Updated: Jun 12, 2018
One of the most common questions I get asked as an eating disorder therapist is whether inpatient treatment is necessary. The New York Times ran a story a few years ago on the ubiquity of new eating disorder treatment centers opening across the country and the concerns that this trend raises. In it, the author wonders if such centers may be “taking advantage of vulnerable patients and their families”. This notion leads savvy healthcare consumers to wonder:
Is residential treatment necessary?
Is it all a scam? Would I be better off just continuing with regular weekly therapy?
(By the way, I use the terms “inpatient”, “residential” and “higher level of care” interchangeably throughout this article. Stay tuned in a later blog post for nuanced descriptions on the specifics of each).
First, let me start by emphasizing that the ONLY time I recommend residential treatment for someone with an eating disorder, is when it’s necessary. And often times, it is. So what constitutes necessity?
The answer looks different for different people. If you’re looking for a “cheat-sheet”, you can look up the American Psychiatric Association’s Levels of Care Criteria, as well as that of your insurance company’s. In short, whether a “higher level of care” is needed depends on the level of impairment the eating disorder symptoms are causing a person, or the degree to which it interferes with a person’s ability to live their life.
One of the most important factors to consider is health. If your doctor suggests inpatient or residential care, or an inpatient hospital stay, you need to go. Now. Do not pass Go, do not collect $200. Go now. Eating disorders are deadly. Eating disorders have the highest mortality rate of any mental disorder. People can and do die from eating disorders every day. This information is not meant to scare you (though I hope it does). I want you to know this because I want you to know how serious this is, and that you need to take your doctor’s recommendation seriously. If your labs are off, your heart rate or blood pressure are low, you’re having suicidal thoughts, or are abusing substances, you are in serious danger. In your case, residential or inpatient treatment can potentially be lifesaving.
Make no mistake: you do not need to be “sick enough” in order to get help. If you have an eating disorder, you may never believe you’re “sick enough” until it’s too late. Trust me, I hear this all. the. time. And it’s always 100% driven by the eating disorder voice. You know that evil little voice in the back of your head that seems to contradict everything the people who love you say? Yeah, that one. Tell it to take a hike (or you may have some more colorful language) and listen to your doctor, your therapist, your dietitian, and your family. Get the care you need, now.
So what if your doctor tells you your health is OK for the moment? Sure, maybe you have some minor health problems, but nothing too urgent. So why go to inpatient treatment?
Ask yourself: what do I need, that I’m not currently getting, in order to recover? The answer to that question will inform your next move.
Let’s say you’re currently seeing a therapist once per week. If your therapist specializes in eating disorders, you’re likely seeing a Registered Dietitian and maybe even a Psychiatrist, too. If all of these team members are in place, and you’re still not making progress, you probably need a “reboot”. You might need 24/7 support in order to break a cycle or stop a behavior that has become out of control. Maybe you need in-person help in order to eat what’s on your meal plan. Maybe you just need more support than your outpatient team can provide. These are all great reasons to seek a higher level of care.
Many people put off getting the recommended treatment because they don’t want to miss work or school. Ask yourself: if you don’t get better right now, are you really doing your best at work or school? Are you really living your life? And what will happen if things continue this way?