Comments on: Rethinking Residential Treatment: Less is More

By: Catherine Larson

Catherine Larson — Thu, 05 Aug 2010 00:57:45 +0000

We should all try and follow something like this, it’s a great idea, I just hope it works out for all of us. The problem is, willpower. I’m actually very lazy so I’m always looking for ways to find someone else to do it but in this particular case I can’t actually get someone to do it for me

By: PTC

PTC — Mon, 05 Jul 2010 23:32:42 +0000

I guess I side with the E.D. on this one because I feel like I could lose a couple of pounds, so gaining them is definitely out of the question. I will freak out when I weigh myself, if I have gained weight.

By: Laura Collins

Laura Collins — Mon, 05 Jul 2010 17:53:39 +0000

Great post. Fascinating comments.

I share your dream of the ideal residential treatment, and Fiona’s hope that there be step-down (and step-up) during transition between there and home.

I see NO REASON why this center would be different for young patients and adults and it perplexes me why people think it would.

PTC, of course you have to reach your body’s normal, optimal body composition to recover. You know that being below that is holding you in ED thoughts and behaviors and keeping you from achieving the insight you need to stay well. The idea that you would be “huge” at a normal weight is something the malnourished brain does to people. We need to let doctors set the targets, nutritionists help us get there, and therapists teach us how to get there and stay there. ED doesn’t like any of the above and should not, in my opinion, get a vote!

By: physician assistant

physician assistant — Sat, 03 Jul 2010 18:13:24 +0000

Pretty nice post. I just stumbled upon your blog and wanted to say that I have really enjoyed browsing your blog posts. In any case I’ll be subscribing to your feed and I hope you write again soon!

By: PTC

PTC — Sun, 27 Jun 2010 11:14:03 +0000

Hmm, again interesting info. Let’s see (I’m thinking aloud here), I stopped growing at when I was about 12 (6th grade), and I’m not sure what I weighed at that time, the weird eating stuff started my freshman year in high school, right around the age of 15 and I weigh less now than I did then, but not by much, maybe like 5-7 pounds. Then when I really started “restricting” I obviously weighed less than I do now, but I was also younger too, so that might make a difference. I guess knowing that my IBW probably would not be 115 makes me feel better because there is no way that I need to weigh that or would ever let that happen. So, from what I get from your info, no doctor would want me to get to that weight, and that makes me feel better. So, learning that helps, but the thought of gaining any weight still freaks me out. I feel like I just can’t do it.

Thank you for answering my questions…and answering them so well!!

By: Fiona

Fiona — Sun, 27 Jun 2010 11:06:25 +0000

I agree that over medication is wrong, and I’m sure in an environment like your idea treatment centre it wouldn’t be necessary.
I suppose I’m just grouchy and guilty because I know that all of your points are right – it’s just that, on my own, without the backing of this ideal inpatient (because it doesn’t yet exist) I failed to be able either to refeed or to keep my daughter from self-harm.

Family Based Treatment is the ideal and should always be used as the first line of treatment, but it does need to come with a plan B and a generous amount of back up, so if you’re not going to start this new treatment centre I hope someone does soon for all those whose families can’t do FBT without support for whatever reason.

If you don’t want to run it would you consider being clinical advisor?

By: Dr. Ravin

Dr. Ravin — Sun, 27 Jun 2010 01:33:40 +0000

PTC,

I’m glad my explanation made sense to you. If you stopped growing in 6th grade, your height and weight will probably be well below statistical averages. If you developed your ED several years after you stopped growing and years after you started menstruating, your IBW would probably be similar to your pre-ED weight, plus 5-10 pounds to account for the natural growth and development that occurs from adolescence to adulthood.

I wonder if learning this makes you more willing to shoot for full recovery?

By: Dr. Ravin

Dr. Ravin — Sun, 27 Jun 2010 01:29:02 +0000

Fiona,

I agree that families should be able to come to treatment centers to learn and become fully involved with their loved one’s treatment. In my opinion, separation from family is one of the greatest detriments of residential treatment as it exists now.

I don’t think my statements about 1.) keeping patients safe from self harm and 2.) no new diagnoses or medications are mutually exclusive. I understand that medication can be helpful in reducing or eliminating the urge to self-harm. That said, I believe that medication should be used only when clearly necessary. Many patients can be prevented from self-harming if they are kept in a safe environment and not given access to sharps or pills or other means of self-harm.

By: PTC

PTC — Sat, 26 Jun 2010 22:53:17 +0000

Thank you for that explanation, Dr. Ravin. I never really thought of that. I’ve never weighed what the chart says is my IBW so I’m guessing no doctor would ever tell me that that’s what I should weigh. Considering that I stopped growing when I was in 6th grade, there wasn’t ever much growth on my growth chart , therefore I know they wouldn’t want me to gain 16 pounds. Thank you for clearing that up.

By: Fiona

Fiona — Sat, 26 Jun 2010 18:34:09 +0000

I agree with the vast majority of the post although I do hope that in the ideal future when your residential program is up and running there will also be half-way houses and respite care places where whole families can come and learn and heal together as well as outreach teams who will go into patients’ own homes to support families in the difficult process of re-feeding.

I understand the rationale behind not giving out diagnoses and medications before weight restoration but I do think that these statements can be slightly contradictory
“• Patients would be monitored for urges to self-injure or commit suicide and kept safe from any possible means of self-harm.” and
“• No new diagnoses would be made and no new medications prescribed.”
Medication can sometimes help in situations where self-harm is a problem.