The truth about life on a locked eating disorder ward

Telegraph article from 4 months ago

The truth about life on a locked eating disorder ward (msn.com)

 

I was on a locked eating disorder ward, although it wasn’t because I was considered as a mentally ill / eating disordered patient but only because this hospital unit is specialized in severe malnourishment and that was the state my gastroparesis got me in. I had my nasojejunal tube fitted (and later replaced) there.

So I didn’t have any harsh restrictions but it felt, to say the least, uncomfortable to have locked windows, a door with a window, and my belongings checked upon arrival with a bottle of water being taken away. Water was dispensed by nurses in 500 mL bottles with a maximum of 3 bottles a day.

The medical staff also insisted on me going through an entire bottle of feed even though I was having trouble tolerating it and clearly told them so. Similarly, all of the (visibly) anorexic patients that I saw had a nasogastric tube and were under strict monitoring by the staff.

Ultimately, even if an inpatient stay in a disordered eating ward can save someone’s life, I’m not sure that such a harsh approach achieves a benefit in the long term because I thought that even if these patients regained weight during their stay, they would probably feel distressed afterwards and plunge back into restrictive / disordered eating. Around that time I browsed subreddits on eating disorders for a brief while and that is certainly what was being reported by some people.

 

Yes, there is a behavioural reward system for eating disorders as that is often the only way the staff have to achieve compliance from a person with a severe eating disorder. It is, of course, very stressful for the person and people often do not understand why these systems are put in place because it takes away the things that support them and they can earn them back by eating meals, which are done under supervision to make sure they do not go to the toilet to vomit it up. It can take several hours for a person to eat a meal but they are given one to one nursing. Behavioural rewards are usually overseen by a psychologist trained in the diagnosis and management of eating disorders.

It was brought into the treatment of severe weight loss due to an eating disorder to reduce the requirement of force-feeding which is highly distressing for the patient and the staff who have to use force for an extended period of time. Using force is counter-therapeutic. It is only used at very low BMI's with electrolyte disturbances that can cause cardiac arrhythmia/cardiac arrest and death. This is when the person due to the fixed false beliefs around eating and body form perception i.e. thinking they look healthy when their BMI is below 12 (75% of body weight lost) But also behaviours that maintain this severely malnourished state eg voiding food by vomiting, not drinking fluids, over exercising, different medications that inhibit appetite or increase voiding.

Also very low BMI's have an effect on the brain, making disordered thinking worse due to cognitive impairment from lack of nutrition. Ultimately it can cause brain atrophy, which is irreversible. Eating disorders have one of the highest incidences of death within all psychiatric disorders because of lack of nutrition and weight loss. The first aim is to resolve the electrolyte disturbances and slowly increase weight, this requires admission to a medical ward. When that has been achieved, they are transferred to an appropriate ward where psychological treatment looking at altering these beliefs is commenced and any psychiatric medication that may be useful is offered. Initially this will be in a locked psychiatric ward and if they continue to progress so it is safe for them to be discharged to outpatient treatment, they can go to a community facility which is not locked and they agree to work on maintaining a weight, that although may be still quite a lot less than the general population, is not a threat to life. There is a high risk of relapse but over time, some people do recover from even the most severe eating disorders.