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Buyer Beware – Behind the Smoke-And-Mirrors: How Residential Treatment Is Being Sold as “First-Line” Treatment For Severe Eating Disorders Despite Research Backing; The Problematic Variation In State Licensing Standards and Oversight Across States; and Whether Accreditation is Really a Remedy to the Lack of Quality Control

Part 2 of an Investigative Series

The first thing anyone sees when they walk through the doors of a residential treatment center for eating disorders is a sub-circle of women who – like me – have already been through several other programs. And who, like me, have been told by the admissions coordinator that this program is different, this program will help them – permanently.

I remember the first time I admitted myself to such a program, in 2004, to try to prevent a longtime battle with mild anorexia from spiraling into something more serious that would derail my life.

I was shocked when, following the preliminary bag search, vitals check, weight-taking and paperwork, nearly every client who introduced themselves to me did so by giving me a warm smile, stating their name, and then asking me my name as well as this question:

“So, is this your first treatment?”

I quickly and vehemently nodded my head, yes, it was my first. And then thought to myself – as a wraith-like 20-year-old, who looked like she should be dead, walked by me – “What?! You mean people do this more than once? I will never, ever become one of those people.” I shuddered in horror, turned quickly away from the woman (who I later learned had been cycling in and out of treatment for the past ten years), and whipped out my reporter’s notebook. If I was going to spend two months inside this place I was at least going to get a story out of it.

Unfortunately, I never did write that story. Because that first treatment marked the beginning of the end of my career, my confidence as a writer, and my life and identity as a “normal,” moderately-successful woman with boundless potential. I left the program with nearly all my underlying conditions unaddressed, but the obligatory weight gained. I had been supervised, the majority of the time, by blue-collar workers lacking any psychological training; women who worked there because it paid slightly better than the cafeterias or cleaning jobs they had held prior (I asked). I had been forced to attend pointless, hour-long chapel services every day despite being an agnostic verging on atheist.

At discharge, I tried to shrug off lingering feelings that for years I had been too “easy” on myself – since my anorexia had never approached the extremes of most women I was in treatment with in 2004. I tried not to think of myself as inadequate because I could never deprive myself as “well” as these women had. It wasn’t the failing to achieve their ghoulish degrees “thinness” that bothered me – it was the rigorous self-discipline it took to get there, and which I worried I lacked, in other areas of my life. Working very, very hard – giving everything 110 percent – had always been of utmost importance to me.

I tried to plunge myself back into my newspaper job. But two months later I had quit, and moved home. A year later I was in the throes of a full-blown relapse, and was trying to manage a menial but full-time, administrative job while having a resting pulse rate in the 20’s, and severe bouts of dizziness and exhaustion.

Finally, my parents intervened, pulled me out of work and, on the advice of my physician assistant – an alleged “eating disorder expert” (hah!) – demanded I go back into treatment. I had been trying, in the months leading up to the crisis, to avoid this outcome – I feared becoming “institutionalized.” I had tried to attend an intensive outpatient program, but lack of work and family accommodations made attending it feasible. So when the crisis came to its head, I begged to, at the least, enter a day or intensive outpatient program closer to home, instead of being shipped off to a residential program again. I had serious doubts as to whether repeating this expensive, level of care – which my parents would have to take a loan out to pay for – was worth it.

But my parents researched and sought referrals for two weeks, and they promised me, this center they’d found in the Midwest, it would truly help me. And the program did look awfully great, on its Web site, and its admissions coordinator told us all the things we wanted to hear. We didn’t know, back then, that you couldn’t necessarily trust what a for-profit treatment program was selling you. And we didn’t know about the accumulating body of evidence demonstrating that residential or inpatient* treatment is, for the most part, an ineffective level of care for adults with long-term anorexia – unless they lack all motivation to recover, are experiencing life-threatening medical complications, or are simply unable to initiate change on an outpatient basis.

Most centers present themselves as the only hope and first-line-of-treatment for individuals of all ages with severe eating disorders, and brainwash our families into believing the same. And once us clients are inside the centers’ doors, we often lack the resources or ability to discharge and fly home without our families’ support. We call home, crying, but the clinicians tell us, as well as our parents, that our protests are “the eating disorder talking”; that they are the rants of inherently broken and malnourished brains.

These people have letters after their names like Ph.D., Psy.D., LCSW, R.D., and more, so what are we (or our families) to think? Of course these clinicians are right, our vulnerable minds believe, even though everything inside us is screaming something isn’t. And it’s not the eating disorder screaming. Because we want to get better, and we know it will be hard. But we don’t understand how being locked up – in effect – and treated with less dignity than dogs, is going to translate to lasting recovery.

When we discharge, and inevitably begin our slow relapse, and finally – following years of repeating the same cycle – start asking whether maybe it’s the treatment center that failed us, instead of the other way around, our views are muted by the industry. Our voices are dismissed as the misguided notions of bitter and angry, “treatment-resistant” anorexics who have failed to “surrender” to recovery.

*“Inpatient” generally refers to treatment which occurs in a hospital-based program.

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  1. Hi Jeanene, Your articles are amazing. We need to link up somehow. Please contact me. I am linking to this article and recommending your site to others.

    I also know that “help” for anyone who can’t pay an outrageous fortune doesn’t exist out there, and that “no treatment” or to escape what is forced upon us is for most of us, the best option of all. I am not the only one who “got better” by realizing that all the lies taught to me over the three decades I spent in “therapy” were completely false, and their drugs were useless to me and poisoning my body. My aim now is to get my family back, to repair the lies that were told to them, and to warn others not to fall into the trap I fell into. My blog is at (or

    Julie Greene

  2. Melanie says:

    Wow! You are so spot on about the needs of treatment for older women! I’m 48, have been in multiple treatment centers, inpatient and out, for the over the last sixteen years. You’d think I’d be in a much better place after having had this much “help”. What I am dealing with now is the shame and humiliation of not being “willing” or “compliant” enough to beat SA. I’m at the lowest BMI I’ve ever been at, the most depressed/anxious and feel I’ll never get better. The most recent attempt at residential was a year ago. Due to my low weight I was forced to sit in a wheel chair every waking moment without any concern how this would affect my severe chronic spine condition (would have been much happier being stuck in a bed tube fed). I complied like a good little girl and the result was the worst pain I’ve had in years finally crawling out of the chair just to lie on the floor bawling and praying for relief. This happened on a weekend which meant there were no specialists at the center. A 20 year old tech admonished me to get back into my chair or I would be in trouble. That’s when I said, “ENOUGH”! so checked myself out never going back. I got an apology from the center but the damage was done. I spent the next month trying to recover from the immense pain and damage of being in that flimsy wheelchair. My doctor was aghast at what happened. And by the way, I was expected to wait for a tech every time I needed to get my meds, eat, go to the bathroom, group, outings, etc…They were way understaffed so I just sat in a hallway most of the day waiting for anyone to help me. The crazy thing is they knew about my concern for individualized care but once they got me in there I received none. I’ll end by empathizing with you and the forced medication issue. At one center I was on enough gabapentin and Serequel to sedate an elephant. I was a walking zombie. When my family came to visit they said it was like I had a lobotomy. The center stated that if I refused to take the meds as directed my insurance company wouldn’t pay my bill and I’d be responsible for the charges. Ugh. Let’s keep this conversation going. THANK YOU FROM THE BOTTOM OF MY HEART FOR WHAT YOU’RE DOING!!!!

  3. Kate G says:

    I have experienced the horrors of a residential treatment center and also the benefits of one. I have gone to two programs and they were as different as night and day. I left the first program much worse than when I entered and relapsed within three months when I then entered my second program. This program was different. They were kind, nurturing, effective and knowledgable. I spent about six months there and that time “jump-started” me into recovery. I left in a very solid place and have now managed to remain treatment center free for about four years. I do credit this to the intense work that happened at that center. They took a whole person approach as well as an individualized patient approach and I (and many other women) responded well to it.

    I won’t say they cured me but I will say that they made it possible for me to begin living in the world again. I’m not in any way, shape or form functioning as a normal person of my age but I am stable enough with my ED that I can be treatment center free and remain physically stable. I struggle more with my co-morbids than I do my ED.

    I agree that residential centers need more oversight and outcome studies but I do think there are more good ones out there than you are implying in your article. And perhaps they shouldn’t be the first line of care but in an area like my own where the next level of care offered up from 1 hour OP sessions is an IOP four hours away there isn’t many other options to receive more intensive help. Perhaps a good answer would be to offer more day programs and the like but I can’t see that happening in my area of the country.

    I do think many of the quality residential programs often aren’t covered by insurance and so many people are limited in their options and end up in places that do have poor success rates and very poor programs. I do believe you when you say that you believe a different approach should be taken for SE-AN. However, for more typical and early manifestations of the disease I do think quality RTCs can be very valuable.

    I look forward to reading the rest of the series but I do hope you fairly portray RTCs when you write the section of experiences inside the centers. Not everyone has the horrible experiences you had. Some like me had good experience and I hope you portray a fair representation.

  4. Krista says:

    As someone who, for many years, was what most would call a “revolving door treatment kid” I have seen the best and worst treatment has to offer. I can say now, with complete confidence, that after a 15 year battle with anorexia, I am recoverED. Not “in recovery” like most facilities tell you that you will always be, but recovered. I have been kicked out of centers, called a chronic case, a hopeless case, and I am now recovered. Have you looked into the Monte Nido programs? I seriously owe them my life. They are the only program have I have been to that fights the eating disorder, not the client. It is the most well rounded program I have ever been to and the founder is one of the most amazing, humble women I have ever met. I worked with therapists, RDs, trainers, etc. who were recovered. I never once felt like it was just some talking head who really had absolutely no idea what I was going through. When they said they understood, it was the first time I was in treatment that that phrase didn’t make me absolutely irate because I knew they actually did understand. They fed my soul as well as my body and made me realize that I had the ability to live the life I wanted to.

    My first treatment experience was Remuda Ranch and where I thought I had failed, it was a case of the facility failing me. It was before insurance would even consider covering eating disorder treatment- they wanted my parents money. They wanted to strip me down and make me feel like I needed them and couldn’t continue to do any of the things I loved if I “really wanted to get better.” I’ve also been to my fair share of inpatient facilities- only one of which I would ever recommend to anyone. Anyway- your article was an interesting read and one with plenty of merit. I’m just saying, I did find the right place, and they weren’t after my money and genuinely wanted me to succeed. I’m still in contact with the majority of the staff i worked with and visit the house any time I’m in California. There is an up side out there- it’s a matter of knowing the questions to ask and what to look for.

  5. Melinda says:

    I would be so interested in your continuing this series. It’s given me a lot to think about. I work in the mental health system in authorization, and find it so interested to see that there is such little evidence based practice for eating disorders, and also find the comparison to SUD services interesting- long term residential isn’t proven to be effective treatment, so my agency generally prefers community based treatment. However, I feel conflicted–I went to a residential program when I was 18, and thankfully have been in recovery ever since. I had tried lower levels of care prior to that and was in a perpetual cycle of brief stabilization and relapse. From the authorization perspective I can completely understand why insurance doesn’t want to pay, and think it’s horrible that there is such little accountability for providers, which results in poor patient care. It’s so sad to think that so many of these for profit companies are earning billions, while the patients are chronically ill with a poor quality of life, or even death. But I also do feel personally thankful to a residential facility that aided me in getting my life back…All that to say, I hope you keep writing. It is prompting a lot of good thought, and hopefully change.

    • Melinda says:

      To clarify-my own treatment was eating disorder treatment, not SUD, which is why I feel so conflicted. I can see why you write what you do, and how the system has failed, but have also maybe by a stroke of luck been fortunate to benefit from it, and was fortunate to have received compassionate care/not have a traumatizing experience, although I now see that isn’t always the norm. Thanks for sharing your research and perspective on this difficult topic.

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