Many patients who suffer with an eating disorder have to follow some strict rules, guidelines, and boundaries in order to find a path towards recovery. At times, the rules that need to be set in place can cause great stress and emotional pain to the individual who is already stressed and in pain from their eating disorder. Requiring a patient to complete their meals, obtain from exercise, attend their sessions with treatment team members, break the rules of their eating disorder patterns, or even remain in residential treatment can lead to displays of desperation including crying spells, expressions of anger and hatred, threats and even behaviors of self-harm, and acts of begging for compassion can tug at the heart-strings of of parents, loved ones, and even inexperienced clinicians. The emotional pleas, while real in their intensity and suffering, also are all-out attempts to avoid or stop the treatment process towards recovery.
In moments such as these, parents and loved ones can begin to feel that they are causing or playing a role in the suffering of the one they love. They can see these expressions and sympathize deeply with the individual, feeling their pain, hearing their cries for relief, and seeing a defeated or aggressive approach to change their treatment plan. Most patients who go to a residential center have a panic like reaction the first week they are there. When this happens they call home telling their family they need to leave immediately and the family should “get them out of here,” as soon as possible. They cry relentlessly. They tell family how bad the environment there is and how all the other patients are so sick they they are worried that they will get even worse or learn new behaviors. They tell family how all the therapists, nutritionist and other staff are so bad and uncaring. They promise they are now ready to come home and take their outpatient treatment seriously and will no longer engage in eating disorder behaviors. Sometimes they will call home several times a day, begging, crying and screaming. Sometimes this works as they family cannot cope with the presentation of the desperation and they discharge the patient, usually against medical advise, so the patient can feel relief from treatment. Although this is done with good intentions to relieve the suffering of treatment, the result also is to not have proper treatment. Stepping down to a lower-level of care when that is not what is in the best interest of the treatment plan tends to lead to a longer course of illness with possible increased medical and psychological complications. Often, this leads only to readmission again to a higher-level-of-care. This results in lost time, lost health and wellness, and lost money.
This over sympathizing towards a patient is not limited to family and loved ones, it can even happen with clinicians who fail to maintain a professional distance or who are not properly trained to understand treatment principles. Recently, I had a patient in a respected treatment center who began the process of begging to come back home from the moment they arrived at the center. The panic set in and the promises to return home and do their treatment more seriously was made. By the end of the first week there was what is know as “a flight into recovery,” where they said their behaviors and thoughts were all better. Nearly each week I received calls and texts from the center saying the patient had booked a ticket to return home. Around week 4, despite still proclaiming a flight-into-recovery, the patient was caught secretly and against rules exercising in their room. The eating disorder thoughts remained very high as noted in the manner of speech and observed behaviors. I was asked to be a part of a phone session where the patient agreed to the need to remain in treatment for at least another month. A week and a half later, I had a message on my cell phone stating they patient was being discharged in two days and was going to return to live in an apartment because he feels he’s watched too closely be family. The therapist admitted that the discharge was sooner then they had wanted and felt he could be trusted to live away from his primary support group, despite being on observation in a supervised clinical setting less than two weeks earlier. A “discussion” took place about this discharge plan as to wether it was in the best interest of the patient or a result of the difficulty watching the patient suffer as they worked for recovery.
These types of situations are very common. There in no argument that it is difficult to watch a loved one in emotional distress acting out and expressing desperation. Well-trained and experienced clinicians, eating disorder experts, are attuned to this behavioral pattern and encounter it regularly. For the experts, it is seen and interpreted as the eating disorders “voice” or neural patterns fighting for it continued existence. This is not to say that there may be instances where a treatment center is subpar or that a therapists is less that compassionate, but it is more common that these reactions are a normal part of treatment and recovery. I inform all my patients from the get go, that treatment is hard, painful and requires some suffering. This is a fact and there really is no way around this. Everyone who finds recovery will always be able to talk about how difficult it was and how many times they felt like giving-up. A treatment than and a patient’s other support systems (i.e. family, friends) can be there to offer support to cope with the pain of recovery, not eliminate it. When a patient is appearing desperate to stop, reduce, or avoid treatment, wether this is on an outpatient basis or a residential center, it is important that all involved consult to better understand the process taking place and proceed with a treatment plan that remains in the patient’s best interest for recovery.
-Dr. Jeffrey DeSarbo