The Risk of Referring to Eating Disorder Programs too Quickly

The growth of residential eating disorder treatment in recent years expands access to care in ways that were unimaginable a decade ago. Programs accept many insurance plans. There are so many more programs across the country. I look back at posts on this blog from a decade ago, and one main takeaway is how few options there are for treatment. What a needed and rapid change!

Availability of treatment for a broad swath of people with eating disorders is a huge relief. I have spoken about many of the concerns about these programs—many of which are now owned by private equity companies—but it’s important to recognize the benefits as well. Many more people sick with eating disorders can receive adequate and timely care.

An unexpected result of these improvements is a more myopic view of eating disorder treatment for outpatient clinicians. Before, referrals to “higher level of care,” i.e. treatment programs, were held at a higher threshold. The limited availability of programs made this referral more of a last resort.

With so many programs accessible and covered by insurance, it’s a lot easier for treatment teams to consider a program even after someone struggles for a brief period of time. There is less patience on the whole in outpatient treatment for patients to have a chance to try new ways to get well. Treatment programs can stop an immediate slide in symptoms, which often puts the clinicians’ minds at ease when facing a patient not doing well.

Programs may excel at making people eat, gain weight and regain health; however, in a bubble protected from the outside world, patients don’t learn how to cope with life while maintaining recovery. Cycling in and out of programs typically leads to patients who are demoralized and lose any sense of who they are outside the eating disorder. Too many of them lose hope for recovery.

The hardest part of recovery is the work done out in the world, not just the eating but dealing with the feelings that arise when eating behaviors are stable. That’s the work people in recovery need help with the most.

A treatment team needs to be able to tolerate the ups and downs of recovery in the world in order to let the patient know she has the support to get well. Clinicians need to remember it’s also their job to tolerate when a patient struggles. Resorting to treatment programs too quickly only reinforces the hopelessness of recovery rather than the projecting the belief and confidence that getting better is really possible.