Inpatient Treatment and
Medical Management of
Anorexia Nervosa and Bulimia Nervosa
D. BLAKE WOODSIDE
Rising costs and contractions of health care budgets and external limitations on insurability of severely mentally ill patients have focused attention on hospital-based treatments for eating disorders in recent years. This interest has not been accompanied by an increase in research as to the effectiveness of various forms of inpatient treatment; as a result, there is little empirical evidence to guide clinicians. This chapter provides a brief overview of the nature of inpatient treatment and indications for the same. The typical medical complications encountered in such treatment are also discussed.
There is some consensus of expert opinion as to when patients should be hospitalized. These indications break down into two main groups: admission for medical management, where there is no expectation of ongoing change, and admissions for treatment, where change is expected to occur. Few patients with bulimia nervosa need to be hospitalized for either reason. Most patients are admitted are hospitalized for specific management of medical complications.
Patients with anorexia nervosa require hospitalization for both brief management and definitive treatment. Severity of weight loss is the usual criterion used as an indication for admission. Seventy-five percent of chart average is a figure often suggested as indicating a need for hospitalization. This translates to a body mass index (BMI; weight in kilograms divided by height in meters squared) of roughly 16.0 to 16.5. There are, however, no published studies examining the efficacy of attempting to treat patients under this weight in outpatient or partial hospitalization settings.