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Forced into Therapy?


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Has anyone else been forced into therapy for their ED?  My tdoc told me last night, when I asked him what would happen if I didn't go to an ED specialist, that he would have to seriously consider whether or not to continue seeing me.  Needless to say, I acquiesced and agreed to make the appointment with the ED specialist, but I'm feeling a bit railroaded.  He also wants me to call my pdoc and tell her about what's going on, which I guess is ok.  Anyway, I'm just not thrilled about seeing the specialist or how it came about,

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My doctor didn't force me into therapy so much but he did tell me that if I didn't go then it was entirely possible that people could intervine and make me go against my will :

 

So I ended up going to an outpatient treatment centre while seeing a specialist.

 

It is terrifying at first but things do get easier the more you go to see them.

 

Sorry if this isn't much help but if you have any questions etc I'd be happy to try to help.

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I was forced into treatment but I was only 13.

 

My DBT therapist is kind of doing something similar. She recommended I got to an inpatient ED program and started talking about how she doesn't think the DBT program is enough for me.

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Not forced, but I had an ultimatum about keeping my weight at a certain point.

I don't think that it's uncommon to have other people make ultimatums, nor to be fairly blunt nor heavy-handed in their "you WILL do this" gameplan. It makes sense to be pretty unhappy about it.

But... they are doing it because they care and because an ED is much more fatal than just about any other MI. And it is pretty easy to reach that point of potentially being dead tomorrow or later today. Surprisingly easy, really. If they don't act, and you keeled over, they are at risk. It makes sense for them to be proactive. Even if we don't want them to be.

 

When is your appointment with the specialist? Feel free to let us know how it goes.

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I went to a counselor who immediately suggested IP for my ED a few years ago. To this day, I think her bringing it up immediately was jumping the gun. On the other hand, I probably was on the brink of needing that kind of medical intervention. At some point, counselors have to refer you up the counseling chain if treatment isn't effective or you are a danger to yourself, I guess. 

 

Sorry to hear that you feel railroaded and I hope you are able to get the right help for you.

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  • 1 year later...

The practice I go to for outpatient treatment is saying that they don't think they have the resources available to help me. Well, let's just say that made me feel like shit. Even a THERAPEUTIC practice can't help me? Am I really that messed up?

Anyway, I think the threats were made as a last resort, as was said, and I hope you get the help you need.

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Sometimes people need contact more frequently or need resources like case management, supported housing, supported employment, etc than can be provided by a private outpatient MH practice. I totally get how that can feel defeating. However, in the long run, it's really best to know that as soon as possible so you can work on getting to the right level of support to stabilize and get better (whatever that looks like for you).

I also am a little wary about people using the word "threat" here. When a provider says they need you to be seen by a specialist, it's because they cannot safely manage your needs without that specialist input. Imagine, for example, if your primary care provider said, "Yeah, you have cancer, but I'm ok treating it even though it's not something I know as much about." Would that feel good? It wouldn't feel great to me.

Some mental health issues like eating disorders really do require specialists because of the interaction with physical health.

Edited by Wooster
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I was 15 when diagnosed and forced into therapy with a psychiatrist.  I knew my father's opinions of them, so I lied and told the DR that everything was good and we all got along fine.  Plus my mother was sitting right there in the appt and he didn't have her leave.  Like wtf, you know?  I ended up only having him for 2 appts.  I sought out my own help in the early 90s for a psychiatrist, but for other reasons than the ED.

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  • 7 months later...

I was in remission from bulimia b/p for six years until I relapsed about a month ago. My graduate program became tougher and then a loved one died, and STUPID ME turned to old negative ways to cope.  I got myself into therapy, but I'm afraid my therapist (PhD) will recommend hospitalization if I am honest about the frequency of my b/p, which averages 5 times per week.  Can a PhD hospitalize someone involuntarily for ED without verifying medical condequences?  As far as I know, my electrolytes are OK and I haven't had any medical consequences.

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I'm not surprised that under stress your brain has decided old coping methods were a good idea. There's good neurobiological reasons for this, including that the neurons that "fire together wire together". That is to say, if you were using something as a coping method and it was really effective at least for a time being before the negative consequences caught up too much, your mind is going to think it's worth trying again when under immense stress.

 

With regard to involuntary treatment, it depends on what state you live in. The rules vary from state to state.

Generally, if a non-psychiatrist (as in psychologist, therapist, counselor) believes someone is suicidally dangerous to themselves or gravely disabled due to their symptoms such that they cannot take care of their basic needs, they can request the person be evaluated for involuntary treatment, but usually cannot directly involuntarily hospitalize someone because PhDs don't have medical admitting privileges.

One of the things that makes binge/purge medically dangerous is, as you've identified, electrolyte imbalances. There is also the significant risk of a ruptured esophagus, which is an immediately life threatening condition.

 

One of the conversations I've found useful to have is around the question, "Under what circumstances would you feel compelled to think I need involuntary treatment?" Sometimes getting that information can be reassuring and/or helpful even if somewhat terrifying.

 

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IMO it is.  Compared to electrolyte imbalance and ruptured esophagus it isn't "as bad."

But personally I wouldn't want to have teeth rotting, enamel erosion, etc from the cumulative damage of acid on my teeth over the years.

Here is a more detailed list of problems with constant acid on your teeth:

http://eating-disorders.org.uk/information/caring-for-your-teeth/

Quote

Individuals with bulimia nervosa tend to experience the most damage to their teeth

as a result of frequent vomiting.

-- Vomit contains stomach or gastric acid, which is highly erosive and if in frequent contact with the teeth will wear the enamel surface away.

-- When the enamel layer has been worn away the next layers of the tooth such as the dentine and the pulp may become exposed leading to pain and sensitivity.

-- Pain and sensitivity may be noticed more on eating/drinking hot, cold or sweet foods/drinks.

-- The teeth will begin to change in appearance and look smoother, glassy and yellowish.

-- Acid erosion of the teeth may also be caused by acidic foods/drinks. The most hazardous are fruit and fruit juices and carbonated or “fizzy” drinks.

-- Individuals with bulimia nervosa may also experience swelling of the salivary glands caused by frequent vomiting.

-- Frequent bingeing on sugary snacks and drinks may lead to tooth decay or caries.


And this:

Quote

-- In our mouths, plaque bacteria are present which attach themselves to the surface of the teeth.

-- When sugary foods/drinks are consumed, the plaque bacteria change the sugar into acid.

-- This acid is harmful to the teeth and immediately begins to “attack” the outer surface. This process is known as demineralisation.

-- Once the consumption of sugary foods/drinks is finished, saliva in our mouths acts as a neutraliser for the acid and begins to repair the damage done to the surface of the teeth. This process is known as remineralisation and may take up to an hour to complete.

-- If sugary foods/drinks are consumed again before the saliva has finished repairing the tooth, it will not have time to restore the tooth to its original healthy condition and a hole will form in the tooth surface – this is known as tooth decay.

-- Therefore it is how many times a day sugar is consumed that is harmful rather than the amount; this is why sugary foods/drinks should be consumed all at once and at mealtimes only. Sugar free snacks and water only should be eaten/drank between meals.

Here are pictures of the damaged teeth (from http://www.bulimiahelp.org/articles/bulimia-teeth-damage-what-you-need-know-and-how-stop-it ):

 

Bulimia Teeth.jpg

 

So I see this as a problem too, like the esophagus erosion and the electrolyte imbalance ... just not "as bad."

Edited by melissaw72
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I think the point is that this is a thread about being forced into therapy and/or being forced into inpatient treatment for eating disorders.

While it's true that purging does wreak havoc on one's teeth, it's not ever be something that gets you held for involuntary treatment.

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Just now, Wooster said:

I think the point is that this is a thread about being forced into therapy and/or being forced into inpatient treatment for eating disorders.

While it's true that purging does wreak havoc on one's teeth, it's not ever be something that gets you held for involuntary treatment.

You're right, that makes sense. 

I was just saying that it still is something that could happen from all the acid on your teeth, and it is important too.  Another reason to get some treatment.

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