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On the Inside of Eating Disorder Inpatient Admission

Figure 1. Thematic map of inpatient experiences.


 

In the final post of our Eating Disorders Awareness Week Blog Series, Imogen Peebles reflects upon some of pertinent themes that have emerged from recent research into the experiences of inpatient treatment for eating disorders.

 

The prospect of inpatient treatment for an eating disorder is daunting and unfortunately, the number of people requiring this type of treatment has gone up. Inpatient treatment is the care received during a psychiatric hospital admission. Treatment includes the monitoring of physical health and round the clock support from a dedicated nursing team. Most inpatient treatment for eating disorders is for people with anorexia, a restrictive eating disorder that can lead to high physical risk caused by low food intake.  Though often lifesaving, the experience of an inpatient admission can be challenging.  As part of my PhD, I wanted to understand inpatient experiences and review the existing research. There was research from a range of countries over the last 20 years and I focused on qualitative research (e.g., research using interviews), exploring experiences of inpatient treatment for an eating disorder. I pulled research together to see commonalities across different studies to explore how people experience their treatment admission.  This is a summary of these themes.


In an inpatient hospital, there will be set rules covering visiting hours, time away from the hospital and unallowed items. People being treated for an eating disorder will have to follow all the generic inpatient rules, plus further specific rules. These will focus on mealtimes, post meal support (whereby people are supported for a period after eating to prevent behaviours like purging), and limits on movement and exercise. Having to follow so many rules made some people who took part in research feel powerless and controlled. They understood the need for some of the rules but felt that many were unnecessary and overwhelming.


People undergoing inpatient treatment will stay residentially at the hospital throughout their admission. During their admission, they will be away from their families, friends, and their usual routines. The research described people finding it difficult being away from family as difficult and their admission as lonely and isolating. Whilst other research reported others benefitting from the break from their usual lives.


Healthcare staff, usually the inpatient nursing team, on hand 24/7 and are an integral part of treatment. The nursing team take physical observations, oversee delivery of care and provide support. The nursing team will be required to enforce the inpatient rules. In the research people who had undergone inpatient eating disorder treatment perceived staff as strict and authoritarian as a result. However, they were also thought to be helpful part of treatment through the support they provided. Reports from the research described nursing staff as were seeing past their eating disorder and trying to understand individuals on a personal level.


A particular feature of an inpatient admission is living alongside other people in treatment, especially when they are also receiving treatment for an eating disorder. The research described peer support within the inpatient community and the benefit of being with others with shared common experience. However, the research also reported that being with others with an eating disorder as challenging, with people finding it triggering being exposed to other’s difficulties and picking up new behaviours.


If you’d like to read the full paper, it can be found here.


 

Imogen Peebles is currently a Clinical Psychology PhD candidate at the University of Edinburgh as well as working as an assistant psychologist in NHS Lothian CAMHS. Her PhD project is looking at interpersonal relationships in young people with eating disorders.


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