The Psychology of Eating: From Healthy to Disordered Behavior

Treating Eating Disorders 273

Problems with inpatient treatment for eating disorders

The problems with inpatient regimens for eating disorders are as follows:

• Unless the patient is committed under the Mental Health Act, admission
  into an inpatient ward is voluntary. Patients who see their thinness as
  the solution to their problems will resist the offered treatment as it will
  be seen as a problem, not a solution.


• Inpatient treatments are useful for weight restoration when a patient is
  critically ill. Relapse rates are high once the patient leaves the hospital
  unless intensive follow-up outpatient care is given.


• It has been suggested that inpatient weight restoration may lead to depres-
  sion and suicide if the weight gain is not accompanied by a sufficient
  change in cognition.


• It has also been argued that weight restoration might lead to the develop-
  ment of bulimia if weight is gained in response to nurse and peer pressure,
  as bulimic symptoms can enable the external appearance of recovery to
  be maintained.


• It is possible that prolonged inpatient treatment can provide a social
  network for the patient which is lost once they recover and leave the
  hospital. This may motivate weight loss to gain readmission.


• Inpatient care removes the patient from their family. If the patient’s rela-
  tionships with the family are not changed, then once the patient
  returns to their family these relationships may trigger relapse.

In summary, inpatient treatment for eating disorders mainly applies to
patients with anorexia, and focuses on the development of a therapeutic
relationship between nurse and patient and aims to restore weight. It
draws on many different theoretical perspectives and although the therapy
offered is not as intensive as CBT or psychotherapy, aspects of these
approaches can be seen to permeate the practice of an inpatient unit both
in terms of the therapeutic alliance and the strategies used to promote weight
gain. In terms of effectiveness some evidence indicates that it is more effective
when offered in specialist units, although to date there is a scarcity of research.

An Integrated Approach to Treatment

Some theories of the etiology of eating disorders can be translated into
their treatment. For example, a psychoanalytic approach translates into