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Psychiatric Hospitalization and Drugs for Anorexia

By December 18, 2012

I am 35 years old and have had an ED for the past 6 yrs. I am anorexic, I purge and I take an excessive amount of laxatives. I have checked myself in for help, but only got drugged out of my head and stuck on the crazy floor of the facility. Because of my actions, there have been multiple visits to the hospital and almost a stroke. My question is: why can’t I find someone to save me without making me feel like I’m crazy or need to be on mind-altering drugs? To me that just covers up what’s really wrong. – Lauri

Hi Lauri,

Obviously, the answer isn’t drugging you out of your head. Medicating someone, without addressing the underlying issues over the course of time, will not help them. However, let me address the medication issue and explain why medications can be helpful for people with eating disorders – but I don’t want you to jump to the conclusion that I am recommending that you should or should not be taking medication. I am a psychologist. Although I have had some training in psychiatric medications, I am not a medical provider and cannot make specific recommendations about taking psychotropic medications. However, it is important for you to have some understanding of why medications are used with – and can be very helpful for – people suffering from eating disorders.

  • Many people with EDs have problems similar to people with Obsessive Compulsive Disorder (OCD). This includes constant thoughts that are distressing. In the case of OCD this might be about forgetting to turn the stove off or about germs; in ED it is usually constant thoughts and impulses about food, “feeling fat” or tormenting obsessions after eating something “I should not have eaten that I am going to get fat…I have got to get the food out of me….” For some people with an ED there are compulsions, such as food rituals and/or even binging/purging. In this way, the ED is very similar to OCD. Some medications have been found to help reduce the obsessive thinking in ED and the strong compulsive aspects of ED. These are usually in the SSRI antidepressant class. Other medications are relatively small doses of atypical antipsychotic medications. The word “antipsychotic” conjures up the idea of being crazy like you mention in your letter. However, these antipsychotic medications are sometimes used with OCD and ED, because they help the SSRI’s reduce the obsessions and compulsions. They also lower anxiety some, which is often a major part of an ED.
  • Most patients that we see with an ED are also suffering with depression. The depression often zaps the energy they need to be active in therapy. People with depression often tend to be pessimistic and interpret things going on around them as negative – “Nothing ever goes right for me.” The antidepressants enable these patients to be more effective as they work on their issues in psychotherapy.

These types of medications have a range at which they are effective. If the amount is too small, they don’t do any good – if the amount is too much, they do more harm than good due to side effects (such as not being able to feel at all, being sleepy all the time, etc.). Psychiatric providers carefully monitor patients to make sure medications are in that range where it can be effective with a minimal amount of side effects. They will lower doses when it is causing the patient to be too numb or causes other problems that reduce the overall effectiveness of the entire treatment package.

Sometimes people believe that taking medications means they are “crazy.” Nothing could be further from the truth. Many people who are living normal and healthy lives are using some form of psychotropic medication. However, that doesn’t necessarily mean that you should be. That is a question that only you and a psychiatric provider working with you over a period of time can answer.

The primary area of treating with eating disorders is dealing with the underlying issues. That is something you need to do with a therapist who has experience with ED and can work with you over a long period of time. This therapy must include individual therapy, but can also include marital, family and support group therapy. Given the severity of your physical history, you also need to have regular check-ups with a doctor who knows about and is able to work with your ED. You would also need a registered dietitian who has ED experience to guide meal plans and work with other nutritional issues.

Concerning your remark about “the crazy floor,” I want to make it clear that I am not criticizing psychiatry units – as they help many people. However, I have met many patients who ended upon on psychiatric units before coming here. They often describe their experience very much the way you have. They felt they didn’t fit in and that no one really understood them. Sometimes, due to the severity of the ED and the dire medical condition, an individual with an ED does need a short stabilizing stay at such a unit, but it is not the long-term solution. Fine treatment centers exist because we recognize the need for people suffering from EDs to have a complete treatment program that is focused totally on the specific issues and problems that come with an ED. Given what I know from your e-mail, and depending upon your physical health and how out of control your ED is, you need inpatient, residential, or intensive outpatient care dedicated to eating disorder treatment. See “Finding Treatment.”

In concluding I just want to touch base about a couple of issues in one of your “…why can’t I find someone to save me.” No matter how excellent or effective, a treatment center or individual provider cannot “save” you. These programs and/or providers can help you save yourself. By this I don’t mean willpower or learning how to pull yourself up by your bootstraps, etc., but rather, we (and others) can help you identify problems, deal with painful wounds from the past, teach you new skills to deal with relationships and other stressors, engage in therapies that help overcome the obsessions and compulsions. But ultimately, you have to be the one to follow through with all of this. I believe God can save, but even with God it is often a process that requires work – such as: eating when you are afraid to eat, going to a support group rather than giving in to an urge to take laxatives, working with new communication skills to develop friendships and a support system. For all I know, you may indeed be doing these things, but it is always important to remember that you have to work the recovery program if you want the recovery program to work for you.

You use the phrase “…without making me feel like I’m crazy…” In my experience, the overwhelming majority of people who have eating disorders are not “crazy” (psychotic). However, the wounds, the obsessions, the anxiety, etc. can make people with an ED do things that appear “crazy.” The truth is that an eating disorder is almost always a person’s way to try to cope with overwhelming distress going on inside of them and outside in their environment. The problem is that the ED can result in a person making decisions to engage in behaviors that can result in severe consequences, even death. Often the ED clouds the person’s mind to the point that s/he cannot see the seriousness of the situation. This extreme danger can cause providers to take strong actions that can be very directive and can cause the individual to feel as if s/he is being treated like s/he is crazy.

This situation is not really treatment at all — it is crisis intervention. Treatment and crisis intervention are very different. Treatment seeks to understand the issues and address the issues overtime with a variety of therapies moving towards long-term recovery. Crisis intervention cares nothing about long-term recovery. Crisis intervention has but one goal – to move the person out of the crisis (physical or psychological) and restore them to whatever state s/he was in before the crisis (including having an active ED, but one that isn’t an imminent danger). Often this includes medicating people to the point that they are less likely to reenter the crisis – again – in the short-term. The thought in crisis intervention is that – after the crisis is resolved – the person can enter into treatment.

What you may have experienced is crisis intervention as opposed to treatment. Again, I do not know your personal history nor what providers have or have not done. They may have overreacted, treated you without respect, etc. There is never an excuse for treating an individual without respect, whether that is in a crisis intervention situation or a treatment situation.

I pray that God will lead you to treatment – a key in successful treatment is a long-term plan that includes long-term therapy.

David Wall, PhD