The Current Role of Residential Treatment for People with Eating Disorders

I have written at length recently about some of the troubling changes in the residential eating disorder treatment programs. Granted, my concerns about residential treatment have shifted during my years of practice at first from lack of access to residential care and now to the quality of care.

Because these illnesses are less of a focus to psychiatry programs across the country, eating disorders don’t have a clear, effective standard treatment plan. Thus, these programs are on their own to develop a strategy that seems appropriate. Clearly, this open debate allows programs much too wide a berth in their decision making.

Despite the varied, serious concerns, there still is a place for residential treatment for people with eating disorders. Some programs do a good enough job and many an adequate one, at least for certain patients.

The most common situation that merits residential care is a patient’s first serious episode of an eating disorder with medical consequences. If a patient is newly diagnosed, unable to curtail symptoms with sufficient outpatient care and at medical risk, then residential care is a reasonable and often necessary option. Treatment can stabilize health, provide education about the illness and inform the patient about the process of recovery. The risks are exposure to people with much more severe symptoms and the introduction of concept of the eating disorder as one’s identity.

Care needs to be taken for first time patients that they don’t end up in a revolving door of treatment. The deleterious psychological effects of ongoing residential and hospital care can cause long-lasting damage that may even outweigh the toll of the eating disorder itself.

Repeat admissions to residential care need to be considered cautiously. The risks of a first admission escalate significantly with subsequent admissions. Anyone returning to a facility needs a clear plan and hopefully a shorter time in treatment followed by a return to their lives as quickly as possible. Cycling through various programs makes people feel hopeless about their lives, unable to envision a future and identify increasingly with their illness. Outpatient clinicians must consider these various effects as much as managing the eating disorder itself.

For people with a longstanding eating disorder, programs are best used as a last ditch option. If someone is stuck in a behavior pattern with serious medical consequences, then a short term stay no longer than a month is best to stabilize the condition. There is nothing new to learn about treatment at this point, and it’s best to return to their regular lives as quickly as possible.

This post is meant to counter some of the concerns about residential treatment I have enumerated in recent months. There is a place for residential care in eating disorder treatment when considers thoughtfully and used judiciously.