Anorexia Nervosa – When Is It Time for Residential Treatment?


Anorexia Nervosa Is the refusal of food/nutrition, along with an obsessional fear of gaining weight or “becoming fat”. This results in a disturbance in the way body image is seen and experienced. In other words, the individual with anorexia not only believes their body is larger than it is, but they also experience it to feel bigger – as if they are taking up more space then they actually are. At Sanford Comprehensive Treatment for Eating Disorders (SCTED) we treat anorexia nervosa in residential and outpatient modalities.


Anorexia Nervosa

Anorexia results in a loss of weight, or a failure to gain weight at the rate expected along the developmental trajectory for a child or adolescent. Some individuals will also engage in compensatory behaviors – vomiting, laxative abuse, or excessive exercise – in a desperate attempt to rid the body of unwanted calories.


Many individuals with anorexia appear very thin, even emaciated. However, individuals whose weight seems normal, or who live in larger bodies, can also experience anorexia. Anorexia is first and foremost a mental health disorder. And we know mental health issues do not discriminate. Often individuals in larger bodies with anorexia are misdiagnosed. Consequently, a delay in proper treatment can result.


We now see anorexia appearing in children as young as 9 years old, with the peak age for onset between 12 and 14.  Although statistics say one in ten of these individuals will be boys or men, the actual percentage may be higher.  Also, members of the LBGTQ community are disproportionately represented. Eating disorders also appear in individuals of all races and socioeconomic backgrounds.



No matter the body size, if an individual is drastically restricting food and water intake, the body goes into a semi-starvation state. This results in many physical changes:

  • slowed or delayed gastric emptying causing fullness and bloating
  • sensitivity to cold
  • lowering of heart rate and blood pressure
  • changes in the metabolic panel
  • loss of hair or nail enamel.


Furthermore, young children and adolescents will often stop growing so the body can conserve all calories to protect the body’s vital functions. The hormone changes expected in puberty will slow, stop, or reverse. Hormones decrease in both females and males, which stops the menstrual cycle and the development of all secondary sex characteristics. Anorexia also interrupts the body’s ability to develop strong bones.


For more information on Sanford’s Eating Disorder Treatment:

Fox 17 Behavioral health provider to house state’s 1st inpatient eating disorder treatment center

The Rise of Orthorexia – Healthy Eating on Steroids

Can Healthy Eating and Exercise Go Too Far?



Anorexia Nervosa and Cognitive Changes

In addition to physical changes, individuals with anorexia experience cognitive and emotional changes. These include:

  • decreased concentration and indecision
  • social withdrawal
  • increased irritability, anxiety, and depression.


If anorexia nervosa is left untreated, the body slowly declines into a state of hibernation. In this state, increasingly vital functions shut down and medical danger increases exponentially.


Most, if not all the above changes are directly related to refusal to take in adequate nutrition.


Residential Therapy

Therefore, the immediate goal is to stop the decline and gradually return the body to a higher state of functioning by increasing caloric intake. In fact, most professionals who treat eating disorders recognize that if the body is in a semi-starvation state, the individual will not be able to think clearly enough to use an outpatient therapy process. When these two factors – medical decline and inability to benefit from “talk” therapy are both present – it’s time to seek residential level of care. The purpose of Sanford Comprehensive Treatment for Eating Disorders residential, is to provide structure, safety and accountability with 24/7 nursing and clinical support.


But there is another significant element to eating disorders, especially with anorexia: denial. The individual with anorexia believes the way they see and experience the world is accurate. Hence, those around them are wrong. We also know there are neurological patterns, likely present pre-illness but exacerbated by the starvation, which cause them to feel anxious when full, but calm and satisfied when empty. Continuing the behavior satisfies a need and provides comfort, called ego-syntonic.


Therefore, many individuals with anorexia are brought to treatment by someone else. Rarely do they seek help on their own. Family members and others on the individual’s support team will likely have to encourage, support, or even push individuals to get the proper help, especially when there is a rapid medical decline.


If you have a loved one you believe to be struggling, please call. Even if not appropriate for Sanford CTED programs, we will direct you to treatment options best for you.


gail hall bio pic

Gail Hall is a licensed social worker, certified Eating Disorder Specialist, and Supervisor with the International Association of Eating Disorder Professionals. She has been treating eating disorders for over 30 years. Gail founded Comprehensive Treatment for Eating Disorders which is now Sanford CTED. SCTED provides state-of-the-art treatment in a personalized, intimate setting in Greater Grand Rapids, Michigan, and beyond. In addition, SCTED offers residential, PHP, IOP, Supportive Housing, outpatient, and family support to eating disorder patients.