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.