Eating Disorder Professional Treatment - Inpatient and Residential
Bridget Engel, Psy.D., edited by Kathryn Patricelli, MA
Inpatient and Partial Hospitalization
If you (the patient) are in serious physical danger and cannot be treated or maintained safely without immediate medical interventions, the professional who is examining you may arrange for intensive treatment. Treatment in a more intense structured setting may also be required if your symptoms are out of control and danger appears to be an immediate possibility. Inpatient treatment involves around the clock care in a medical or hospital setting. It is designed to treat medical complications and restore weight, as well as provide limited therapy.
If you are not following treatment recommendations and doctors feel that your life is in jeopardy unless you receive treatment immediately, you may be admitted to the hospital against your will. This is known as "involuntary commitment". If you continue to refuse food and nutritional supplements while in the hospital, you may need intravenous (I.V.) feedings to save your life. Involuntary hospitalization does not typically last for long periods of time. The goal is to physically stabilize you, and prevent serious medical complications and death. Insurance companies cover the cost of brief admissions to the hospital only when medically necessary and thoroughly documented by qualified professionals.
If you need more support than can be given through outpatient therapy but need less supervision than an inpatient program, you may be asked to attend a partial hospitalization or day treatment program. These programs are becoming more popular as an alternative to the very high cost of inpatient programs. You will attend treatment at a hospital or clinic several days per week for a few hours each day. You will not sleep at the hospital, but instead return to your home in the evening.
Residential facilities offer 24-hour care to people who may not be in serious medical danger but who continue to do eating disordered behaviors. These patients need intensive support to help them with daily functioning. This might include people who use binging, self-induced vomiting, laxative abuse, compulsive exercise, and restricted eating. They might not have serious medical problems yet, but can't stop these behaviors without intensive supervision. These programs generally offer specialized treatment, including supervision of behaviors and daily living activities. However, they still provide people with opportunities for increasing responsibility for their own recovery. These programs are often located in medical hospitals or exist in estates or renovated houses. It is not very common for insurance companies to pay for this type of program. Generally, the patient or their family must pay "out-of-pocket" (without insurance benefits) for residential care.
Another option is a stay in a halfway or recovery house. These options provide support and relapse prevention within a less structured setting than a typical residential program. These programs offer care in between hospital and regular home environments where residents can live with others who are also in recovery. Residents attend group therapy and recovery meetings. They go to individual therapy, either as part of the house program or with an outside therapist. Residents are typically generally free from the worst behavioral, physical and medical eating disorder symptoms already. They are working toward living in the community again.
Typically, care progresses along a path. It begins with immediate, life-saving treatments in a hospital setting. Then the person moves to partial or residential programs and intensive therapy and then to less frequent outpatient therapy sessions. As people gain physical and emotional health (or if treatment started at a less severe stage), they will transition to a recovery program or to outpatient services while living at home again. As needed, they may return to a more intense level of care if symptoms come back or they feel out of control again.