While in PHP, my fellow patients and I would commiserate about the misconception by the general public that one is fine upon discharge from inpatient/residential. We would talk about how psychologically it seemed to work in reverse – body image and ED thoughts became worse once starting treatment and having to eat, and are in no way resolved upon inpatient discharge.
However, even though I do not have the expectation that I will be fine mentally upon discharge, for some reason I have this expectation that I should feel fine physically when I get out of inpatient/residential. If you were to poll my treatment providers as to my number one complaint during treatment, my guess is they would say it is “why don’t I feel better yet? I thought eating was supposed to make me feel better.” They always say “it will, it just takes time.” While I understand that years of damage from eating disorder behaviors cannot be wiped with a few months of normalized eating, the notion that I am not fine physically upon being discharged from inpatient/residential is something that I struggle to wrap my head around. I always think “well, if I am healthy enough to not have to be in the hospital, I must be physically healthy, and if I am physically healthy, I should FEEL physically healthy.”
Recently though, I was reminded that my thought of “I am physically healthy upon inpatient discharge” is quite disordered. I was looking through some old journal articles I had saved on my computer, and I came across one that says: “Patients are often discharged from inpatient units once acute medical problems are resolved and when anorexic patients have achieved 85% of ideal body weight, meaning that many patients are still ill at the time of inpatient discharge” (Short-term outcome of psychiatric inpatients with anorexia nervosa in the current care environment.). As soon as I read that, my first thought was “Wait, What? Still ill? That’s not true – I’m fine when I get out of inpatient!”
Then from a 2008 paper: “Our ﬁndings document that most patients can meet modest inpatient goals during a relatively brief inpatient stay, but they remain acutely ill upon discharge and are in need of continued intensive care….nutritional rehabilitation was far from complete on inpatient discharge, and signiﬁcant medical problems persisted. (Treatment of anorexia nervosa in a specialty care continuum).
The phrase “remain acutely ill” really stuck out at me. Like I said above, I always get frustrated that I don’t feel fine physically when in PHP. Re-reading these articles was a good reminder that treatment is a lengthy process, and while PHP is a good step-down from inpatient/residential, being there means I’m not fine, as opposed to the opposite.