Hospitalization and Residential Treatment for Eating Disorders

Providing Structure, Support and Medical Management

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Eating disorders can be extremely dangerous and potentially deadly diseases. People with eating disorders frequently experience medical complications, which can affect all systems of the body. As a result, sometimes people with eating disorders, including anorexia nervosa and bulimia nervosa, and binge eating disorder may require treatment in a hospital or residential treatment center (RTC).

Both inpatient hospitalization and residential treatment centers for eating disorders provide patients with additional support, structure, medical care and monitoring. It may be helpful to understand what will happen in these settings for an eating disorder.

Hospitalization for Eating Disorders

Inpatient hospitalization is the most intensive level of treatment. The main reason for inpatient hospitalization is medical instability. As a result, eating disorder patients needing inpatient hospitalization are usually admitted to the medical units of hospitals, rather than psychiatric units where patients with other mental disorders are usually treated.

Whenever possible, eating disorder hospitalization should take place in a specialized medical unit for eating disorders versus in a general medical or psychiatric unit. Eating disorders require a unique collaboration between many medical and mental health specialists and general hospital units may not be set up to provide the appropriate care.

Because hospitalization is very expensive, it is usually short-term. Many patients only stay at the inpatient level of care until they have been medically stabilized enough to continue treatment at a lower level of care. The medical management available at the inpatient level is extremely important.

Many patients require monitoring of vitals, intravenous fluids, medication, and laboratory tests.

Patients are monitored by round-the-clock nursing staff. The inpatient hospital treatment team will usually consist of physicians, psychiatrists, therapists, dietitians and nursing staff. It may also include other specialists if needed. Inpatient units are often connected to or affiliated with a full hospital which can provide access to different medical specialists, including cardiologists, neurologists, gastroenterologists, etc.

Hospital staff also will provide basic nutrition information and nutritional counseling, and a dietitian will plan meals. If the patient can't eat enough to regain or maintain weight, doctors and other treatment team members may recommend medical refeeding, which involves inserting a tube through the patient's nose down into the stomach. This tube then can carry nutrition directly to the stomach. Medical refeeding is one of the unique services that inpatient hospitalization is able to provide.

Another form of support that inpatient hospitalization is able to provide is supported meals. Staff members will typically supervise all of a patient’s meals to provide support and monitor intake.

They will be available before and after meals, to process any urges that patients are experiencing and to support patients during these anxiety-provoking times.

Hospitalized patients will also receive counseling with a therapist and an evaluation by a psychiatrist.

When are Patients Hospitalized?

Any time a person is experiencing medical complications due to their eating disorder including but not limited to an unstable heart rate or blood pressure, fainting, or bleeding from vomiting, they should be screened for hospitalization. Patients may require hospitalization if they are severely malnourished and/or have lost a great deal of weight and are at risk for refeeding syndrome

Although hospitalization can be scary, it is also a very necessary component of treatment for many people. If your therapist, physician or dietitian is recommending hospitalization, please go. It may save your life. Choosing not to go to the hospital when needed can be extremely dangerous.

Patients may often be transferred to residential treatment or a partial hospitalization program when their vitals are stable, they have resumed some eating on their own with structure, and they have gained some weight. They may still require high levels of support and structure, but this can usually be provided at a nonmedical residential treatment center or a partial hospitalization program, which a patient attends during the day, but returns home at night to sleep.

Residential Treatment Center

Residential Treatment Centers also house patients 24 hours a day, but these are nonmedical facilities that provide housing, meals, and multidisciplinary treatment. Residential treatment is appropriate for patients who are medically stable but need full supervision to address eating disorder symptoms such as vomiting, excessive exercise, laxative use, and dietary restriction. It can also be appropriate when someone is suicidal, if the patient lives far away from treatment providers, if there is a lack of social support, or if there are other complicating medical or psychiatric factors.

The goal of residential treatment is to improve physical and psychological health. The average length of stay in a residential treatment center is 83 days.  

Patients receive supervised meals. Intensive psychotherapy, or counseling, is usually a routine part of residential treatment. Because patients are at residential treatment centers 24 hours a day, seven days a week, patients may be able to have sessions with therapists more frequently than on an outpatient basis. In some centers, they may be able to meet with their individual therapist several times during the week. They will also usually attend group therapy sessions and family therapy sessions.

Full Continuum of Care

The full continuum of care for eating disorders includes outpatient care, intensive outpatient programs (IOP), day treatment or partial hospital programs (PHP), residential programs, and inpatient hospitalization. A patient may move in either direction through the varying levels of care based on factors including symptom severity, medical status, motivational for treatment, past treatment history, and financial abilities.

Sources

American Psychiatric Association. American Psychiatric Association Practice Guidelines for the treatment of psychiatric disorders: compendium 2006. American Psychiatric Pub, 2006.

Anderson, Leslie K., Erin E. Reilly, Laura Berner, Christina E. Wierenga, Michelle D. Jones, Tiffany A. Brown, Walter H. Kaye, and Anne Cusack. 2017. “Treating Eating Disorders at Higher Levels of Care: Overview and Challenges.” Current Psychiatry Reports 19 (8): 48.