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Treatment Modalities

Inpatient Treatment

Inpatient treatment is the most intensive and expensive treatment for eating disorders. The primary rationale for inpatient treatment is to achieve medical safety in a controlled environment. For individuals who seem unable to interrupt their disordered eating behaviors despite imminent health risks, inpatient treatment provides a safe environment where they will be prevented from hurting themselves. Most often, inpatient treatment is used for individuals with AN who are dangerously underweight (see Figure 9.1) because of the severe medical consequences of starvation (see Chapter 8). Many patients, however, consider inpatient treatment the least desirable form of treatment and resist entering it. This was true of Emily.

Case Study: Emily

In addition to seeing a doctor to monitor her medical condition, Emily began seeing a psychologist and a nutritionist. However, she continued to lose weight over the first four weeks of treatment. In therapy, Emily admitted that she was afraid of becoming fat as a result of treatment and that she had been increasing her weight loss efforts to protect against this potential outcome. Emily’s weight was now critically low, and her treatment team feared that she might go into cardiac arrest. They informed her that she needed inpatient treatment. Emily pleaded that that she had not been “truly trying” and that she would be able to gain weight on her own. However, her treatment team informed her that doing so would be unsafe because the process of regaining weight could be dangerous once her weight dropped below a certain point. Reluctantly, Emily agreed to enter an inpatient treatment program for eating disorders. She hated the program, hated the loss of autonomy, hated being woken at 5:30 a.m. every morning to have her weight and vital signs checked, hated the nursing staff, hated the other patients, hated being monitored all the time, hated being forced to eat, and hated being forced to take part in “stupid groups.” However, Emily slowly gained weight. As this happened, she found that it was easier to read and concentrate on conversations and that some of the other patients and nursing staff were actually “interesting.” As she neared her target weight for discharge, Emily felt a combination of eagerness to be free from the

Patient hospitalized for anorexia nervosa in attempt to prevent her death. Source

FIGURE 9.1 Patient hospitalized for anorexia nervosa in attempt to prevent her death. Source: Valanne, E. H., Taipale, V., Larkio-Miettinen, A. K., Moren, R., and Ankee, M. (1972). Anorexia Nervosa: A follow-up study. Psychiatria Fennica, 267.

antiseptic environment of the inpatient unit and fear of leaving what had become a safe place where it didn’t matter whether she wanted to eat or not because it was not her decision.

Inpatient treatment also is employed for patients who purge very frequently, because of the dangerous electrolyte imbalances that accompany this symptom. Finally, inpatient treatment is used both to prevent suicide attempts and after suicide attempts. Depending on the severity of the attempt, inpatient treatment may be used to achieve medical stability in addition to ensuring safety from additional attempts.

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