When Is Inpatient Treatment Necessary for Anorexia Nervosa?

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Anorexia nervosa is a type of eating disorder involving a very low energy intake. It’s a severe mental health disorder that causes young people mental, physical, and social harm. Without adequate support, anorexia nervosa can become very dangerous, with the highest mortality rate of any mental health condition.

Most people with anorexia nervosa can recover with professional treatment, especially in the earlier stages of the disorder. But some young people require more intensive care than others. In particular, some adolescents and young adults need inpatient or residential treatment to stay safe and have the best chances of recovery.

Many families are unsure about when inpatient treatment is necessary for their young person. Even among professionals and researchers, there is still debate about when inpatient care is required. But there are some agreements and guidelines to work by.

When a family is looking for eating disorder treatment, it’s essential to have a conversation with a mental health professional when choosing a program and level of care. They can help families and young people ascertain the appropriate level of care for their needs.

What Is the Difference Between Inpatient and Outpatient Treatment for Anorexia Nervosa?

In inpatient treatment programs, young people stay at a treatment centre as they receive mental health and medical support. This might involve staying at a residential treatment space with medical facilities or, in some cases, in a hospital setting. Young people have access to 24/7 medical monitoring and support, including doctors and psychologists.

During outpatient programs, on the other hand, young people attend treatment programs while continuing to live at home. They may travel daily to a treatment space for intensive outpatient care or attend appointments several times a week. Young people in outpatient programs can continue some aspects of their everyday life alongside treatment, such as studying, spending time with family and friends, or pursuing hobbies. 

There are several different levels of care within inpatient and outpatient treatment.

Inpatient treatment includes:

  • Residential treatment, where young people live in a treatment space with the necessary medical facilities
  • Inpatient hospitalisation

Outpatient treatment includes:

  • Outpatient care, usually involving one or more appointments a week with psychologists, nutritionists, and other mental health professionals
  • Intensive outpatient care involving several hours of treatment each day on several days each week
  • Partial hospitalisation involving full-day outpatient care

Many young people receive different levels of care at different stages in their recovery journey. They may begin in residential care before moving to intensive outpatient or outpatient support.

Is Outpatient Care as Effective as Inpatient Care?

Research shows that specialist outpatient care can be as effective as inpatient support. Both outpatient and inpatient programs can lead to lasting changes in young people’s physical health and mental well-being, including their eating habits, self-esteem, and mood.

However, for some young people, outpatient care may not be sufficient to keep them safe or offer an environment conducive to recovery.

When Is Inpatient Treatment Necessary for Anorexia Nervosa?

While outpatient care can provide exceptional care for some young people, others require inpatient treatment to stay safe and recover. 

The American Psychiatric Association (APA, 2000) suggests that inpatient care is necessary when a young person:

  • quickly reduces the amount of food they are eating or continues to eat less and less for some time
  • continues to lose weight even though they receive intensive or full-day outpatient treatment
  • experiences other challenges that might affect their ability to eat, such as recurrent illnesses
  • has other psychological symptoms like self-harm or suicidality that require inpatient support
  • reaches a body weight at which they have previously required inpatient support

Some experts refer to three different goals of inpatient care: crisis intervention, change of environment, and intensive treatment. This means that a young person may require residential care to stay safe during a crisis, to live in a different, supported environment, or to receive more intensive treatment.

Crisis Intervention

Sometimes, inpatient treatment may be necessary when a young person experiences a mental health crisis or reaches a dangerous physical condition. 

This can happen if a young person has a very low body weight and/or severe malnutrition. In these circumstances, young people are at risk of potentially life-threatening medical complications without full-time medical support. 

Residential care may also be required when a young person is at risk of seriously harming themselves or attempting suicide. Residential settings provide a safe environment with monitoring from professional psychologists who can intervene to prevent crises.

Change of Environment

Anorexia nervosa is a complex disorder that’s about more than food or body shape. Instead, personality traits, ways of thinking, and interpersonal relationships all contribute to maintaining the disorder. 

Supportive relationships are significant for recovery from eating disorders. Social isolation and/or hostility and criticism from family members can allow disordered eating attitudes and behaviours to dominate a young person’s life without relationships that highlight other positive aspects of their identity and value. 

While family therapy and other interventions can help families and close friends build supportive relationships, this can take time and, in some cases, may not be possible. In these cases, residential programs provide a social environment where young people can form supportive relationships with peers, support staff, and professionals.

Inpatient treatment may also be recommended when stresses and triggers in a young person’s everyday life act as barriers to recovery.

Intensive Treatment

Inpatient treatment may be necessary when a young person requires intensive treatment that is difficult to deliver in outpatient programs. This might happen when a young person has a complex presentation or experiences one or more co-occurring mental health conditions. It can also occur if a young person has lived with anorexia for a long time or experiences relapses.

Inpatient treatment can be required if outpatient programs aren’t effective and don’t lead to sustained mental and physical recovery. 

The Wave Clinic: Specialist Residential Care for Anorexia Nervosa

At The Wave Clinic, we provide both inpatient and outpatient treatment for young people with eating disorders.

Our residential, inpatient treatment space combines exceptional clinical care with education and enriching experiences, supporting young people to grow, develop, and build fulfilling futures. Our programs emphasise identity development and self-confidence, creating the foundations for lasting recovery.

For young people in the most need, we provide ICU beds with 24-hour medical monitoring and support. Other young people live collectively in our main house, supporting one another towards recovery alongside a diverse team of professional staff.

It’s often difficult for young people to get well in the same environment they became ill. Our programs support young people through transformative change by creating new memories and experiences that most enable and inspire.

Alongside our inpatient programs, we offer outpatient care for children, teenagers, and young adults. Our outpatient programs include a diverse selection of treatment modalities to provide each young person with the best treatment available.

If you’re interested in finding out more about our programs, get in touch today. We’re here to make a difference.

Fiona - The Wave Clinic

Fiona Yassin is the founder and clinical director at The Wave Clinic. She is a U.K. and International registered Psychotherapist and Accredited Clinical Supervisor (U.K. and UNCG).

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