

Hospitalization can help break any addictive patterns or cycles and start a new behavioral process for the patient, but it is not the cure. Long-term follow-up is necessary. Success rates for hospitalization are hard to come by, but there are many aspects to choosing the right program, which will not be the same for everybody.

The cost of inpatient eating disorder treatment is anywhere from $15,000 to $45,000 per month or more, and, sadly enough, many insurance companies have exclusions in their policies for eating disorder treatment, which some have referred to as a "self-inflicted" problem. Careful assessment of cost and reimbursement possibilities should be done prior to admission unless there is an emergency situation. This is an outrage to people familiar with those suffering and/or those treating these individuals. There are some recovery homes or halfway houses that charge far less, even as little as $600 to $2,500 per month. However, these programs are not as intense or highly structured and are inadequate for individuals needing higher levels of care. These programs are useful as a step down from more intensive treatment. When considering admission to a treatment program it is important to review the philosophy, staff, and schedule of various program options. To help patients and their families in the selection of an appropriate treatment program, the following "ingredients" were developed by Michael Levine, Ph.D.

INGREDIENTS OF A GOOD EATING DISORDER TREATMENT PROGRAM

• Nutritional counseling and education designed to restore and maintain a body weight normal for that person. This is a body weight the person can maintain easily without dieting and without being obsessed with eating.
• Behavioral lessons designed to teach eating patterns that restore control to the person's body, not to some diet or some cultural ideal of slenderness. In other words, cognitive-behavioral lessons in how to live with food, stop black-and-white thinking, deal with perfectionism, and so forth.
• Some form of psychotherapy aimed at overcoming the eating disordered person's characteristic overvaluation of weight and shape as central determinants of self-worth. In general, this psychotherapy will address pathological attitudes about the body, the self, and relationships. The focus here is on development of a person, not refinement of a "package."
• Individual and group psychotherapy that helps the person not only renounce illness but also embrace health. In this regard, the person will probably need to learn (a) how to feel and to trust, and (b) specific skills for assertion, communication, problem solving, decision making, time management, and so forth.
• Psychiatric evaluation and monitoring. Where it has been deemed appropriate after a careful psychiatric evaluation, judicious use of antidepressant medication, for example, fluoxitene (Prozac) or antianxiety medication, or other medication to correct biochemical abnormalities or deficiencies.
• Some form of education, eating disorder support, and/or therapy that helps family and friends assist in the process of recovery and future development.
• Step-down levels of care are provided, offering increased freedom and responsibility to the patient for recovery. The key is that continuation and intervention be the same treatment team, and care involves and addresses relapse.