Hospitalization for Anorexia Can Do More Harm Than Good
"This is an excellent article and long overdue," Ronald Liebman, MD, tells WebMD. Liebman recently served on a panel that revised the APA's treatment guidelines. Those [guidelines] recommend that patients be placed in one of five levels of care depending on the severity of the illness. These range from outpatient to partial hospitalization and residential care. Inpatient hospitalization is suggested only for patients who have very low heart rates, who have a plan to commit suicide, and are less than 75% of their ideal body weight.
There are number of reasons adolescents may be hospitalized for eating disorders, few of which are valid, according to Liebman, also a professor of psychiatry at Temple University and former head of psychiatry for Children's Hospital of Philadelphia. Doctors may suspect that the child has been abused, is psychotic, or is a danger to him or herself or others. Sometimes parents are the ones pushing for hospitalization, believing it will be better for the teen-ager and will provide them with a break. But that is not usually the case, according to the results of this study and to Liebman.
"What we have found is that in the hospital, [adolescents] learn bigger and better ways of being anorexic from other patients," says Liebman. "Their self-esteem and their self-confidence are obliterated. They are alienated from their school and peer group and the community. There is a tremendous burden on the parents. The parents are made to feel ineffective and impotent."
Edmund Neuhaus, PhD, director of the eating disorder program at McLean Hospital in Belmont, Mass., called the study findings "interesting but not surprising." He faulted the study for providing little detail on the type of inpatient programs the study participants were engaged in, and suggested that the lengths of stay in Britain are likely to be longer than in the U.S., which would contribute to poorer results. Neuhaus, who is also an instructor in psychology at Harvard University School of Medicine, reviewed the study for WebMD.
Neuhaus says the key to improving results for people who are hospitalized for anorexia might be to ensure that there are programs in place to support their adjustment to life outside the hospital. He agrees with Liebman and Hsu that some patients can actually worsen in a hospital setting.
"Anorexia, of all the eating disorders, is by far the hardest to treat, and [patients] have the worst outcomes," Neuhaus says. "Part of the problem is that no one has really figured out what works in treating it."