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Even in the maelstrom that is 2020, the need for eating disorder treatment is as vital as ever. Some individuals who seek treatment may worry, with ample justification, that residential treatment is impossible during the COVID-19 pandemic, but it’s still the best option in many cases. Many of these reasons are just as true now as they were before the virus changes the way we group together, socialize, and even breathe.

The idea of residential mental health treatment can be a frightening prospect for adolescents and their families, particularly when psychiatric care is involved.The thought of being separated from their family and friends added to the difficulty of challenging disordered eating behaviors can cause hesitation, and that’s quite understandable. 

However, if the eating disorder treatment facility has taken steps to ensure client safety during the pandemic – here’s what we’re doing in that regard – residential treatment is a more comprehensive course of treatment with greater success rates. In severe cases of eating disorders like anorexia nervosa, bulimia nervosa, OSFED, ARFID, and others, residential treatment may be the only viable option. 

Personalized Treatment Options and the Most Complete Care Outside a Hospital Setting

In some ways, psychiatry is still misunderstood by many people without firsthand experience. Often spurred by hyperbolic portrayals of “mental institutions” in popular media, people sometimes imagine cold, detached “shrinks” running tests on their clients or a sterile hospital setting with disturbed individuals locked away. Modern eating disorder treatment, which usually has a psychiatric element, couldn’t be more different than that.

Psychiatric treatment focuses on the medical aspect of psychotherapy and may include both talk therapy and medication, although the latter is usually not prescribed for people who have an eating disorder without any co-occurring disorders. Residential treatment works best when a full spectrum of treatment options, from psychiatric care to mindful movement classes are available in a way that fit’s the individual’s specific, unique needs.

While the best course of action might be for the individual to take part in therapy a few days a week and then going about their daily lives, another patient might be better served by temporarily separating from “regular life” for a month and focusing completely on recovery. That’s why the treatment team at a good residential treatment center will work to design a specific plan of treatment for each individual.

This individualized eating disorder treatment plan involves several elements. The first priority is to ensure any physical or psychiatric emergencies are properly treated; these might include stabilizing kidney failure or heart palpitations caused by malnutrition, or suicidal ideation necessitating sedation. Following that, the residential team will work on various therapeutic methods to help the client rebuild their relationship with their body and with food – the specific plan will vary depending on the nature of the client’s eating disorder and any other issues they may be experiencing.

Here Are the Ways Residential Programs Can Be the Best Choice for Treatment

1. Recovery is the only priority in residential treatment.

Dropping everything and going to live at an eating disorder treatment facility is no easy thing. People with eating disorders have responsibilities and duties just like everyone else. That’s why it’s tempting for some people to try outpatient treatment instead; it allows them to continue their work or other responsibilities. Even adolescents, while their careers aren’t at stake, run a risk of falling behind at school to undergo residential treatment.

While outpatient therapy—where the client goes to therapy sessions several times a week but then goes home and lives their day to day lives afterward—can be useful in aiding recovery, it by nature can’t put sole focus on getting better. Residential treatment can. 

In treating long-term cases of an eating disorder, or extremely severe ones, the time spent away from treatment in outpatient settings can be counterproductive. An intensive period spent in residential allows management of the initial crisis as well as allowing the client to put all their energies toward recovery.

2. Residential remove potential triggers for disordered eating behaviors.

Most people who have an eating disorder experience periods in which their disordered eating behaviors recede, if only temporarily. For example, a person with bulimia nervosa may cease purging for a few days or weeks. Relapsing is common, however, and these relapses can be caused by triggers.

A trigger can be something as simple as an offhand comment by a co-worker or as difficult to experience as PTSD – in fact, trauma-informed treatment is a must at residential treatment facilities. Because a trigger can come from any situation that influences self-perception or causes negative emotions that prompt a disordered coping mechanism. They are nearly unavoidable in the “real world” outside treatment, which is why the haven provided by residential treatment so useful.

Certainly, not every trigger can be avoided. For example, if another client calls them “fat,” or makes another comment that spurs self-criticism, the individual might be triggered into a relapse, even while in-house. The difference is that all other factors are controlled for by the treatment staff, who are trained to respond to emotional crises in a compassionate and non-judgmental fashion. Residential treatment provides far more support when triggers are present than the client would receive while only engaging in treatment a few hours a week, as they would in outpatient eating disorder treatment.

3. Residential treatment programs control mealtimes and snacks and provide nutritional foods at all times.

Residential programs provide people with eating disorders freedom from the difficulties of managing their relationship with food on their own. A person living at home can make all kinds of justifications for why they shouldn’t eat very much, or why they should purge, or in the case of binge eating disorder, why they should eat in secret. 

The facility controls access to food, which promotes regular mealtimes and nutritious foods, helping to avoid eating disorder behaviors. Establishing a regular eating routine and encouraging shared eating experiences – especially with peers who share similar challenges surrounding body image and eating – are essential parts of normalizing a healthier relationship with food. 

Nutritionists and dieticians at the residential center can supplement the medical and psychological care as well. Brain function surrounding emotional regulation and mood is closely related to getting the right amounts of vitamins, proteins, and other nutrients a balanced diet provides. As they progress along the treatment schedule, clients can enjoy healthful snacks as well as scheduled mealtimes.

4. 24-Hour Care for High-Risk Clients

Eating disorders rank among the most dangerous forms of mental health conditions. Anorexia nervosa has a higher fatality rate than depression, anxiety, or schizophrenia, and while malnutrition is a major cause of that, suicide is far from uncommon. Higher-risk individuals, especially those prone to psychiatric episodes, simply need more complete coverage than outpatient treatment can provide. A residential center ensures that medical as well as therapeutic staff is available 24 hours a day, providing unequaled security and a sense of safety for the client.

Even for less at-risk individuals, the safety net of always having someone to talk to is important. While most people are nervous when they first arrive at a treatment center, they quickly discover that they only need to ask for help to get what they need. Many times, the clients form long-lasting friendships with their counselors and begin to act as informal support personnel for new arrivals.

There is also an immediacy provided by 24-hour care that outpatient treatment can’t match. Imagine that a person with bulimia nervosa is feeling a strong desire to purge. If they’re in outpatient treatment, while they can reach out to someone close to them, they may not be able to reach a professional until their next scheduled session. In residential care, there is someone present at all times.

5.Residential Treatment Programs Incorporate Multiple Types of Therapy

Every quality residential eating disorder treatment center offers multiple types of therapy, which when combined can produce more dramatic positive results than any single type of therapy on its own. Psychiatric care forms the cornerstone of most programs. It’s  conducted by a licensed psychiatrist, who specializes in treating eating disorders and may prescribe medication. In combination with group therapy, exposure therapy, and other psychological techniques, a full continuum of care. 

Beyond the treatment with the psychiatrist, the patient may engage in therapy sessions with a therapist certified in specialized areas like cognitive behavioral therapy (CBT), which helps to identify disordered thoughts and replace them with healthier ones over the course of weeks of therapy. Family therapy and group therapy to provide a support structure and cathartic breakthroughs are also essential tools for recovery and are standard aspects of residential care.

All of these therapy sessions integrate with one another to help the individual walk the path towards full recovery. While it still takes time—and is not without its challenges—the participation in so many different types of therapy can greatly enhance the experience of the patient at the treatment center. It is an experience that is not possible without the inpatient setting, which is why some individuals are so encouraged to enter an inpatient program.

6. Inpatient programs are focused on emotional safety.

Recovering from an eating disorder is difficult enough without facing emotional risks from people and environments that do not support recovery. Residential ED careis carefully designed to protect the emotional health of clients. The treatment center directors are well aware of the ways that environments can present an emotional risk to clients and are careful to ensure that the programs they create avoid these risks. The goal of every eating disorder treatment facility is to help their clients achieve a full, lifetime recovery. That is only possible if the residential treatment center promotes an environment of emotional safety for every individual who comes through the door.

Melissa Spann, PhD, LMHC, CEDS-S

Melissa Orshan Spann, PhD, LMHC, RTY 200, is Chief Clinical Officer at Monte Nido & Affiliates, overseeing the clinical operations and programming for over 50 programs across the U.S. Dr. Spann is a Certified Eating Disorder Specialist and clinical supervisor as well as an accomplished presenter and passionate clinician who has spent her career working in the eating disorder field in higher levels of care. She is a member of the Academy for Eating Disorders and the International Association of Eating Disorder Professionals where she serves on the national certification committee, supervision faculty, and is on the board of her local chapter. She received her doctoral degree from Drexel University, master’s degree from the University of Miami, and bachelor’s degree from the University of Florida.