Specialized eating disorder inpatient programs provide medical and psychiatric stabilization for individuals with eating disorders. Many people who have an eating disorder will never need to stay at an inpatient unit during their journey towards recovery. But for those who require it, the care they receive on inpatient units is usually lifesaving.

So, it’s important to understand when an individual might need to admit to an inpatient program. While determining level of care isn’t an exact science – especially without seeing an individual first-hand – below are  5 common symptoms that could lead to a referral to an inpatient program for eating disorders:

Low Body Weight: This might seem obvious, but low body weight can be, in and of itself, very dangerous. This is especially true for people who maintain a low weight for a long period of time, or for those who experience a rapid and significant weight loss.

The Academy of Eating Disorders recommends inpatient treatment for anyone at or below 75% of their ideal body weight.  As previously stated, this is a general suggestion for medical professionals, not a hard and fast rule. What we do know for sure is that people with severely low body weights are at a much higher risk for health consequences like dizziness, fainting, osteoporosis, amenorrhea as well as the more acute and life-threatening symptoms discussed below.

Electrolyte Imbalance: Electrolytes are salts and minerals, like potassium and sodium chloride, which allow our bodies to perform most of its vital biochemical functions.  Potassium, for example, helps to keep blood pressure stable and regulate heart contractions. Calcium helps with things like blood clotting and cell division.

Eating disorder behaviors, like purging and restricting, can cause our bodies to produce too much or too little of these electrolytes. When this happens it’s known as an electrolyte imbalance, and it have catastrophic consequences. Here are a few examples that are common in eating disorder patients:

Hypokalemia, or low potassium, can be caused by purging behaviors like self-induced vomiting or laxative abuse.  Low potassium levels can lead to heart arrhythmias and a weakened heart, which in turn can lead to sudden death.

Hypernatremia, or too much sodium in the blood, can also be caused by purging behaviors. Think of it as dehydration on a cellular level. Hypernatremia can cause all sorts of problems like cramps, seizures and comas.

Bradycardia: Did you know that eating disorders can cause your heart to actually shrink? Scary to think about, right? But it’s true.

When we lose weight, much of what we lose is actually our muscles shrinking. And in cases of low body weight or significant weight loss, the heart–which is a muscle–can start to shrink. When this happens our bodies will slow our heartrate to protect the weakened heart. This abnormally low heartrate is called bradycardia.

Bradycardia is a common–and potentially deadly–eating disorder symptom. Individuals with heart rates in the 40s and lower are at risk for arrhythmias, which can lead to sudden cardiac arrest and death.

Psychiatric Instability: Many individuals are referred to inpatient units for psychiatric–rather than medical–stabilization.  For example, those living with an eating disorder and a second comorbid condition like depression, may find that their depressive symptoms make them unable to effectively engage in lower levels of eating disorder care. These individuals may need to be hospitalized in order to stabilize depression symptoms before they can return to a lower level of care. Similarly, individuals with eating disorders who exhibit suicidal thoughts or behaviors at a lower level of care may be referred to an inpatient program for safety purposes.

Unwillingness to Engage in Treatment:  Occasionally, individuals are admitted to an inpatient program who are medically and psychiatrically stable, but are refusing to engage in treatment at a lower level of care. A typical example: An individual already engaged in treatment at a residential or partial hospitalization program reports to their treatment team that they have had nothing to eat in 24 hours, and that they are refusing all food and liquids. This person may be medically stable at the moment, but could still be referred to an inpatient setting in order to prevent their current medical condition from deteriorating.

Ultimately, the best way to determine if someone is in need of inpatient hospitalization is to have them evaluated by an eating disorder specialist. As stated earlier, it is important that an evaluation looks at the whole person – medically, psychologically as well as any historical information. Based on those results, a recommendation will be made as to the appropriate level of care. Regardless of which level of care you enter it, please know that recovery is always possible. If you would like to schedule an evaluation for yourself, a loved one or a patient, please call 888-791-0004

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Pat Jones is the Marketing and Professional Relations Manager for Walden Eating Disorder Center at Rockville Hospital. Prior to joining Walden, Pat worked in marketing and admissions for several other mental health agencies in New England. He is passionate about finding appropriate care for patients and their loved ones. Pat spends his time outside of work hiking, fishing and watching LSU football. He lives in Avon, Ct with his partner Lauren, a dog named Zoe and a cat named Mitch.