Eating disorders

Staying in hospital

When someone with an eating disorder is severely underweight, seriously unwell or refusing treatment they are sometimes advised to stay in hospital most will be treated as an outpatient but some will be admitted and treated as an ‘inpatient’. They are then treated in hospital in order to stabilise their health and help them participate in treatment.

When people are admitted to hospital, they stay on a psychiatric children’s ward, adult ward, a general hospital ward or a specialist unit for eating disorders. The young people who we spoke with had stayed from a few weeks to a year or longer. The reasons for their admissions included:
 
Being very unwell and/or underweight
Outpatient treatment (outside of hospital) not being successful 
Needing to remove young people from their home environment because it was contributing to them being ill. 


Sometimes people relapsed after coming out of hospital and had to go back in again, several times.
 
Being admitted to hospital
People were often scared when they first went into hospital. They were often very ill at the time and afraid of losing control over the routines and habits that they had developed. Steph said, “It’s when they take away all your coping mechanisms, [you] feel so bare and vulnerable”. People could feel very ill physically and suffer from exhaustion. James was so ill at admission he was having “hallucinations and hearing voices”.
 
Some people found the ward frightening or “intimidating”. The ward could feel restless and some of the other people there could be very ill with a variety of mental health problems people had never seen before.
Even the idea of being in hospital could be shocking. Many didn’t feel they belonged in there as they didn’t think they were ill enough to be in hospital. Although ill with anorexia nervosa herself, Annabelle said she felt she was different from the other people and “nothing like the anorexics there”. Chloe said she was so upset she couldn’t speak and Rebekah described staying in as “heart breaking” because she had no idea she was that ill. People had often expected to be out in a matter of days when in fact they ended up staying for much longer.
Those who had been in inpatient treatment in their early teens often felt homesick and missed their parents. Their families or friends often visited weekly, some every day and they could also phone home. On some wards, phone calls were limited to only a couple per week. Once they improved, they started meeting visitors outside of the hospital and went on home visits.
 
However, admission to hospital could also be a relief. Being moved from home into an environment that they could no longer control could be very helpful. Looking back, the beginning of the experience in hospital was often the hardest and things often improved.
 
Daily routines, therapies and schooling
Life on a ward involved adapting to different routines and activities. Treatment consisted of individual therapy, group therapies (such as art therapy) and workshops. For many, talking treatments were essential in recovery. (See ‘Talking therapies’).Workshops often involved practical activities, such as cooking skills, beauty treatments/massage and creative writing. Sometimes people would join outings to the cinema or day trips. There was also free time for watching TV or resting.
Being on a ward involved certain restrictions. On some wards, all personal belongings like phones and money were taken away. In secure units people were not allowed to walk in and out. Freedom to move could also be restricted so that people were only allowed to use a wheelchair (chair rest) or lie down (bed rest), in order to limit the burning up of calories. People could be under ‘observation’, which meant having a staff member with them constantly, or checking them regularly, day and night. The purpose of observation was to prevent people causing harm to themselves through exercising, purging or self-harming. Having no control over personal belongings and experiencing very little privacy even when going to toilet, having a shower or sleeping could be “distressing”. People described feeling like they were “in prison” or “being punished”. Steph said she couldn’t even be alone to cry. However, Charlotte felt “safe” when everything was taken off her.
Sara describes how a staff member tried to make the experience of having a shower while under observation less uncomfortable;
 
“There would be a curtain between us and I remember one nurse would sing because obviously it wasn't really comfortable for her and she knew how uncomfortable it was for me to have that kind of privacy taken away. I can understand now why but at the time it was a bit distressing. So she sang Disney songs which was quite funny and kind of did break the ice between us.” Sara
 
Many people attended hospital school but only if well enough. For many, school work was important and going to lessons or sitting exams in hospital helped them stay on track. School work also provided structure, “normality” and a focus to the day.
Some had a lot of support from their own school and their teachers would regularly keep in touch to give them work. After their health had improved, sometimes people went to their own school and returned to the ward in the evening. Often people were allowed to increase their time at school as their condition improved and this could be an incentive to try and get better.
 
Not everyone was able to attend hospital school because they were too ill or didn’t feel motivated enough.
 
Relationships between people on the ward could be complicated. While people said they often felt supported by others, they could also feel “different” and “an outsider”. James, who was the only male on his ward said:
 
“I felt like I had to sort of step up because I was the only male there. It made me more determined basically to do it … It was just so strange being in there at first because I was the only guy there and when all the staff are women as well it’s, it’s pretty hard. Everything that seems to be in there’s just talking about like women’s magazines and stuff like that… I had to get used to letting women see me go to the toilet, and it’s really, it’s demeaning.” -James

Spending time with other people with eating disorders wasn’t always helpful. Many shared a perfectionist mindset and some people described the atmosphere among patients as a competition over “who was thinnest” or “who could eat the meal with the lowest calories”. Some of the things they learnt during inpatient care were unhelpful in recovery. Observing others, newcomers soon picked up “tricks of the trade”; for example how to try and minimise calorie intake, exercise in secret or try and trick the scales. Many had been unaware of such behaviours before; Felicity said she went in “as a novice anorexic”.
Some people made good friendships in hospital and found that peer support could be very helpful in their recovery (for more see ‘Working towards recovery’).
 
Eating and being weighed
Learning to eat well again; nourishing the body properly and learning how to deal with food in a balanced way is the main aim of inpatient care. James compared food to “medicine” that they were “prescribed”. It was often very difficult for people to let go of control over food and found it hard to follow the ward's mealtimes and routines. Mealtimes could be “tense” and “awkward” and take hours. People with eating disorders often struggle to eat with others, which could add to the pressure.
For people with anorexia nervosa, food had to be introduced very carefully and gradually. Sometimes high calorie nutritional drinks were part of the diet. Once people started improving, they were often given choice over their meals and sometimes allowed to cook later on. People pointed out how important good quality hospital food could be for someone recovering from an eating disorder and how eating “frozen and vacuumed” food wasn’t helpful.
 
Sometimes, if people refused to eat or their weight was life-threateningly low, they could be fed through a nasogastric (NG) tube. A NG tube is put into the body through the nose and is used to deliver a nutritional solution or medication straight into the stomach. Having an NG tube was often a very difficult experience. People described feeling “out of control”, “medicalised” and “isolated”. At the same time, they said it had often been “a necessity” and that having the NG tube had worked as an incentive to get better. Some people said they had been force-fed or threatened with NG tube feeding if they did not eat.
Young people were also regularly weighed to assess their improvement. On some wards weigh-ins were organised “discreetly” in private but for some people, the experience was very upsetting. Annabelle described shared weigh-ins in their underwear as “degrading”. Depending on a person’s weight or BMI, they could be rewarded with privileges such as exercise allowance, outings, leave and meal choices. Francesca had always been unaware of her weight but after being regularly weighed in hospital she started weighing herself obsessively at home.
 
Being detained under the mental health act (section)
“Being sectioned” refers to the process when someone is required to be assessed, held against their will (detained) or treated by law. It often happens when someone is so ill they are “unable or unwilling” to agree or ‘consent’ to go to hospital by themselves. 
Sometimes people felt that sectioning had been used as a threat when they didn’t agree to go to hospital. Some worried about having a record of the section in their medical notes. Having their choice taken away could hold people back from wanting to get better and be involved in care. Sara felt very vulnerable when she was told if she didn’t agree to admission, she would be detained. She became “a shell” and her recovery went backwards.
People’s views of the role of inpatient care on their wellbeing varied, and often the same person had had both positive and negative experiences, depending on where they stayed and how much they wanted to get better.
 
Looking back, many people felt that inpatient care had been a necessary step. Eva said, “It saved my life”. Getting better was often a slow process, with a few steps forward and one back.
People described staying in hospital as a life changing experience; they learnt a lot about eating disorders and about themselves. Annabelle says she “grew up a lot” and Rebekah said inpatient treatment helped her become “the person I was always meant to be”. Rob says staying in hospital was a “formative” experience; he had always relied on his parents but became much more “self-sufficient.”
Some people felt that their health got worse in hospital. Maria says because she was “uncooperative” her health didn’t improve in hospital. Francesca and Nikki felt their eating had worsened during their stays:
 
“The eating flared up while I was an inpatient, like the nutrition plans, it’s almost become a form of self-harm you know it’s a tool rather than a kind of a means to an end.” Nikki
 
Nico, who had been hospitalised for severe depression, said he developed the eating problem while in hospital being treated for depression. He felt eating was the only thing he could control.
 
People’s relationships with hospital staff often had a huge impact on their experience.
 
Discharge and thinking about “what next?”
Leaving hospital (being discharged) was a process that usually happened over a period of time. Before discharge, people usually spent time at home at weekends, for example, or went first back to school. Moving from living on a ward to life at home could be a big change. It was often managed by a transition to outpatient care (treatment whilst living away from the hospital), with intensive home care. However, a couple of people said they left with no plan for their care in place.

Last reviewed July 2015.
​Last updated July 2015.

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