Inpatient care

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What is inpatient care?

Inpatient care is the most intensive level of treatment for eating disorders that usually takes place in specialized hospital units or residential treatment facilities. It is required for people who are medically or psychiatrically compromised and need around-the-clock supervision. (1) Patients struggling with disordered eating have shown significant improvements on their road to recovery through inpatient care. 

Both residential treatment centers and inpatient hospitalization for eating disorders provide a safe, well-defined environment with highly specialized medical and psychiatric care, structure, and monitoring. (2) A comprehensive treatment plan tailored to the individual involves a cohesive team that may include a psychiatrist, psychologist, dietitian, nutritionist, social worker, nurse, and other medical professionals if necessary.

How are eating disorders treated with inpatient care?

Inpatient care is designed to treat the person as a whole, taking into account mental and social factors, in addition to the symptoms of the eating disorder. (3) Treatment may include:

  • Nutritional counseling and education
  • Individual and family psychotherapy
  • Medication management
  • Supervised meals and snacks
  • Round-the-clock monitoring by nurses

Medical management is usually an important part of the treatment, as some patients may require intravenous fluids, tube feeding, monitoring of vitals, and regular lab tests. Other specialists, such as neurologists, cardiologists, and gastroenterologists, may also be involved to aid in the treatment of any medical complications.

The length of stay is usually less than 3-4 weeks. Once a patient is medically stable, they’re transferred to a lower level of care program. This may be partial hospitalization (PHP), intensive outpatient, or outpatient program.

Before committing to a treatment facility, It’s a good idea to learn as much as possible about the care program to determine if it meets the individual’s specific needs. Some treatment centers focus on only anorexia nervosa, for example. Higher weight individuals may feel uncomfortable and stigmatized if surrounded by lower weight individuals. Some good questions to ask include:

  • How close is it to home?
  • Is treatment covered by insurance?
  • What types of therapy are offered?
  • Does the facility treat co-occurring disorders?
  • Does the staff have the necessary level of expertise?

What to expect in inpatient care?

During inpatient care, patients are guided through the day with a structured timetable. This aims to prevent individuals from remaining sedentary and ruminating on their thoughts. Some inpatient programs offer supervised outings to help clients adjust to life outside the treatment facility.

As inpatient care is usually carried out in a treatment center 24 hours a day, 7 days a week, individuals usually have more frequent sessions with their therapists than on an outpatient basis. They’ll also attend group therapy and family therapy sessions.

Dieticians and nutritionists provide individualized nutrition education, nutritional counseling, and meal plans.

If a client is struggling to eat enough food to regain or maintain weight, the treatment team may recommend medical refeeding. This involves inserting a feeding tube through the nose and into the stomach, which allows nutrition to be delivered directly to the stomach, and usually occurs in a specialized hospital unit. 

Nurses and other members of the treatment team usually provide support before, during, and after meals, to help individuals process any urges and ease worries experienced during these anxiety-inducing moments.

Types of inpatient care

The type of inpatient care received depends on the individual’s specific needs and medical stability. (4)

Inpatient hospitalization

Inpatient hospitalization in a medical facility that specializes in eating disorders is usually required if an individual is experiencing medical or psychiatric complications and deemed unstable as a result of their eating disorder. These include but aren’t limited to: (4,5)

  • Unstable heart rate and/or blood pressure
  • Fainting episodes
  • Bleeding from vomiting
  • Severe malnutrition and/or weight loss
  • Thoughts of suicide and self-harm
  • Complications arising from coexisting medical conditions, like diabetes
  • Lab tests indicate an acute health risk, such as severe electrolyte disturbances, bradycardia, and hypotension

Patients are monitored around the clock by a team of nurses and medical professionals.

Once vitals are stabilized, a patient has started eating on their own with structure, and/or gained some weight, they may be transferred to residential treatment or a partial hospitalization program (PHP).

Partial hospitalization (PHP)

Partial hospitalization programs (PHP) are structured day treatment programs that require attendance several days a week, for multiple hours. Day treatment can include medical care, nutrition counseling, structured eating sessions, and group, individual, and family therapy. (6)

PHP patients are medically and psychiatrically stable but:

  • Require daily assessment of mental and physical status
  • Struggle to function in normal social situations, such as in school or at work
  • Still engage in harmful eating behaviors, such as binging, purging, fasting, limiting food intake, or other weight control techniques

Residential treatment

Like inpatient hospitalization, residential treatment cares for patients for 24 hours a day and provides multidisciplinary treatment for eating disorders. Residential treatment is generally for medically stable patients who still require full supervision to address their disordered eating behaviors, such as dietary restriction, excessive exercise, binging, purging, and laxative use.

Patients of residential treatment programs may also be psychiatrically impaired and therefore might not respond to PHP or outpatient treatment.

What are the benefits of inpatient care?

There are several benefits of treating eating disorders with inpatient care, including:

  • Nutritional education and counseling
  • Tailored nutritional meals and supplements to help tackle deficiencies and imbalances
  • Round-the-clock medical support in comfortable and nurturing surroundings
  • Additional support and camaraderie from peers

During an inpatient program, the care team works with individuals in therapy to identify any root causes or underlying factors contributing to their eating disorder.

What are the limitations of inpatient care?

Greater expense

As inpatient treatment requires overnight accommodation and constant surveillance from staff, it tends to be significantly more expensive than outpatient treatment programs. However, some of the expense of an inpatient program may be covered by health insurance.

Difficult transition

Some individuals may find the transition from residential care into lower levels of treatment challenging. Losing the structure of residential care may leave some feeling unprepared for the triggers of everyday life. Such people will benefit from outpatient programs to help them adjust to life outside the facility.

Efficacy of inpatient care in healing eating disorders

The scientific literature has shown some inpatient care success in healing eating disorders. Research suggests that, for BN, inpatient treatment is more effective than day clinic treatment, but both still showed significant levels of remission, both at discharge and at follow-up, 18 months later. (7)

Research has shown that AN patients were able to gain significant weight between admission into a nutritional rehabilitation inpatient program, discharge, and follow-up. (8) Additionally, those with AN were able to increase their calorie intake throughout their treatment, and few patients required readmission.

A review of studies into PHP treatment concluded there is a significant improvement in weight gain for AN patients, as well as reduction in binging and vomiting episodes in those with BN. (9) Furthermore, there were also significant improvements in depression, anxiety, and eating disorder psychopathology.

Inpatient treatment for eating disorders at Within Health

At Within Health, although we do not offer inpatient treatment at a facility, we are providing a new form of virtual treatment that exists between PHP and intensive outpatient (IOP) levels of care. In general, patients who have been in residential care programs, and return home for a PHP or IOP program, often experience challenges with staying in recovery while in their home environments. These patients are moving from a recovery-oriented safe space at the facility, to life at home, which can feel very different. Within Health has developed a treatment model that addresses this gap in care when it comes to eating disorders. 

Within Health uses virtual technology, such as video calls through our app, to keep in close contact with patients for up to twelve hours per day. Our team will sit with you while you’re cooking, eating, moving, or living, as a caring support system, advocating for your success. Call our team today to learn more about first steps, and our commitment to creating clinically-superior, individualized care programs for people with eating disorders.

Disclaimer about "overeating": Within Health hesitatingly uses the word "overeating" because it is the term currently associated with this condition in society, however, we believe it inherently overlooks the various psychological aspects of this condition which are often interconnected with internalized diet culture, and a restrictive mindset about food. For the remainder of this piece, we will therefore be putting "overeating" in quotations to recognize that the diagnosis itself pathologizes behavior that is potentially hardwired and adaptive to a restrictive mindset.

Resources

  1. Ekern, B., Ekern, B., (2016, May 31). Understanding when inpatient treatment for eating disorders is right for you. Eating Disorder Hope. 
  2. Susan Cowden, M. S. (2020, March 19). How hospital or residential treatment centers can help eating disorders. Verywell Mind. 
  3. What is inpatient treatment? (2012 Nov. 7) Eating Disorder Hope. 
  4. Williams, P. M., Goodie, J., & Motsinger, C. D. Treating eating disorders in primary care. American Family Physician. 2008 Jan 15;77(2):187-195.
  5. Types of treatment. (2020, November 16) National Eating Disorders Association. 
  6. Eating disorder treatment: Know your options. (2017, July 14). Mayo Foundation for Medical Education and Research.
  7. Zeeck, A., Herzog, T. and Hartmann, A. Day clinic or inpatient care for severe bulimia nervosa? Eur. Eat. Disorders Rev., (2004) 12: 79-86.
  8. Morris, J., Simpson, A. V., and Voy, S. J. Length of Stay of Inpatients with Eating Disorders. Clin. Psychol. Psychother., (2015),22, 45– 53.
  9. Friedman, K., Ramirez, A., Murray, S., Anderson, L., Cusack, A., Boutelle, K., & Kaye, W.A Narrative Review of Outcome Studies for Residential and Partial Hospital-based Treatment of Eating Disorders.European Eating Disorders Review: The Journal of the Eating Disorders Association, (2016) 24(4), 263-276.

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