Adult anorexia diagnosis

[Mumto32022]

Hi,
I have recently been diagnosed with anorexia (a few months ago) lots of issues in the past but no diagnosis. After a period of intense stress my weight has plummeted and I am absolutely controlled by food/calories- very much aware of why I do this etc.

I am under outpatient eating disorder services which I have to say are amazing - seen weekly by practitioner, dietician. Seen every few weeks by consultant. I cannot complain about the care I’ve received atall.

my BMI at initial assessment was 15.5 and it is now early 14s. I’ve had a few discussions regarding ‘when’ I will accept inpatient admission.
I am obviously very reluctant - I have children and a job. I have been told it would most likely be a 3-4 month stay.
because my referral was delayed by the GP pushing antidepressants on me by the time I got through to outpatient services my bmi was very low so I don’t feel like I’ve had the time to make really significant meaningful changes.
I am following my meal plan - eating 6 times a day but still losing weight. I am aware I need to increase my calorie intake.

so my question is - if as an adult when did you have to go to inpatient treatment or when did you choose to accept? What made you accept?
I am aware other factors come in to okay including observations / bloods / general health etc.

I am really trying! Consultant said she’s concerned the Lowe my weight gets the longer I will need as an inpatient. if it was just me and nothing else to worry about I would be more inclined just to accept it. also what did Inpatient treatment consist of - I want the good the bad the ugly.

thank you

Hi OP,

I’m so sorry you are struggling like this. I don’t have any recent experience with anorexia but I have suffered with eating disorders for 40+ years and had psychiatric inpatient treatment several times.

My view is that you are seriously ill and the nature of anorexia means that it is difficult for you to make rational decisions about your wellbeing.

The best thing you can do for yourself and especially for your family is to take the inpatient treatment as soon as you can.

i really hope you can take advantage of this opportunity as you can’t deal with it yourself. 💐

OP with a BMI of 14.5 ish you are severely underweight and at risk of very serious health consequences including possible cardiac arrest. Your health team would not even have mentioned inpatient as an option unless tgey were severely concerned- the inpatient beds are extremely difficult to access and only available to people who are very very unwell and no longer able to be safely treated outpatient.
Even though you say you are eating 6 times a day, you must be aware that you are not eating adequately even to maintain- the anorexia is still in control and you need more support to be safe and get better.
As for treatment- it will be difficult and you will have times where you want to leave. You will be in a highly controlled environment where the initial focus will be on you taking in enough calories to be a) physically safe and b) have enough calories and nutrition to allow your brain to work well enough to engage in the psychological therapy aspect.
But you will be alive and hopefully it will be an opportunity to get well and go home to your chikdren who need you to be well and strong.

Thank you for your response.
were you treated for anorexia ?
how was inpatient treatment in terms of was it a ward / own room - did you get psych input or was it just about eating and gaining weight ?

Thank you - yes I know you are right.
I have a rational side of my brain that says ‘if this was a friend what would you say to them’ and I would say - take the treatment and take care of you and get this sorted asap before it becomes life threatening.
and then I have another side of my brain that says you can do this alone. Or you don’t need to gain weight.
it really is very difficult - I want to get better but I am fearful of the weight gain (I know that is the anorexia talking).
I obviously don’t see myself as a person with a bmi of low 14s. I look at myself and think I look much bigger - but I know that’s the anorexia. I don’t think I look unwell or look like I need inpatient treatment- almost like I don’t feel worthy of taking up a bed someone else needs more than myself.

It’s very tricky to know what to do - it’s because they’ve left it in my hands. If they just said ‘we are admitting you’ I would probably be more willing to accept rather than me having a choice if that makes sense.
the consultant said to me ‘what number will you accept admission?’ Rather than her telling me we will admit you if your bmi becomes ‘X’

"was it just about eating and gaining weight ?"

OP at this BMI your brain won't be working properly. The initial treatment is food. It's really hard to engage with psychological treatment when your brain isn't being nourished.

I know what you mean about it being hard to make the decision yourself. However, you are at real risk of serious illness or even death at any moment so please make the decision to go into the ward. After that, you will be looked after and you can focus on getting well.
If you can’t do it for yourself, would it help to focus on the fact that it is the best thing you can do for your family?

I have considered numerous times to accept it.
however my partner hasn’t been the most supportive about this and that’s what has also put me off accepting admission.
which I know isn’t great - I am also actually following my meal plan. And have actually increased what I’m eating compared to my meal plan as it obviously hasn’t been sufficient.
so I am hoping I’ll have a gain next week.
it’s really difficult - I am worried about admission. I am a terrible patient. Hate feeling trapped. I like my own space. I worry about the detriment to my family and Christmas etc. as it is likely to be such a long admission I won’t be paid by work for the whole length of time I’m likely to be admitted and finances are a real concern.
I just keep hoping I can pull myself out of this mess like I have done in the past.

If anyone has been admitted as an adult either voluntary or forcefully can they disclose what bmi this was ?

Everyone is different, OP, but be aware that if the medics consider that you are a danger to yourself, they have the right to section you. Voluntary compliance may be preferable to a forced situation.

I have watched a lot of friends suffer with eating disorders. They always insist they are eating plenty, but when I've is eating 6 times a day and not gaining weight, that's just impossible.

Could you consider telling the team what you've told us? Or even just sending them a link to the thread?

I totally understand why you are baulking at the idea of inpatient treatment, but a BMI in the 14s is shockingly low and really does put you at serious risk.

I was under the impression that BMI is no longer the primary consideration. Some ED services don't even discuss it. There are multiple factors that may mean that hospital admission is the best option for a patient.

My BMI was in the 14's when I was admitted as a voluntary inpatient into an adult eating disorder unit. I was an inpatient for seven months. I have no doubts they would have sectioned me if I'd tried to leave early on. And I wanted to do this voluntarily which is something for you to think about, because if your weight becomes too low, you may end up with no choice in the matter.

My experiences of outpatient community care was absolutely dire, but I did have an excellent GP who monitored me physically and advocated for me to try and get me the care I needed.
I got my weight up to a healthy BMI in hospital but the therapy there wasn't great. The whole day revolves around food and supervision afterwards, but over time and with weight gain, you get more freedom and home leave.
I had my own ensuite room but initially they were doing 15min checks day and night. But for the most part the ward was calm and I met some really nice people. I was concerned it would be all young people, as I was in my late forties. I was the oldest patient in there, but there were some close in age to me. The majority of staff with, a couple of exceptions were really lovely too.

It can feel brutal in hospital, especially those early days, but I believe it saved my life and I wouldn't have been able to do that part of recovery at home. It's two years this week since I was admitted and I continue to be on the antipsychotic medication they prescribed in hospital and I still have ED thoughts, but I'm maintaining my weight.

It seems that you are hoping to have the decision taken away from you so could you possibly say that at your next consultation?

I totally get it, I have been sectioned and forced to take medication against my will because I couldn’t make the decision myself.

OP it might be helpful to tell your team that you are really struggling to make the decision and in addition don’t have support to do so from your partner.

People shouldn’t tell you the number because it will be a target for you to aim below.

You are already at risk of death.
You know that you are at risk of death.
You are the mother of 3 children.
You should already be in hospital and fully committed to getting better. You should be asking now to be admitted as part of your commitment to recovery.

You seem to be saying that your partner is sabotaging you getting better. Is that correct? That isn’t not great - it is appalling.
What about wider family, yours and his?

How are you now OP? Have you managed to make the decision to go for the inpatient treatment?