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Treatment of eating disorders: in or out of the hospital? TREATMENT OF EATING DISORDERS: IN OR OUT OF THE HOSPITAL?
One crucial decision is whether the patient should be hospitalized or whether she can be managed as an outpatient. There are advantages and drawbacks to either approach.
It's generally better if treatment can take place outside the hospital. The patient won't be snatched out of her familiar surroundings and plunked down into a strange environment. Yet sometimes those "familiar surroundings" are contributing to her disorder.
And, of course, it's easier to monitor and control behavior in the hospital. Often the hospital provides a kind of safe haven in which a patient and her family can begin to gain control of the problem.
Realistically, you can't "cure" an eating disorder in the hospital. People have to eat every day for the rest of their lives. They have to learn how to function on their own, in the "outside world," without supervision. A bulimic woman usually has to keep wrestling with the urge to binge and purge even after she leaves the hospital. In follow-up counseling, we continue to work on controlling these urges.
Inpatient care is required when:
• There is a medical emergency-the patient is severely emaciated, has a severe electrolyte imbalance or arrhythmia, is blacking out, or is otherwise unable to function
• She can't keep any food down
• She is unable to break the binge-purge cycle
• She is severely depressed or suicidal
• She is so obsessed with food that she can't function
• She is a substance abuser and can't break the habit
• She is a severe laxative or diuretic abuser and can't stop as an outpatient
• She has a severe personality disorder that complicates her ability to be treated outside the hospital
• Her personal situation is so unstable that treatment outside of the hospital is impossible
• Her family can no longer cope with the problem
• A careful program of outpatient care fails to work
• Adequate outpatient care isn't available
Although hospitalization is expensive, it is certainly more effective-in terms of both symptom improvement and cost - than a prolonged, unsuccessful outpatient treatment.
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