The Traumatic Effects of Inpatient Treatment for Eating Disorders

Traumatic responses to inpatient and residential treatment have many facets and interfere with one’s ability to find and commit to successful treatment. 

First and foremost, the trauma of treatment programs causes a lack of trust for clinicians. In programs, clinicians usually promise health and happiness by committing to a new meal plan, but the reality of eating and disobeying eating disorder thoughts and beliefs feels painful and frightening.

The disconnect between trust in clinicians and the outcome of following their advice convinces many patients that clinicians are not in fact to be trusted. Patients learn that it’s more advantageous to negotiate with providers rather than to trust them. The result is that the ultimate goals of the treatment team and the patient feel at odds. 

Once out in the world, trusting clinicians seems almost absurd after feeling so betrayed in programs. Without any guidance, people rely on their eating disorders, refuse to speak frankly with their treatment team and often relapse quickly. 

The experience of feeling trapped while eating and gaining weight fulfills the worst nightmare and deepest fear of many people with eating disorders. After living through such a difficult time, patients talk about reliving moments of terror in programs and how alone they felt while in treatment. Any suggestions to adhere to a meal plan or work on food consistency feel like a reenactment of treatment and engender the same feelings.

Moving forward in recovery in the world often means facing these traumatic memories of treatment first. For many people, finding a path towards a recovery entails undoing much of the effects of treatment. 

The other most important traumatic experience of programs is the drastic change in one’s body. Body image thoughts and fear of weight gain are central to most people with eating disorders. Programs often lead to a rapid change in one’s body, and handling the traumatic fallout of this transformation is painful.

For many patients, the only recourse of to lose weight as quickly as possible to regain a body that feels comfortable. Even if this impulse is not intended to lead to relapse, any attempt at weight loss triggers a relapse most of the time. 

The transition to outpatient treatment not only means learning how to eat on your own without the structure of a program. It also means facing these important traumatic elements of treatment in order to make recovery possible at all. To be clear, many people have positive and helpful experiences in treatment. Trauma is far from universal but is a real effect many people with eating disorders experience.