A Treatment Refresher

While I do have several new posts on the way, I want to highlight a couple of older Grey Thinking posts (some are several years old!  I bet you were not reading GT two years ago) that talk specifically about treatment, your attitude toward treatment, recovery expectations, etc.  While there are a couple of people that I have in mind when it comes to the subject of these posts, I think that everyone can use the refresher.

You as your own case manager
Originally Posted: 01/01/2009

I wish that all these guys were going to stay clean, I really do. I’ve just seen it so many times that I can tell when someone’s really willing to do whatever it takes and when someone’s willing to do what they think it should take. And it’s just not going to work like that, unfortunately.

–Shelly, Celebrity Rehab with Dr. Drew 2

Wanting to want to recover
Originally Posted: 06/12/2008

Motivation to change implies an intention–weak or strong–to change one’s behavior. However, AN patients may at the same time both wish to recover and be highly resistant to change their behavior. Therefore, we suggest that assessment of motivation in these patients should include not only their motivation to change, but also their different wishes to recover which do not necessarily imply a behavioral intention.

Dr. Drew should treat eating disorders
Originally Posted: 07/01/2008

There are a lot of components of addiction treatment that I believe in and think are important, and should be applied to eating disorders:

1. Recovery is a lifelong, daily process
2. Denial, and not necessarily that you have a problem, but that you need help
3. The importance of personal accountability
4. There’s no magic cure
5. The disorder should be taken as seriously as any potential fatal disease

Do not pass Go, Do not collect $200
Originally Posted: 12/09/2008

“I don’t want to play the rehab game anymore”

– Jeff Conaway, Celebrity Rehab 2

I think that recovery can feel like a game at first because it is so different from the rest of your life. It’s nice to have others care about your wellbeing and there’s something about treatment that gives you permission to take care of yourself. Plus, there is so much positive reinforcement (gold star for following your meal plan over the weekend!). All of this doesn’t sound so bad… and I do believe you can make progress — even with this mindset.

When does the game end? Personally, I think this is when the disorder starts to feel threatened. There is something scary about recovering, and suddenly it doesn’t sound like a great idea anymore.

“I don’t want to play the rehab game anymore”

– Jeff Conaway, Celebrity Rehab 2

I think that recovery can feel like a game at first because it is so different from the rest of your life. It’s nice to have others care about your wellbeing and there’s something about treatment that gives you permission to take care of yourself. Plus, there is so much positive reinforcement (gold star for following your meal plan over the weekend!). All of this doesn’t sound so bad… and I do believe you can make progress — even with this mindset.

When does the game end? Personally, I think this is when the disorder starts to feel threatened. There is something scary about recovering, and suddenly it doesn’t sound like a great idea anymore.

The dark side of inpatient stays

‘But I ask myself if an eating disorder unit is the best place for an impressionable young girl to be,’ says Deanne Jade. ‘As any inpatient will tell you, a specialist unit is the best place to learn how to be really, really good at anorexia.’ They also breed their own subculture.

— Still at war with our bodies

Oh, what a statement! This article is a couple of years old, but I still think it’s bold to suggest that the “highest level of care” for eating disorders actually makes people sicker. Everyone’s inpatient experience is different… but there is a lot of truth to this statement.

What about inpatient stays can make people sicker?

1. Exposure to the sickest of the sick. You know who these people are… the frequent flyers who have the most severe symptoms and often are the most manipulative and/or resistant to change.
2. Picking up other ED symptoms that you didn’t originally have. It’s not unheard of for a restricting anorexic to pick up purging after treatment.
3. Competition among eating disorders. This ranges from being the thinnest, eating the least, and having the most inpatient stays to comparing “worst BP episode” and visits to the ER.
4. Unhealthy modeling. Everyone around you is doing a great job of modeling ED-behaviors.. but other than the staff, there’s not a lot of “healthy eating” modeling going on.
5. Negative attitude toward treatment. If you weren’t originally treatment-resistant, there’s nothing like being surrounded by a group of girls who don’t want to be there to kill your motivation.
6. No life outside of the eating disorder. This is such a catch 22 of ED treatment… by making your recovery first and putting everything else on hold, your whole day revolves around the ED–which is kinda want the eating disorder wants. There’s no stress of school or work because all you’re doing is eating and sitting in eating disorder therapy.

As as for “breed[ing] their own subculture”… well, I’ve always said that there is an eating disorder world. You make friends in treatment. After discharge, you keep up and talk about how everyone is doing… is so-and-so back in treatment? I heard so-and-so is doing really poorly. Because you’ve given up school or work to go into treatment, the most interesting things going on in your life are your therapy and nutrition appointments. Everyone talks to each other about their appointments. You send each other cards. You continue doing the same arts and crafts that you were doing inpatient. Everyone’s lives are still consumed by the eating disorder so no one is doing great. It’s all very dysfunctional.

This is not true to everyone’s experience (not even necessarily to mine) and often residential treatment is the level of care that someone needs to get better and make progress in his/her recovery. My own inpatient stays were KEY to my recovery. However, negative stuff does go around in treatment. It’s kind of the dark side of inpatient treatment that people don’t talk about very often.

In ED Research, 40% is a passing grade

This is what kills me about mental health research (especially with eating disorders). I ready a study today about the “Effectiveness of day hospital treatment for anorexia nervosa and bulimia nervosa.” 83 eating-disordered patients were assessed before and after (a year after) a day hospitalization program. The study boasts “significant improvement on all outcome variables (frequency of binge eating/vomiting/laxative abuse, BMI and core EDI-subscales ‘drive for thinness’ / ‘bulimia’ / ‘body dissatisfaction’), with large effect sizes and improvements that continued even upon long-term follow-up. In conclusion:

The results demonstrate both the short-term effectiveness and long-term stability of day hospital treatment in a large sample of patients with anorexia and BN.

What’s the kicker? Less than half the patients were “remitted” (only 40%)! How is that a success? Yes, granted far fewer than that would have recovered on their own…. but I would just not be satisfied with that outcome. To me, that says the treatment (an expensive, timely treatment) is less than mediocre.

It’s no wonder that people think that as soon as someone with an ED enters a treatment facility, they will be cured.