BL: I completely agree about having a separate program for “chronic” eating disorders. While on one level I hate to make that distinction (where do you draw the line? What makes an ED chronic?), I have been in those groups where everyone around me has had an ED for less than a year or just has bad body image issues. I didn’t want to talk about my history because it seemed so chronic (for lack of a better word) in comparison. I didn’t feel like I could relate to a lot of the things that they said. Also, it’s always frustrating to be in a group where those around you are just realizing that it’s not JUST about the food. That there are other things going on too. That dawned on me 7 years ago — and not to minimize the importance of that realization, but talking about that just is not helpful at this point!

I guess that the personalities and dynamics of the group are probably more important than the varying ages. There are some amazing 15-year olds that are so mature beyond their years — and some pretty immature adults. I think that professionals need to be so careful in evaluating individuals to add to a group… between different ages, disorders, motivation levels, personalities, treatment history, etc., there are a lot of things that can make a group competitive or just unhelpful.

Thanks for your feedback, both of you!!

I think there is also something to be said for separating, especially in inpatient, the people with more “chronic” eating disorders and those who are just starting out, and particularly those who are still in denial and perhaps only there because they were forced by parents or others. While I am sure a lot of the differences between myself now and 9 years ago is that I am an adult and so have different priorities and commitments, I think a lot of my differences when it comes to treatment needs and outlooks also comes from just having dealt with this a long time. I no longer need to be convinced that it is “not just about being skinny”, nor do I need to spend hours exploring my relationship with my parents. Obviously not living at home is part of that, but also, I have already done that! I think a lot of adults in treatment are those who have been suffering for awhile, so it is hard to sit there and relate to others who are just starting out. There just isn’t the same insight and the same struggles.

I was 23 when I went in– most girls were in their late teens/early twenties. Even though I was youngish, I’d been out of college for a few years & self supporting, plus I had parents who weren’t supportive [to be fair, they had no idea I was in therapy, in treatment, had an ED].

There was a lot of competitive/weirdness amongst the high schoolers, but I don’t think it was tempered by the older women present. And as far as triggering goes… I think teens say more inappropriate things, I had a 15 y/o girl tell me I had her idea of the perfect body. I’ve never had any older patients say things like that, you know?

I don’t feel like adults should HAVE to feel like role models. You’re there for you to get better, and there was too much of a sense, especially among the mothers in the group, that the older women were taking care of the younger ones.

Plus I got REALLY pissed when some 15 y/o who’d been sick for less than a year tried to tell me how easy it was once you let the program help you/blah blah go recovery. [She's been in at least four times since.]

And I think staff need to work differently with adults than adolescents, and when they work with you as one group that gets lost. I didn’t like being treated a child, but some of the groups seemed off-topic for kids who weren’t living on their own.

I don’t know how you draw those lines though, honestly. There were women in their thirties and older who had never lived on their own, should they really be with the adults, or would they relate better to the younger patients? What about patients who were younger but effectively independent adults?

I don’t know what the best solution is. I just know that in my experience, it wasn’t helpful for me to be in treatment with people who were at such different life places than me. I don’t know if that would have changed if the other patients were my age though– I think a lot of it had to do with life goals/educational stuff/job stuff.

I don’t think I’ll ever go into treatment again. But I’m really intrigued by the idea of executive style rehab. For professionals. Where you’re treated like a grown up. I think there’s something to be said for making the patient more accountable for their life in a realistic way. [Which is maybe why FBT works well for the younger kids?]