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Should I Return to an Inpatient Eating Disorders Treatment Center?

By December 7, 2012

I’m just plain scared. I’ve been to so many treatment centers, learned so much intellectually and yet I’m still stuck. My therapist says things will change when the trauma is fully dealt with but that seems years away. I’m scared. Is it too late for me? Is there a point after being in treatment where you just have to have enough willpower like my mom insists? I’m going downhill again and I don’t know what to do while waiting for my issues to resolve. My body is tired, I am tired, and I don’t know how much longer I can hold on while I wait for treatment to work. I feel like it’s hopeless. Is this a situation where I should go back into a treatment center instead of trying to keep doing it on my own, or do I just wait it out and hope for the best? – anonymous

Dear Anonymous,

Let me start with your last question about going back to a treatment center. Without more information, that isn’t something I can directly advise you about. However, I can give you some general principles, which would help you make that decision. It is always important to start with medical issues before talking about psychological ones.

Go to your medical doctor and be very open and honest about any and all eating disorder behaviors you have been practicing. If there is also a substance abuse problem (or any other relevant piece of information), do not minimize it. This information is vital in helping your doctor assess your health. Ask your doctor about the stability of your current physical health given the information you have told her/him, and whether-or-not it is likely to change in a few weeks if you continue to use the same eating disorder behaviors. You have to assume, given your current circumstances, that the behaviors are not going to significantly improve in the next few weeks. If your doctor has significant concerns, you should strongly consider going into an inpatient center or, at a minimum, stay under the close and frequent care of your physician.

Psychologically, you should consider going back into a treatment center under the following circumstances:

  • You have been honest with your therapist and she/he believes you need inpatient treatment.
  • You are feeling suicidal.
  • Your eating disorder practices are severe and are out of control (restricting, binging and/or purging several times per week). Be honest about this and ask the opinion of trusted people who care about you and will be honest with you, especially your therapist and doctor.
  • Your home situation is very stressful and you are using the eating disorder to cope because no other coping skills are working, and nothing is changing for the better in this situation.
  • Your life is reduced in quality—significantly decreased social life, major school/work problems and/or your eating disorder and related psychological problems consume most of your time.
  • Even though you are working hard in outpatient, you are getting worse.
  • You are abusing substances in addition to the eating disorder.
  • You have lost hope to the point that you are hardly even trying to work on your problems anymore. 

Please note that this list is not exhaustive; it is imperative to get a professional opinion both medically and psychologically.

Now to your statement, “I’ve been to so many treatment centers, learned so much intellectually and yet I’m still stuck.”

As a psychologist, I am a big believer in helping people learn about their problems and issues intellectually. However, this has some pretty significant limits in terms of helping a person to change their life. Learning in therapy is extremely helpful, but must be combined with active changes in your everyday life, outside of the therapy office, in order for real change to occur.

Some people believe that therapy is a place to open up, gain understanding about what happened in the past, learn how the past influences current behaviors and emotions, perhaps learn a few new skills, as well as get in touch with and express emotions. While that is a part of how therapy works, what happens outside of the therapist’s office (as a result of the therapy) is usually more important than what happens inside it. If what is happening outside quickly reverses any progress in the therapy sessions, inpatient treatment is a wise choice.

In your letter, you write that your therapist stated that things will change when the trauma is fully dealt with. I don’t know the context of this statement or the details of your circumstances, and I am in no way questioning your therapist. However, I am concerned about this issue. Believing that the trauma must be fully dealt with before things can change is not good. It can be extremely hard to stay motivated if you believe that everything in your life will continue to be bad and even get worse until you reach that point years down the line. This belief can, all by itself, completely discourage you and make it extremely difficult to overcome any of your problems. It is my firm belief that you do not have to fully deal with your trauma before you can make significant improvements/changes in your life.

The first stage is to bandage the wounds, receive support and start to prepare yourself to take back your life. You will need social support. You also need skills to deal with stress—ones that can replace the eating disorder in helping you cope—which therapy can provide (individual and group). Then you need to set goals about slowly adding good things to your life. Removing the bad parts is a goal as well, but it is often easier to add positive parts rather than take out the negative. In fact, adding positives to your life often results in removing some of the negatives, even when you are not directly trying to get rid of them.

You write, “I don’t know what to do….”

There is something very important that you can do—and can learn about your wounds and your recovery. People/relationships are almost always the source of our emotional pain and wounding. And yet, it is equally true that people/relationships are the source of our emotional healing and recovery. That is one reason why your intellectual knowledge from past treatments isn’t making the difference for you. Knowledge without healthy relationships is of little value. Working to establish a variety of healthy relationships will be one of the most effective tools you can use in the fight to take back your life.

With the people in your life, openly tell them what you want them to do. Perhaps it is just to listen, at times you may want advice, other times you just want them in the room. Don’t let them guess what you want, or both of you will be frustrated. You also need as much normal quality relational time with family and/or friends as possible.  Why do I say this? Because everyone needs this, wounded or not. Healthy lives are defined to a large degree by these types of healthy relationships. Doing normal everyday activities with others (such as going to a movie, concert, sporting event or church; playing a game, shopping, watching TV, talking about a favorite book or a common interest) can be as healing, or even more healing, than talking about deep emotional subjects.

Your feelings may pull you away from moving in these positive directions, but it is very important not to let them control what you do. When you feel like isolating because of shame, guilt, hopelessness or other such emotion, push back and do something anyway—with other people if at all possible. When people have been physically hurt and have to learn to walk again, the last thing they want to do is to go to physical therapy and experience the overwhelming pain of taking even one step. Yet, they must push through that pain, so that the pain does not cripple them for life. It is not too late for you!

Finally, I can see that you are fast losing hope. If there is one thing I could give to you, it would be hope. Restoring hope is going to be a critical step. Hope is something that comes from God, but it isn’t a magical feeling that floats down from heaven, nor is it something you have to work really hard to obtain.

There is a concept in psychology called learned helplessness. Basically, learned helplessness is a state of mind that happens when someone tries over and over again to escape painful circumstances, but no matter what they do, nothing works. This leads to feelings of hopelessness, depression and ultimately to giving up. Learned helplessness causes us to look externally for solutions, “waiting for treatment to work.” I do not mean this to be a criticism of what you said, but I see your statement as a symptom of the learned helplessness that has understandably developed in the course of your struggles.

Hope in God doesn’t take away the pain or problems. The very fact that you need hope right now means that your life is not where you want it to be. “Who hopes for what he already has?” (Romans 8:24).” What hope does is to help you endure, remind you that ultimately victory will come, and more than anything, redirect your focus from the overwhelming problems to a focus on God and the good aspects of your life (although they may seem rather dim right now).

It is fairly clear from your letter that you are in a lot of pain and are feeling as if you are at the end of your rope. I pray God will strengthen and guide you. I want to clearly communicate that you can recover. May God grant you hope, peace, recovery, and the ability to love yourself in the way that He intended. May He set you free from the pain that was none of your doing—and grant you a life of abundant relationships with Him and others.

Warmly,

A. David Wall, PhD