When a person is “inpatient” it means that they will be living at the facility for a certain period of time. This can range from a few weeks to several months. Most will expect you to be medically stable before entering, so if your health is extremely poor, you may need hospitalization before admittance.
By this stage, you’re past the point of recovering alone: you need others to stop you doing yourself any more damage/killing yourself and to say ‘no’ to the behaviours that are dominating your life. Most inpatients will feel ambivalent at best; if not strongly opposed. Anosognosia is a symptom of anorexia, which means the patient does not see their behaviors as sick and they fail to recognize that they are ill. They may also be terrified of having to give up their eating disordered behaviours and taken away from normal routines. For this reason the inpatient programme tends to be very structured, with set meals and activities.
You may have to spend the first week or so without visitors to help you settle, but after this visiting or family weekends are often encouraged, as well as phonecalls. You’ll also be given round the clock monitoring to stop you engaging in bingeing, purging, restricting and substance abuse: and a break from the stresses of everyday life.
The facility usually has medical doctors, registered nurses, therapists, dieticians and volunteers on staff to work with the people in recovery on a daily basis. Routines vary, but may include group sessions, one-on-one therapy, medical evaluations, weigh-ins, nutritional counseling, art therapy, medication administration, meal times, and social or leisure activities. You may also have weekly sessions with nurses, medical doctors, social workers, case managers and/or nutritionists.
From the moment patients wake up they are usually guided through their day. This might start early, eg; 7:30, with ‘vitals check’ – a nursing staff member who assesses the patient’s heart rate, blood pressure, body temperature, and weight. You may have supervised showers and then breakfast. Meals and snacks are usually together and will be set as part of your care plan (especially in the early stages, where you’ll have very little choice). You will be expected to finish these and if you can’t, will be given supplementary drinks or (if it’s an ongoing issue), you may be given a feeding tube, (especially if you are critically ill).
It’s likely you will also have individual counselling or therapy sessions and you may be offered family therapy if appropriate. (But if you are at a very low weight, this is usually stabilised before you start talking therapies). CBT is often used to address wrong thinking and you may also be given training in building confidence, assertion, self-expression, improving sense of control, recognising and identifying emotions.
After meals groups may take place, including art, stress reduction or body-image training. As a group you may be encouraged to talk through the challenges of the day, (though there are usually rules on what can be discussed, eg; no talk about numbers). This also helps address the social anxiety and isolation that is often a part of the ED. Over time, you will given help in dealing with food anxieties, eg; eating small amounts of ‘trigger’ foods without bingeing, expanding your diet, nutrition education, portion control, eating in public or at a restaurant, shopping, etc.
Different units will have different approaches to treatment, eg; the Maudesley approach or the 12-step programme.
The Maudesley Method is usually used with minors and their families. It argues that where an Eating Disorder started matters little in its treatment. Instead of allocating blame, all members of the family are asked to accept responsibility in “fixing what is broken.”
The first phase (Sessions 1-10) puts the parents in charge of the eating behaviour of the patient, making food the medicine. The first two sessions engage the family to determine their eating habits and assemble a picture of the ED on all family members. The therapist externalizes the illness by presenting the eating disorder as controlling the patient. The therapist then encourages the parents to find their own method to control the adolescent eating behaviours without using force or punishment, eg; “I cannot let you get your driving licence while you are too weak”.
The second phase (Sessions 11-16) transfers the control of the feeding process back to the adolescent, and addresses related family problems. The third and final phase of the treatment focuses on encouraging adolescent development and establishing new family relationships disentangled from the eating disorder.
Twelve-step programmes are typically spiritually based in nature and use recovery mentors or ‘sponsors’ as part of group therapy. The steps are
1. admitting powerlessness – that life is unmanagable;
2. believing that a greater power could restore sanity;
3. deciding to turn will and life over to the care of God;
4. making a searching and fearless moral inventory or self;
5. admitting to God, self, and another human being the nature of our wrongs;
6. being ready to have God remove all these defects of character;
7. humbly asking God to remove our shortcomings;
8. making a list of persons harmed and being willing to make amends with them;
9. making amends with people hurt except when doing so would hurt them or others;
10. continuing to take personal inventory and admitting our wrongs;
11. improving the relationship with God through meditation and prayer and praying for knowledge of the will to carry out the power of His knowledge;
12. having a spiritual awakening as a result of these steps, and carrying the message to other addicts to practice these principles.
Finishing inpatient treatment
As you improve, you’re normally given extended periods of leave to help you re-enter normal life and to check you can maintain your weight without the unit. As well as friends and family, you should be given a care programme which may include outpatient appointments, telephone counselling and access to support groups. It’s important to remember that recovery is often a process that takes place in community and over time: but having left inpatient care, the goal is to be better equipped to deal with these challenges.
Next: recovery goals and self-care.