Eating Disorders Part 2 – Residential or Day Treatment?
If you or someone you love is struggling with an eating disorder – or symptoms that strongly suggest you may have one – treatment is crucial to your health and well-being. In severe cases, it may even save your life.
In Part 1, the initial steps toward getting help were discussed. This second part covers the treatment options available for eating disorders. It’s important to clarify that the word “options” is applicable primarily in the sense of the types of treatment that exist. However, if your eating disorder has seriously compromised your physical health or resulted in potentially life-threatening medical issues (e.g. severe malnourishment or dehydration), you may only have one option at the moment, and that’s inpatient treatment. Serious medical issues are always a top priority; the psychological issues can be addressed until those are stabilized.
If your situation isn’t quite so dire, then it’s good to understand all the types of treatment options that are available. You, along with your doctor and/or therapist, can then determine the best treatment approach. This will be based on several factors, including the type of eating disorder you have, your specific symptoms and treatment needs, your financial resources and your personal goals.
Treatment for eating disorders often includes a multifaceted approach, including individual psychotherapy, medication, medical treatment as indicated, and nutritional counseling and education. Family therapy is often a crucial part of treatment as well.
Your initial success, as well as your long-term recovery, will depend on your commitment to getting better, sticking with your treatment program, and working with qualified treatment professionals who are experienced in effectively treating eating disorders.
Unfortunately, there is often significant denial and resistance when it comes to eating disorders, especially anorexia nervosa. It’s always best to start treatment as early as possible, because the more ingrained the disorder becomes, the more difficult it is to break through the denial and resistance that perpetuate the disordered eating.
Psychotherapy, often referred to as talk therapy, is one of the most important aspects of treatment for all types of eating disorders. This is where the underlying issues that triggered the development of the disorder as well as the various factors that keep it going (e.g. irrational beliefs, family conflict, relationship problems, a distorted body image), are identified and addressed.
Psychotherapy can be done with any qualified mental health professional, such as a psychologist, licensed clinical social work or psychiatrist. However, it’s important to work with a therapist who has experience treating eating disorders. Outpatient therapy usually involves one session per week, and may last several months or a few years. In an inpatient or residential treatment program, psychotherapy may occur several times a week or even daily.
Different therapeutic approaches are used to treat eating disorders, including:
Cognitive behavioral therapy (CBT): CBT is a relatively short term therapy that helps you identify negative thoughts and feelings, irrational beliefs and unhealthy behaviors that fuel your disordered eating. As these are identified, your therapist will help you replace them with healthier ways of thinking and behaving. Research has shown that CBT is very effective in treating a variety of psychiatric disorders, including eating disorders.
Psychodynamic psychotherapy: Stemming from the work of Sigmund Freud, this type of therapy centers around the relationship between you and your therapist as a significant part of the overall therapeutic process. Highly insight-oriented, psychodynamic approaches explores issues pertaining to your emotional/psychological development as well as subconscious and unconscious factors that are believed to play an important role in your feelings, relationships and behaviors. Psychodynamic therapy is usually a long-term process.
Interpersonal psychotherapy (IPT): Interpersonal psychotherapy, as the name suggests, focuses on identifying and addressing relationship issues that play an underlying role in your eating disorder. For example, family conflict, romantic relationships and rejections, life transitions (e.g. starting college or getting a divorce), significant losses and unresolved grief are all things that can trigger or influence an eating disorder. Addressing and resolving these issues are believed to be the key to overcoming your disordered eating.
Family therapy: Family therapy often plays a very important role in treating eating disorders, particularly in children, adolescents, or young adults who still live at home. Family dynamics, such as communication problems, control issues, and conflict, are addressed as family members all take part in the therapy process. Family therapy is especially helpful for parents in terms of helping them understand the problem and best support their struggling son or daughter. Along the same lines, couples therapy can be beneficial by having your spouse or significant other partake in the therapy process.
Because of the complexity and unique challenges of eating disorders, and the frequent need for an intensive and multi-disciplinary approach, residential treatment programs can be particularly effective. Rather than meeting with a therapist, nutritionist and other treatment providers once a week, and returning home each day (which may or may not be a supportive environment), a residential program allows you to live in a therapeutic setting with all of your treatment providers in one place. The pace is much more intense than outpatient treatment. Not to mention, residential programs give you a break from the demands of your day to day life. This allows you to focus exclusively on your treatment and recovery. Residential treatment is often required if you’re not making progress (or getting worse) with outpatient treatment only, or if you’ve been in and out of the hospital and haven’t gotten better. Residential treatment can also be particularly helpful if you have a co-occurring psychiatric disorder, such as depression or anxiety.
Eating disorders can cause serious medical issues, especially over time or when the symptoms are severe. For example, anorexia nervosa is one of the most deadly psychiatric disorders because of the toll it can take on your body if left untreated. Extreme malnutrition, dangerous electrolyte imbalances and heart failure can all be fatal.
Hospitalization is necessary when serious psychiatric or medical issues are present that require 24/7 monitoring. Patients who refuse to eat, are suicidal, or are dangerously underweight typically need hospitalization. Once the urgent issues are stabilized, residential or outpatient treatment can be started or resumed.
Hospital Day Treatment
Another fairly intensive treatment option for eating disorders is hospital day treatment. Unlike residential treatment, you go home each night rather than stay at the facility. During the day, you attend your treatment program for several hours. This can be an ideal treatment option if you require more structure and intensity than outpatient treatment, but need or want to work or attend school during the course of your treatment.
Nutritional Counseling and Education
Eating disorders involve a disturbed relationship with food. Unhealthy eating habits, whether it’s too few calories or binging on junk food, need to be addressed as part of the overall treatment. Nutritional counseling and education help you learn how to eat in a healthy way in order to reach and /or maintain a healthy weight while giving your body the nutrition it needs to heal. Learning how to plan meals, avoid “dieting,” and develop a regular eating schedule are typical goals of this aspect of treatment. Nutritional counseling often also helps you identify how your eating disorder can lead to other health issues.
Medications may be used as part of your eating disorder treatment. They are usually used to alleviate symptoms of anxiety or depression that frequently occur with eating disorders, or to treat a co-occurring psychiatric disorder (e.g. bipolar disorder or OCD). They may also be used to treat any medical issues related to your eating disorder. Antidepressant medications, such as Prozac, may also help reduce the urge to binge.
If you or someone you love is struggling with an eating disorder, the sooner you get into treatment, the better. Ask your doctor for a referral, or contact a mental health professional or an eating disorder treatment center for an appointment for an evaluation.