Residential Treatment Programs for Eating Disorders are Too Restrictive

The treatment options for eating disorders remain very limited in this country. For the most part, there is one way to get help. If that doesn’t work for you, then there are very few other paths. 

Even as financial companies have bought and aggregated treatment facilities, there is no innovation in treatment, only more of the same programs. Outpatient teams funnel into residential treatment programs and their outpatient step-down plans. There are a smattering of hospital-based programs for the sickest people which are usually even more rigid and punitive. 

These programs function on a very strict model. All eating disorders are essentially treated as equal. The focus is on 100% compliance with the meal plan, weight restoration and complete acceptance of the treatment philosophy of the program. There is little room for individualized care. And if following any of these rules is impossible or even difficult, the patient is labeled intractable, ostracized and eventually moved out of the program.

As a clinician who works with people with chronic eating disorders, I am aware of how difficult and long a course of recovery can be. There rarely are easy answers. Changing long-standing eating patterns takes enormous time and effort which cannot happen in these short-term programs.

However, programs are intended to be stepping stones into more active recovery. The goals are stabilization of eating patterns, health and psychological symptoms. With those achieved, the transition into intensive outpatient treatment can be more effective.

The people who can’t benefit from programs end up feeling more hopeless and often more entrenched in their illness. The sense of failure reinforces a deep feeling of inadequacy and an internal inability to weather the storm of recovery.

The only option left is to set up a treatment team and work on the slow process of recovery on their own out in the world. This plan can be effective although the deep sense of failure from treatment only makes it more difficult.

The harder question is what other options are there for different kinds of treatment. I will start to address this question in the next post.a