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Sometimes eating disorders can be treated on an outpatient basis. Sometimes they can be addressed in residential treatment. And sometimes eating disorders have to be treated in the hospital. Here are 10 signs inpatient care is needed.

No two people living with an eating disorder are exactly alike, and very few people who live with an eating disorder can be placed in an ideal treatment program. Fortunately, inpatient hospitalization isn't always necessary for eating disorders. There is a range of options for treating eating disorders.

People living with eating disorders who are making progress with needed life changes and who don't have serious medical complications may be treated with outpatient therapy. This may consist of going to meetings and seeing a therapist one to five times a week; there are also internet-based and book-based treatment options.

Sometimes the best option for treating an eating disorder is residential care. This is something like a halfway house for eating issues. Patients come and go during the day, but they spend their nights at the treatment facility. Eating issues are carefully monitored. Even when this is the best option for treating an eating disorder, residential care may not be available. It's expensive, and not every community has residential care.

Then there are situations in which the only way to preserve life is with a hospital stay. Doctors have protocols for hospital admission to ensure that no one at risk of serious worsening of the eating disorder or loss of life is overlooked for care. Here are 10 situations in which hospitalization for an eating disorder is a must.

1. Suicidal intention

Not everyone who expresses thoughts of suicide will be admitted to hospital care. Doctors look for a specific plan for suicide that is highly likely to be lethal. People who make a failed attempt at suicide or who stop their attempt at suicide may or may not be admitted to inpatient care. The doctor also considers history of suicide attempts. Increasing potential lethality in successive suicide attempts is an indication hospital care is necessary.

What are the signs that someone may be thinking about suicide? They may cut off social contact. Maybe they will cancel their social media accounts. Or maybe they will stop answering the phone. Another sign of suicidal intention is giving away prized possessions. Sometimes suicide attempts occur as someone is pulling out of a prolonged depression. They simply didn't have the energy to be suicidal for a long time. Then they show how little they value life by taking extreme risks. People who are suicidal may be very angry, sometimes to drive off people who might keep them from ending their lives. 

2. Worrisome vital signs

Have you ever noticed that just about every time you do to the doctor someone takes your pulse, temperature, and blood pressure? Sometimes vital signs alone will indicate the need for admission to the hospital.

In children, the indications hospitalization may be required are:

  • Heart rate 40 beats per minute or lower
  • Blood pressure 80/50 or lower
  • Temperature below 97° F/ 36.1° C
  • Increase to heart rate of more than 20 beats per minute or drop in blood pressure more than 20 mm Hg when moving from a seated position to a standing position
  • Blood tests showing low potassium, low magnesium, or low phosphorous levels

In adults, signs that hospitalization is immediately needed are:

  • Heart rate 40 beats per minute or lower
  • Blood pressure 90/60 or lower
  • Temperature below 97° F/ 36.1° C
  • Blood tests showing la potassium level below 3 mEq/L or electrolyte disturbances
  • Poorly controlled diabetes
  • Dehydration
  • Signs of imminent kidney or liver failure

3. Low body weight

Anyone who has body weight less than 80 percent of the average for their height is likely to be admitted to the hospital. If the percentage of normal body weight is between 80 and 85, then the concern is whether the patient is improving or getting worse. If percentage of normal body weight is 85 and falling, hospitalization is usually needed.

4. Motivation to recover

Attitude is also a consideration in whether hospitalization is needed. Doctors consider motivation to recover, cooperativeness, insight, and the ability to control repetitive thoughts. When a patient is only cooperative in a highly structured environment, the patient may be put in hospital. When a patient is preoccupied with intrusive thoughts more than six to eight hours a day, psychiatric care may be needed. 

5. Ability to control excessive exercise

An inability to stop exercising is usually not by itself a reason to admit someone to the hospital, although other considerations apply.

6. Structure needed for eating activity

Anyone who needs nasogastric feeding is likely to be kept in the hospital. Anyone who needs to be supervised after each meal is likely to be kept in the hospital.

7. Purging with laxatives and diuretics

Anyone who needs supervision after every meal and every time they use the toilet, or who has multiple episodes of purging with laxatives and/or diuretics every day, or who has had multiple episodes of purging that are severe and disruptive to daily life, is likely to be recommended to hospital care regardless of good lab tests and vital signs.

8. Home environment

A hostile family environment or severely deficient living conditions are indications for residential care, if available, or hospitalization, if not.

9. Availability of residential care

People with eating disorders who could function with residential care but who aren't safe to go home may be kept in the hospital if no residential treatment facility is available.

10. Comorbid conditions

"Comorbid," coexisting conditions such as anxiety, obsessive compulsive disorder (OCD), schizophrenia, and addiction are considered separately as reasons for admission.

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  • Photo courtesy of SteadyHealth

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