Behind Locked Doors: Deciding On Inpatient Treatment

In February 2010, I entered inpatient treatment for anorexia nervosa, anxiety, and depression. I felt like a complete failure that this was my sixth inpatient admission, and I vowed that it would be my last admission.

On Monday, I will once again admit myself to the hospital for six days of psychiatric treatment. It was a difficult decision to make, and one that many of us struggling with eating disorders and co-morbid illnesses often face.

The Pros and Cons of Inpatient Treatment for Eating Disorders

I live in a large, Midwestern state that does not have any treatment facilities for those with eating disorders save one hospital on the state's westside. However, many hospitals treat people with eating disorders on the psychiatric unit.

I have been in inpatient on one such ward many times. There are some positives for choosing inpatient care for eating disorder treatment. In February 2010, I checked myself in after about two months of severe restricting of eating and self-harm. I had some physical problems, including low potassium and high ketones, and was placed on a NCG feeding tube and fed very small amount until I became stronger. My heart was monitored to make sure I was not being refed too fast, and it was a time for me to heal and take care of myself — something I often struggle with.

The hospital often feels like a microcosm of the outside world. There are nurses and doctors, and people who are paid to care about how you feel and are there for you 24/7. I would look outside the window, watching the cars go by and the snow fall, and felt safe within. There were groups everyday in which I could talk about what was bothering me, and often fellow patients to talk and relate to. It was safe, and I felt safe and free to loosen my grip on some of the self-destructive behaviors that sometimes still plague me.

But I never forgot that the doors were locked, and that I could only leave when my psychiatrist discharged me. My things were searched upon admittance, and there were many things I was not allowed to have, such as hoodies with strings, anything that had a battery, and the thing that is almost like my right hand — my cell phone.

I had to ask for such innocuous things as dental floss and contact lens solution each night, and I was not allowed to leave the floor for any reason. Because I was an eating disorders patient, I could not use the bathroom for a half hour after each meal unless a nurse or nurse's aide stood outside the bathroom door. I remember watching visitors going out the door and having a strong urge to run and flee the place where I was safe, but not free.

I vowed that would be my last hospital admission. I should have known to never make such a vow, particularly after six admissions and constantly fighting the eating disorder voice that often did not want to let me eat and be healthy.

Deciding On Inpatient Treatment

There are some compelling reasons you should go to the emergency room and into the hospital immediately:

* If you are suicidal or homicidal, or have urges to harm yourself or another person.

* If you have harmed yourself through cutting or other behavior, and the wound looks severe enough to need stitches.

* If you are having severe symptoms from your eating disorder such as throwing up blood, severe diarrhea, fainting or near-fainting when standing up, passing out and hitting your head, or anything that you might be concerned about and are not able to discuss with your eating disorders doctor.

• Losing time, meaning that you cannot remember certain time periods and the things you did.

* Anything else that seems severe and concerns you and/or your family and friends. It is better to go to the emergency room and find out you are okay than to not go, and develop even more severe symptoms later on. For example, if you experience severe tachychardia or brachycardia (racing heartbeats and very slow heartbeats, respectively.) Either one of these can be signs of something more serious.

It can be difficult to decide to enter inpatient treatment for an eating disorder. For one thing, most inpatient psychiatric units are not geared solely toward eating disorders and have patients with a variety of mental illnesses.

This means treatment of eating disorders can get lost within the treatment of other disorders. I still believe the best treatment for eating disorders is one that focuses solely on eating disorders, but such an inpatient treatment program does not exist at most hospitals.

Then there are those of us who have an eating disorder and a co-morbid illness. I wrote last week about my struggles with alcohol abuse. The main reason I am being admitted is so I can detox within a safe setting. I find it ironic that I am returning to the hospital at a healthy weight, although my eating still will be monitored because, with the exception of a few days each month, my total food caloric intake has been from 400 to 600 calories — the rest of the calories have come from alcohol.

The decision to go into inpatient is a personal one and should be discussed with your doctor and other members of your treatment team. It also is a good idea to talk about it with family and friends, as they can help solidify your thoughts and feelings. In the end, inpatient treatment can be an invaluable tool to help you recover.

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