I have struggled with an eating disorder on and off for about 9 years. I thought I had it under control.
There were times I would restrict and would tell myself, “I can quit any time.” Truth is, I couldn’t. Over the course of several months, my friends and family reached out to me and expressed concern.
After about 6 months, I finally started treatment. I knew a partial hospitalization or intensive outpatient would be best for me. But I was so focused on my career and did not want to jeopardize it by leaving.
Getting better?…or not?
So, I did the best I could. I built a treatment team of a psychiatrist, a psychotherapist, a physician, and a dietician and saw them weekly. My physical findings were less than stellar, which assured me I was doing the right thing by getting treatment.
My recovery seemed to be going well for months. Then it came back and hit me full force after a trip for my 25th birthday and changes at work. My eating disorder is all about control, and a changing my work environment sent me right back into my eating disorder ways.
I found myself struggling at work. All I could think about was food. I was so distracted I couldn’t even listen to what people were telling me. Sitting through movies was impossible. I even gave up a lot of my favorite activities in exchange for wandering the aisles of the grocery store.
Asking for help
I finally contacted a treatment program I was familiar with and went for an assessment. Throughout the assessment I realized how bad things had gotten and how much more I was struggling than I even realized.
Their treatment recommendation was a partial hospitalization program (PHP) for 6 weeks. This would be difficult to do with my work schedule, but I knew I had to do it.
Either I got treatment now, or I wouldn’t have a job for long, as my performance and enjoyment was rapidly declining. So in the course of a few days I went from assessment to starting my PHP journey.
My first day was a whirlwind of seeing the doctor, psychiatrist, therapist, nurse, dietician, and meal techs. I was so overwhelmed. Eventually things settled down and I got into a groove.
Here is a short glimpse into the thoughts I had during my experience:
“I have to get weighed and I can’t see the number?!”
“You want me to eat what?”
“I can’t eat all of this!”
“I won’t eat all of this.”
“My stomach hurts. I’m bloated. I’m gassy. This is the worst.”
“You have to watch me go to the bathroom?”
“I hate you! You’re trying to make me fat!”
“Why did I do this? I’m fine!”
“I haven’t had this food in so long! I missed it!”
“I’ve never eaten this before, but I like it!”
“I gained a little weight, but that number doesn’t really matter. I feel so much better!”
“Oh my gosh… you get exactly what I’m going through.”
“Yoga is kind of fun.”
“Meditation isn’t that hard after all.”
“I’m not anxious anymore!”
“My blood work looks good? Finally!”
“I totally get how my past helped shaped this.”
My thoughts slowly went from extremely negative, to more positive. The thing that was the most amazing were the thoughts people shared with me as I returned back to normal life….
“You just have a new aura about you.”
“I’ve never seen you so calm!”
“You really want to go out to eat with me?”
“I can’t believe you actually ate real food.”
“I am so proud of you.”
After, I was so amazed at how much better I felt mentally and physically. Although it was a hard choice, I’m so thankful I finally chose more intense treatment. Now I still see my providers, but I am also back to work and normal life. I know for certain that intensive treatment gave me a better quality of life.
What are my options?
If you are considering more intensive levels of treatment, there are a couple options. All options are determined by your treatment team in accordance with current American Psychiatric Association Guidelines:
This is often for medically unstable or acute psychiatric emergencies. Inpatient treatment ensures round the clock medical care, can aid in refeeding, and monitoring for safety in regards to self-harm. Length of stay can vary based on medical need.
A residential program that often is recommended when other treatment options have not been beneficial. These programs are also 24 hours a day and ensure round the clock medical follow-ups. Intense psychological and meal support is usually a part of the program as well.
Individuals referred to residential programs are typically significantly impaired by their disordered eating and require significant support for their physical and emotional safety. They often incorporate group, individual, and family therapies for psychological and dietary concerns. The length of stay varies, but on average a person can expect to spend several weeks or months in a residential environment.
3. Partial hospitalization program
This is a step-down from residential. In this program patients receives intense therapeutic treatment during the day but return home in the evenings. This allows a person to see how they can handle the stresses of being on their own, with support of their treatment team.
These individuals often have intense disordered eating behaviors causing significant functioning in their environment. Treatment usually involves group, individual, and family modalities for both psychological and dietary concerns. There is medical monitoring and meal supports as well. The schedules vary, but partial hospitalizations are generally at least 20 hours a week, with some up to 70. A starting point for treatment at a PHP is generally 4-6 weeks.
4. Intensive outpatient program
This is a step-down from PHP. It allows one more support than basic outpatient care as one transitions into the community. The schedules vary by program but are anywhere from 9 to 30 hours per week.
Groups and meal support are the primary interventions of IOP. Length of stay can vary from several weeks to several months as one transitions from active recovery to remission.
5. Basic outpatient
This involves an individual fully committing to recovery and taking back control in their life. Someone in BOP has few disordered eating behaviors. This usually involves weekly follow-ups with a therapist and dietician. Medical and psychiatric follow-ups generally occur monthly. Your treatment team will best determine follow-up schedules with you.
Remember this, whatever you place your eating disorder above (career, family, friends, your own happiness) you are in danger of losing.
My career, my family, my relationship, and my friends were all slipping away due to my disordered eating.