What causes the disorder?
Do individuals with eating disorders have other psychiatric problems as well?
Is inpatient treatment the best place for the individual with Anorexia?
When is hospitalization appropriate?

What causes the disorder?

Contrary to popular myth, not all eating disorders are caused by rape or molestation, although some are. The incidence of such traumas is only slightly higher for individuals with eating disorders than it is in the normal population. The causes of eating disorders are varied and usually determined by multiple factors. Rarely is there a single cause.
The environment usually plays a large role, with the push to be thin combined with the custom of having most social encounters center around food. In addition to which, we are presently seeing an epidemic of obesity and obesity related disorders that result from the presence of inexpensive high caloric fast foods and the perception that whole foods take too much time to prepare.
There is often a history of family dysfunction of one form or another. Sometimes there is a precipitating event, such as a serious injury, a death, a rape or molestation. Even a difficult or protracted divorce can be a precipitant. More often today than ever before, there is a history of childhood obesity. Severe food allergies and other metabolic or medical disorders are also fairly common in Anorexics and Bulimics.

Do individuals with eating disorders have other psychiatric problems as well?

Yes. The co-morbidity, i.e. the presence of more than one condition, is fairly high. Many individuals with eating disorders also suffer from Obsessive Compulsive Disorder, Anxiety Disorder, Social Phobia, Bi-Polar Disorder, and/or Depression. Undiagnosed Attention Deficit Disorder, food allergies, and disturbances in eating patterns as infants, are also common among individuals with eating disorders. Abuse of diet pills and laxatives along with excessive exercising are common compulsive behavioral patterns for purging. Likewise binge drinking and compulsive shopping, often in an attempt to stop binge eating, are becoming more common.

Is inpatient treatment the best place for the individual with Anorexia?

Not necessarily. Inpatient treatment for the individual suffering from Anorexia often makes the problem worse, since the experience of being forced to eat large amounts of food, in short time periods is quite traumatic. Recent studies suggest that hospitalization for anorexia nervosa changed between the 1970s and 1990s in ways that have negatively affected outcome. Patients in the 1970s stayed in the hospital longer and gained weight more slowly, and although they left at a lower discharge body mass index, they were less likely to be re-hospitalized.

By the 1990s, managed care was beginning to have it’s characteristically negative impact, i.e. patients were forced to be at a lower weight prior to admission and (which means that they were probably more chronic) and were forced to be out in shorter periods of time, necessitating more rapid weight gain. Rapid weight gain can be quite traumatic for the individual resistant to the idea of gaining weight, which represents all but a small percentage of the Anorexic population. For those individuals that want to regain their weight, the rapid weight gain is a positive prognostic sign. However, most individuals with this disorder do not wish to gain weight, making the rapid weight gain a poor prognostic indicator and making re-hospitalization and mortality more likely.

While in-patient, the individual with Anorexia usually has the goal of being the smallest Anorexic present. Many individuals with the disorder admit that they learned more about being a better Anorexic while inpatient, than they do about getting well. When forced to eat, as part of the program, such individuals will often gain weight for the sole purpose of getting out of the program, so that they can lose the weight as soon as they are free to restrict again. When this happens, such individuals may end up at a lower weight than before entering the program. Many can verbalize that this is a payback for being forced into treatment.
Another problem is that inpatient treatment has by and large adopted a One Size Fits All approach. As a result, the individual suffering from Bulimia often feels as though he/she is binging, since he/she is forced to eat the same amount of food as his/her Anorexic counterpart, despite the fact that he/she is not underweight. Being forced to eat large meals but prevented from purging them, may even precipitate the development of Anorexic symptoms in the Bulimic post-hospitalization. Likewise, being forced to eat large amounts of food, that is surprisingly high in simple carbohydrates, can cause individuals with Anorexia to develop symptoms of bulimia post treatment.

The biggest problem is that the patient does not make the decision to get well in a program that lasts a month. Another problem is that there are very few programs that offer transitions back into the real world or much in the way of follow up. The research is very clear on this issue, mortality rates go down and recovery rates go up with the length of treatment. In a nutshell, until the individual suffering from the disorder decides that he/she wants to get better, he/she will not get better. While in-patient, being forced to eat and/or prevented from purging, triggers feelings of loss of control and a sense of failure. These are often the dynamics that were present when the disorder began. Initial treatment goals must be to establish a trusting bond that isn’t conditional upon symptom elimination and from there to help the patient reestablish his/her identity as something other than her eating disorder diagnosis. This takes months, or even years, not weeks.
The ideal is probably intensive outpatient with supervised local hospitalization for purposes of medical stabilization. If you feel you must have inpatient treatment, look for a center that offers longer term treatment, individualized feeding protocols, and transition arrangements as part of the program.

When is hospitalization appropriate?

Hospitalization for medical intervention is appropriate when the individual is in danger of serious medical complications and/or dying due to medical complications, as it will save his/her life. If you have the right therapist, he/she will be willing to visit you or your loved one in the hospital until medical stability has been reestablished. Admitting yourself or your loved one into a treatment center out of fear may be very tempting, however according the research, it may actually increase an individual suffering from Anorexia’s chances of a more protracted illness and/or dying from the disorder.