Eating Disorder Treatment: Leaving Before You’re Ready

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By Kiernan O’Dell

For many of us who have been in eating disorder treatment, the first few days are often a blur. You are whisked from one appointment to the next, either exhausted or full of anxious energy. You meet so many new faces and mistake staff for clients and vice versa.

That said, I can say that I almost always remember my last day in treatment. I remember how I left. I’ve left hopeful. I’ve left angry. I’ve left terrified. I’ve left determined to lose the weight “they made me gain.” I’ve left with the best and the worst of intentions. I’ve left because of insurance. I’ve left because of work. I’ve left AMA.  I’ve left with excuses. To bring you up to speed, I am currently sitting in treatment so it’s not difficult for me to admit: I left too early.

I know some of you may be sitting at home while you read this, struggling. Perhaps you have not been to treatment (and I encourage you to seek treatment, even if it seems impossible or scary!), but if you have and you are still engaging in your eating disorder, it may be true that you, too, left treatment before you were ready.

The unfortunate thing is that leaving treatment often depends on two factors: 1) Insurance coverage and 2) Our own ideas of readiness. While there is amazing progress being made in Congress to combat the limited coverage available for eating disorder treatment, unfortunately and often infuriatingly, I personally know and have been one of those people who have been sent home long before they were ready. They left because their insurance provider thought they had made enough progress or not enough. Because they had limitations on their policy or on time available for treatment at a certain level. Because their case manager didn’t understand how to fight insurance or simply because they had been in treatment before that year (or that decade).

It’s a fight we need to keep fighting but often, there feels like there is little we can do about it.

Source: Flickr
Source: Flickr

I have also seen too many people leave because they are, like I was, angry. Unwilling, Terrified. Uncomfortable. They had, emotionally, come undone. They thought they’d be ok. To turn this to myself, I will tell you that I have been in eating disorder treatment on and off for the past 15 years. In so many ways when I left all of those treatments, I was not ready to leave. I usually either needed more time or more surrender. I alternately felt misunderstood or way too understood. Fear often drove my decision to leave abruptly, if it was my decision, and fear also ruled my world if I left after completing a program.

Now I think that fear is healthy when leaving eating disorder treatment. On one hand, I usually knew I was not ready to be in the world; not ready enough to continue the work outpatient. There were times I was confident that I could continue implementing what I had gained in treatment and was not afraid, but to be completely honest, I was willing to use the knowledge while still holding onto back pocket behaviors that kept me sick. I kept a scale at home, just in case. I didn’t throw out those jeans. You know, those jeans. My meal plan became optional and while I really wanted to be in recovery, I was not ready to take the steps.

If this is where you are, I understand. Sometimes I was simply not ready to be in recovery. Sometimes I really did need more time in treatment and did not get it because of financial reasons. Yet here I sit, trying again and maybe that is what is most important.

Maybe we never really know when we are leaving too early. Sometimes it really is an illusive concept, readiness. Perhaps some more important traits are willingness. Surrender. Teachability. Openness. I think that these mindsets, put to use, engender readiness.

Prepare all you want, but if you are not surrendering to the process, all of the process including your body, mind and soul, you may not be ready. I know I wasn’t.

While I never had made New Year’s resolutions, this year am resolved to carry hope and tenacity into 2017.

I am surrendering. I am willing to learn and take a real look at myself. I’m willing to stay as long as I can or need to. I’m willing to keep trying when I get home. I am honest with myself and my team. In 2017, I believe I can recover, but more importantly, I have hope in my heart that I can recover.

I don’t know if I’m ready to be in recovery, but I truly believe that ready or not, here I come.

 


 

About the Author:

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Kiernan O’Dell was born and raised in Chicago, Illinois. After earning a BS in Psychology at the University of Illinois in Urbana-Champaign, she attended Columbia University’s Psychological Counseling Program. O’Dell enjoys writing, and hopes to one day adopt it as a full-time job. According to O’Dell, the current road to recovery and sobriety enabled her to discover her purpose, which is to serve as a mentor for others using her firsthand experience.

 

 

 

An Open Letter To Insurance Companies

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Dear Insurance Companies,

 

It has become increasingly apparent that there are some significant injustices when it comes to treatment coverage for individuals suffering from eating disorders. Though eating disorders have the highest mortality rate of any mental illness, a mortality rate that actually rivals that of some cancers, many of you, the insurance companies, have policies that specifically exclude reimbursement for eating disorders. As someone who has had to obtain treatment for my own eating disorder, and now years later, is working as a professional in an inpatient eating disorders treatment facility, I feel that I can offer a unique and multifaceted view on this managed care issue. Here are some of the main problems that I have noticed with the way that you deal with eating disorder coverage:

  1. All too often, you provide very low caps, particularly on inpatient days. In fact, the number of inpatient days provided is often so shockingly low that it leaves me wondering if you have been educated as to what the purpose of an inpatient facility even is? What do you expect us, the psychologists, psychiatrists, and dieticians, to accomplish in five days? Perhaps it would be helpful for you to read through the DSM-5 and other accompanying literature, so that you may better comprehend the chronicity and stubborn nature of this illness.

 

  1. Many of you will only cover expenses that are “medically necessary” but will not rule on medical necessity until well after treatment has been initiated. Then, ridiculously, upon review it is decided that care for an eating disorder is not deemed medically necessary. Once again, this leaves me wondering if you have been provided with the proper education needed to understand the nature of eating disorders. These illnesses often include a medical and psychological component. Both are serious enough to warrant treatment.

 

  1. You tend to use weight as the defining factor in whether or not someone receives coverage. This is particularly problematic. I cannot begin to describe how much heartache this ill-thought-out notion has caused both myself in the past, and now the patients that I work with currently. For one thing, it provokes and provides fuel for the long-standing and stubborn “I am not sick enough to deserve help,” thought that plagues so many individuals with eating disorders. Secondly, it colludes with current societal ignorance that eating disorders must be accompanied by weight loss. Did you know that the vast majority of those suffering from eating disorders are not underweight? Please try to understand- you cannot tell who has an eating disorder by looking at them. Low body weight is a symptom of some (the minority) of those suffering from eating disorders. Can you now begin to see the absurdity of basing coverage on a symptom that most sufferers do not have? This would be like basing coverage for chemotherapy on headaches. Some people suffering from certain types of cancer might have headaches, but to base coverage on this transient symptom simply makes no sense

 

  1. You seem to place a hierarchy of eating disorders that is not based in fact. For example, Anorexia Nervosa is typically considered easier to obtain coverage for than Eating Disorder Not Otherwise Specified. However, a 2009 Longitudinal study by Crow et al determines that there is an increased rate of mortality for Bulimia Nervosa and Eating Disorder Not Otherwise Specified. This new study shows that this diagnosis has an elevated mortality rate similar to that of Anorexia Nervosa. I urge you to read this research, in order to better understand that coverage should not be diagnosis-specific.

 

  1. Some of your policies appear to base coverage entirely on medical necessity, with no regards to emotional or psychological symptoms. Hence even if you do take other factors (aside from weight) such as blood work into account, when these symptoms clear up, you decide to stop covering treatment. Again, this leaves me wondering if you understand the nature of eating disorders. To clear up some of your misunderstandings, I recommend that you read “The Great Starvation Experiment” for a research-based perspective on the long-lasting psychological effects of manipulating food intake and weight. Eating disorders do no “go away” once weight/blood pressure/ electrolytes have been stabilized. Please understand- pulling coverage as soon as medical symptoms have cleared leaves patients confused, and clinicians aggravated.

 

These, insurance companies, are the main problems that I have noticed thus far. Because treatment for eating disorders is so critical and can, quite literally, mean the difference between life and death, I urge you to begin to think more deeply and in a way that makes sense about coverage for these illnesses. Please hear my plea, and the pleas of sufferers, family members, friends, and clinicians all around the world. The request is quite simple. We want eating disorders to be covered by all insurance companies in the very same way that medical illnesses are. We want time and consideration placed into length of stay granted, and we want a deeper understanding about the nature of eating disorders by you, the people who are controlling the very treatment that will save our lives, and the lives of our patients.

Thank you for your time,

C