The Eating Disorders “Residential Treatment Industrial Complex”: Harm or Help? Part 1 of an Investigative Series

by Jeanene Harlick | June 27, 2015 3:25 am

How An Industry Which Claims to be the Solution for Women Suffering from Severe, Long-Term Anorexia May Be Doing More Harm Than Good, and Destroying Lives in the Process

When I first entered the residential treatment system, for anorexia, in 2004, I thought it would clothe me: with nourishment – mental, spiritual, and physical – as well as flesh.

Instead, it stripped me. Bare. It tore from me my dignity, my sanity, my confidence – and, most of all, my hope. Before I admitted myself, at the age of 30, to Remuda Ranch – the first of the slew – I was an over-achieving journalist with a manageable eating disorder that had waxed and waned since high school. Most of my colleagues would have never guessed I was “anorexic.” Most thought I was merely rather thin; but I was also a runner, so it made sense. Prior to Remuda, when I worked several years as a staff reporter for daily newspapers, I was slightly underweight; thin, but not emaciated. I entered “The System” in a proactive attempt to prevent a longtime struggle from spiraling out of control, and derailing my life.

Little did I know that it was the treatment – not the disorder itself – that would end up derailing it.

By 2010 – several treatment centers later – I was emaciated enough to turn heads, struggled to walk up the stairs of my apartment, and had to admit myself to the hospital for the first time. Worse, however, was my daily functionality and quality-of-life: zero.

Now, thanks largely to the eleven years of inappropriate – and often dehumanizing, shaming, and non-evidence-based – treatment I’ve received at the hands of some of the nation’s most lauded residential, for-profit treatment centers, I’ve been reduced to an unemployable, psychiatrically disabled woman subsisting off of SSDI and food stamps. I’ve become a woman whose identity, to the outside world, is now completely defined by the mental health labels I’ve been branded with. And I’ve become someone who prays, almost daily, for death – because those labels (particularly, “ANOREXIC”), and the treatment that’s robotically administered when one’s saddled with it – have taken away my power to make my life mean something.

I drink at night – even though I feel guilty about the calories – so that I can distance myself enough from my thoughts to eat, and so I can have a couple hours’ relief from the daggers of self-recrimination which constantly fly through my head.

Whenever I’ve entered a new residential or day program, I’ve achieved the target weights the centers required of me. I’ve endured the humiliation of having to defecate, urinate and shower with 20-year-old “direct care” staff standing beside me – even though vomiting has never been one of my behaviors. I stayed the months and months the centers wanted. I participated in sometimes-pointless forms of group therapy which did not resonate with me, and imbibed the 5,000-plus calories daily they forced down my throat, producing an abundance of nausea and indescribable, painful bloating, among other things. Food consisting of staples such as tater tots combined with fried chicken strips, candy bars, and milkshakes, to name just a few. All in the name of “challenging me.” Overly-aggressive food regimens and weight targets, in other words, which have been shown to do little to improve the recovery rates of older women with severe, chronic anorexia and often force them to drop out of treatment even though they desperately want to shed their illness.

My last treatment center in Utah – which was, for me, the worst of the lot – put 40 pounds on me in three months and set a weight target that was not only far above what I needed, to be at a healthy BMI, but clearly not realistically maintainable upon discharge. One 36-year-old woman in that center with me had a meal plan which – while still not as high as mine – was so aggressive, for her, she developed a massive intestinal blockage. Writhing in pain, her complaints were dismissed for over a week. Finally one day, the center took her to the emergency room, where alarmed doctors discovered the blockage and had to pump stool out of her through a naso-gastric tube for two days.

At this same center I applied myself methodically to what therapy was provided and pled for homework my clinicians could never find the time to give me; it was my attempt to individualize my treatment because the center failed to live up to its promise it would do so, when I asked them pointedly about this, prior to admission.

Researchers and eating disorder advocacy groups have been increasingly attempting to spread awareness that anorexia and bulimia are not merely superficial disorders which mostly afflict teenagers struggling with dysfunctional families or the pressures that come with adolescence. There is no age limit to eating disorders, as Dr. Cynthia Bulik – director of the University of North Carolina at Chapel Hill’s eating disorders program, and a leading researcher in the field – puts it. Recent studies have shown that women ages 35 and over are being increasingly admitted to treatment programs for long-term battles with eating disorders. A landmark, 2012 study published in the International Journal of Eating Disorders also showed that 13 percent of women 50 and over displayed eating disorder symptoms, more than 70 percent reported they were trying to lose weight, and 62 percent felt their body dissatisfaction was negatively impacting their life[i][1].

About one-third of women who develop anorexia never achieve full recovery; and once they get past 15 years of struggling with the disorder, the most likely outcome is continuing, severe and chronic anorexia, or death[ii][2].

The media is starting to pay attention to this issue, at least a bit – such as in a 2012 Oprah Magazine story[iii][3]. But what nobody is paying attention to is how poorly women my age and older are being treated.

If you look at where the nation’s most prominent, residential programs and nonprofit advocacy groups – the National Eating Disorders Association (NEDA) being one of the biggest players – are directing their lobbying and advertising efforts, what do you find? They’re trying to get various state and federal legislatures to pass laws requiring insurance plans cover residential treatment for all age groups, and they’re waging expensive outreach campaigns proclaiming residential treatment as the gold-standard approach for women of all ages with anorexia. This, despite the fact that, current evidence is showing the treatment occurring at these programs – designed and geared, years ago, for mostly-adolescent populations – simply doesn’t work for older women.What current evidence does say is that outpatient care should be considered the first line of treatment for anorexia in both adolescents and adults, unless a person is acutely medically unstable, at a dangerously low weight, or unable to initiate change in an outpatient setting[iv][4].

We go to these centers, we relapse following discharge – and yet, we’re told to return again.


  1. [i]: #_edn1
  2. [ii]: #_edn2
  3. [iii]: #_edn3
  4. [iv]: #_edn3

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