Finding Hope in the Hardest Moments of Eating Disorder Treatment

Helping people with eating disorders who are also severely hopeless and suicidal doesn't mean just sending them to a hospital. It is important to recognize how serious the suicidal thoughts are while simultaneously seeing that developing trust in treatment is the only way to make progress. 

Many patients with eating disorders are scared to bring up suicidal thoughts to their treatment team. Not infrequently, the team responds by immediately recommending hospitalization or even calling 911. As much as I respect the need to focus on patient safety, everyone is different. Often, overreacting sends a message to the patient not to reveal their deepest and most painful thoughts and feelings. As I have written many times in this blog, secrecy strengthens the eating disorder. 

If the patient is imminently planning on committing suicide, then it is important to consider all options. But if the person has thoughts without any immediate intent, the next step is to try to talk more openly about these thoughts. The hopelessness and suicidal thoughts are almost always a window into the most powerful parts of the eating disorder, and exploring these thoughts can be an important step towards recovery. 

The circular reasoning of an eating disorder leaves patients trapped. It feels impossible to change eating patterns, challenge the thoughts and live a fuller life. The eating disorder thought process is intent on blocking all avenues of escape. After years of being trapped in this maze, it is common for patients to think that ending their life may be the only way out. 

Revealing that level of desperation can be a sign to a clinician that perhaps there is an opening for change. It is important to engage both practically and emotionally with this hopelessness and challenge the false beliefs of the eating disorder. It's hard to face that fear of change, but it is also possible to summon the courage to live life differently and alter deeply ingrained patterns. 

Sharing the intensity of hopelessness is often a sign of impending movement in recovery. Safety is clearly a priority but so is respecting the openness and trust in treatment along with acknowledging that clear, consistent support makes even he most challenging steps possible.

Eating Disorders and Suicidal Thoughts

Eating disorders are relentless mental illnesses. The struggle and suffering that stem from both the physical starvation and the mental torture are exhausting. People who have not had much treatment and don't know what the recovery process looks like can become very hopeless. The severity of the despair can sometimes lead to suicidal thoughts and even suicide. 

Three components of eating disorders increase the risk of hopelessness and suicidal thoughts for people with eating disorders. 

The first risk factor is secrecy. The eating disorder thought process involves a constant need for secrecy. Only in private can someone fully engage in the eating disorder. This urge often leads to lying and hiding in order to create time and space for the illness and the behaviors. Since most people with eating disorders are straightforward and direct, the secrecy creates a sense of hopelessness and despair based on behaviors anathema to their true selves. The idea that the illness leads them to behavior so out of character opens the door to feeling hopeless that life can ever change or be different. 

A deep sense of shame, something I have explored many times in his blog, creates a thought process of feeling intensely negative thoughts about oneself. Years of reinforcing behaviors and thoughts can create a hopeless feeling of being trapped in this shame with no way out. Shame is often a feeling that inundates all other feelings about oneself. Buried in shame, someone with an eating disorder typically feels very hopeless. 

Most people will seek treatment at some point, but the kind of therapy they receive makes a difference as to whether this cycle of hopelessness continues unhindered or comes into question. Seeing a clinician with a profound knowledge of eating disorder thoughts quickly makes a sufferer imagine that the secrecy, shame and hopelessness may very well be unfounded. It makes the idea and process of recovery realistic. On the other hand, a session with a less experienced clinician can only confirm these fears thereby strengthening the hopelessness and suicidal thoughts. 

Suicidality is a common and very serious component of chronic eating disorders. It is the absolute responsibility of the treatment community to provide solace and guidance to find a way out of this desperation towards treatment and recovery.

When to Choose Residential Treatment

One difficult decision in eating disorder treatment is whether or not to go to residential treatment. The factors around patient safety, the course of recovery and the anxiety of the clinician all make the process tricky. 

The number one reason for someone to go into treatment is patient safety. If an eating disorder has led to medical instability, organ damage or significant functional impairment, then the recommendation for inpatient treatment is clearcut. More often than not, any treatment team can come to this conclusion fairly easily. 

Many situations do not present such clear alternatives. When a patient has been in treatment for a period of time without making much progress, the choice of a higher level of care, clinical jargon to mean day treatment or residential treatment, becomes an option on the table. Frequently, the suggestion for more care comes from frustration of the treatment team around the lack of progress rather than a clear indication or need for residential treatment. The idea is that more treatment will kickstart the recovery process and lead to more rapid improvement. However, there is little evidence that this clinical step is successful. 

Another reason clinicians recommend inpatient treatment is the discomfort of the team with the level of a patient's symptom use. Even if that person is functioning and is medically stable, many clinicians struggle with the anxiety of seeing a chronically ill patient. Recommending residential treatment may be a salve to the concern of the clinician, but the key question is whether or not it is beneficial to the patient. 

Instead there are a few questions that would behoove a clinician or team before suggesting inpatient treatment. First, if the patient is at significant medical risk or is minimally functioning, then residential treatment is an option. If someone has not had good experiences with inpatient treatment before, then it is crucial to have specific reasons to consider this option and why it would be different. All clinicians and teams must assess their own fears and anxieties before suggesting inpatient treatment. Last, a team must have clear and reasonable goals for this step in recovery. Unrealistic expectations or even imagining a panacea that sets up the patient for failure are ways to absolve oneself of responsibility, not a benefit to the patient. 

Inpatient treatment is an option for the process of recovery. It must be considered carefully and clearly. The expense in time and energy is significant. This step should never be considered without clear and reasonable intention and assumption of the gravity of the decision.

Facing Eating Disorder Delusions, Part II

Internalizing the idea that the eating disorder creates a false world of beliefs is a significant step in recovery. But delusions, by definition, feel like reality to the person who has them, so questioning that reality is a monumental step forward. 

By and large, people with eating disorder delusions live in a world founded on these beliefs. If these thoughts come under question, one's entire belief system and even the structure of daily life has to be reevaluated. 

It is rare that adults are forced to reassess the way they live their lives. Catastrophic events can force adults to do so, like war or natural disaster or financial ruin. Social changes such as divorce or the loss of a loved one can also make adults rethink their lives. But most adults live in a world of set values and mores. They don't need to question the fundamental rules of the world they live in. 

There comes a point in recovery when people are capable of identifying and questioning the delusions of their eating disorder. They may not always want to question them because it is painful to recognize the lies that have governed their lives; however, they also know that living according to these lies is too destructive to continue. 

For them, facing the delusions is akin to completely reassessing their world and the foundational beliefs of their lives.  This is often the most important step in treatment. It enables people to see a life that is fully recovered and much more full.

As scary as this new world looks, reminding the person that disavowing these long held, false beliefs will create a truer and complete life will enable the person to take large steps in recovery. Above all, emotional support and compassion are the key to facing the delusions and entering a new world.