I am a freshman in college and I also happen to be anorexic. I have been to the medical services on campus and I am going to be attending the eating disorders group at my university. I also have been seeing an individual therapist for three years, but my weight is pretty bad right now. The doctor who has been keeping tabs on me says that I am very close to my “critical weight.” My therapist and I have discussed hospitalization ad-nauseam, but he's really not in favor of it, saying that hardly anything can be accomplished in a one month stay (which is basically all insurance companies allow for nowadays). He also said that the whole system is like a “revolving door” because people typically go back to their “old” behaviors one to two days after their discharge. However, I feel like the hospital might be the best place for me right now. My parents also are kind-of against the hospital. I really don't know what to do because my gut feelings so contradict my parents and partially my therapist. Also, what is the relapse rate of anorexics after they are released from the hospital? Is there any info on that?
First of all, the fact that you are reaching out for help takes lots of strength and is incredibly brave. It is also a very good sign for recovery. Your willingness to attend the group therapy around eating disorders, and reach out to your medical team, as well as talk openly with your therapist and your parents, and write here, shows a lot of determination and courage, qualities which have probably gotten you through other challenges previously in your life.
Your questions about various forms of treatment are good ones. Most studies put the recovery rate for outpatient treatment (what you are currently receiving) at about 60 to 70 percent. Studies indicate that the vast majority of hospitalized patients respond favorably to treatment. However, (and this is what your therapist may be referring to), there are high relapse rates following hospitalization (30 to 50 percent) so what happens after hospitalization is crucial to maintaining the benefits. Relapse rates for outpatient treatment aren’t available because it’s often so unsuccessful in the first place, that it’s too tricky to accurately measure relapse rates. The fact that the data is skewed in this way may make hospitalization look less effective than it is. If your gut is telling you that it’s time for hospitalization, keep fighting for it. Tell your parents and therapist that you think it is best for you right now. They need to understand that you have a potentially life threatening condition. It is not your fault. It’s not a character flaw. You deserve treatment.
Hospitals that treat eating disorders do so holistically. Anorexia needs to be addressed from a nutritional, bio-chemical, psychological, and social perspective. They have you work with psychiatrists, psychologists, dieticians, gastro-enterologists, endocrinologists, and other health care providers. Any co-occurring issues such as substance use, depression, body distortions, etc. need to also be addressed, and hospitals that treat eating disorders understand this. When people are released from the hospital, it can feel like a significant loss of structure and support. Therefore, it is important that you, the hospital, your parents, and therapist plan for this and have such structures in place.
Research indicates that a combination of individual therapy, group therapy, and family therapy (if you’re living with your family), plus visits with a dietician and medication (often antidepressants) can prevent relapse. Individual therapy should specifically be cognitive behavioral therapy, preferably with a clinician that has had specific training in treatment of eating disorders. And it’s important to know that even in cases of relapse, you can bounce back. When people learn new behaviors and new ways of thinking about themselves, mistakes are almost inevitable and should be expected, because you are changing patterns that are firmly etched into your way of being.
As far as insurance goes, it may be a good time to have a heart-to-heart with your parents. Let them know how you feel and share any information or research that you have found. The National Eating Disorders Association has specific information on insurance coverage and how you and your parents can discuss what is and is not covered with your insurance company. Your willingness to seek out help is a real strength and will likely inspire other readers. So thank you. For more resources on eating disorders, see these resources and the related Q&As.