Patients who get Stuck in Residential Treatment

In recent years, I have seen more people go to treatment around ages 16-19 years old who proceed to get trapped in several years of an endless cycle of residential and outpatient programs. Although some patients did go through similar experiences in the past, the number of people languishing in this cycle seems to be increasing.

Typically, these are young women with anorexia who have little incentive to change their eating, for either psychological or physical reasons, and who are very vulnerable to the messaging in eating disorder programs. These messages instill blame and shame around not being able to “fully recover,” thus reinforcing the negative self-image at the heart of an eating disorder.

The combination of a sense of failure to follow the guidelines of programs and the shaming about having an eating disorder leave this cohort of people hopeless and alone. Even involved families are convinced that there is no other option for recovery.

These patients are forced to integrate the hopeless and helpless state as part of their eating disorder identity and then feel the pull give up on themselves and their future. The resulting trauma from treatment often overrides even the struggle with the eating disorder itself. To a person, this cohort reports that their self-worth tumbled dramatically after entering treatment.

Some find ways to exit the cycle often through extreme measures such as a feeding tube for regular nighttime formula feeding or avoiding any health care providers who might force them into treatment again. The result is more isolation and increased fear of seeking any help that may lead to being imprisoned in treatment again.

It’s hard for me to ignore the fact that private equity investment in eating disorder treatment seems to encourage a revolving door of patients who provide an unlimited pool of insurance money for these programs. For the group of people in and out of treatment for years, it’s clear that the current state of eating disorder treatment is not working. No one should have to repeat treatment that’s punishing, cruel and ineffective.

That’s one reason I’m looking into other possible medical causes for some eating disorders. Many of those mentioned above have MCAS symptoms, which I have written about in recent posts. Providers ought to include MCAS screening for newly diagnosed people with eating disorders, especially Anorexia, to assess if the difficulty eating is connected to MCAS. Forcing people to eat may very well be torturing them by worsening these uncomfortable, painful and sometimes debilitating mast cell symptoms.

Eating disorder treatment providers need to stop relying on methods that often fail and can be traumatic and instead think outside the box for new ideas. Even referring to higher level of care, which may be clinically appropriate, often causes irreparable psychological harm to people just learning about their eating disorder and starting to get help. Our goal must be to help and heal, first and foremost.