Beige Food Eight

Inpatient Treatment Realities

The big challenge if you are navigating recovery in an inpatient hospital setting is underfeeding. If this is where you’re at right now, in an inpatient setting trying to recover from an eating disorder, then I’d encourage you to read Inpatient Underfeeding where I go into all the details of navigating this challenge. As underfeeding in hospital settings is rife, that article may also be of use to you if you are facing a hospital stay associated with a crisis due to another chronic condition beyond an eating disorder. 

Attempting to negotiate with, or school, treatment team professionals in an inpatient setting yields poor results for most patients. There are always exceptions, but generally patients are expected to absorb and accept the fact that they are the ones with the least agency and autonomy in the system.

I recommend extracting the value of the inpatient setting for what it is: it will medically stabilize you so that you can be released. The actual process to remission occurs after that release from inpatient care in any case.

Outpatient Treatment

There are two kinds of outpatient treatment for eating disorder recovery: stepped down formal oversight from an inpatient setting, and ad hoc and informal care. Informal care may involve regular medical biomarker assessments and/or new symptom-specific investigations. Informal care may also include psychological guidance as well as nutritional and dietary advice.

When a patient is released from an inpatient setting, they could be released to a formal outpatient program that includes regular mandatory medical assessments, weigh-ins and group therapy attendance. If you are placed in such a step-down program, you can now choose to focus on your recovery process in a way that fully supports your energy restoration needs. 

You may recover more weight than the program deems acceptable, keeping in mind that most programs have a “recover, but not too much” approach to restrictive eating disorders in that they wrongly assume getting any larger than BMI 20 or so predisposes someone to develop so-called binge disorders. Here I am assuming that you have read the material on this site and have decided, based on the data provided here, that binge eating disorders are restrictive eating disorders in larger bodied individuals. The enemy is always restricting food intake across the entire spectrum of named eating disorders.

Although you will be warned off of “eating too much” or “eating unhealthily,” your weight restoration will not trigger readmission to the inpatient program even if they decide you are “gaining too much weight.” Readmission to the inpatient program primarily occurs if you lose the weight that you have initially gained as that will be a marker of moving back into a medically unstable state requiring another inpatient stay to rectify that.

If you gain more weight than they deem appropriate in a formal outpatient program, you are unlikely to be readmitted. They will use shaming and admonishments to try to rectify what they deem as risky weight restoration. You will be told that you are risking your health. They will focus a lot of attention questioning you on whether you are applying any compensatory behaviours like purging or laxative use. Of course, they should be concerned about the development of those compensatory behaviours, but usually they address those actual risky behaviours by reapplying restrictive food intake recommendations (a so-called healthy diet and healthy calorie intake).

If you are struggling with bulimic behaviours, unfortunately these outpatient settings tend to reinforce the moral panic around weight restoration rather than helping you develop the techniques to distract and replace the drive to compensate for eating with exercise, purging, laxatives and all the other ways that ease panic through avoidance.  In that situation, and if you can, it’s best to discharge yourself from that outpatient program and seek advice from a psychologist trained in exposure and response prevention therapy.

Next and final installment December 19.

Image in outline preview: Flickr.com Rafael Edward.