PHP Day 1: “I Won’t Put It On.”

Today was my first day of Partial Hospitalization, and it went both better and worse than I expected.

I don’t normally post two days in a row, but I’m in a writing mood and thought a few people might be interested in reading about my time in a partial hospitalization program for eating disorders over the next few days. I’m not sure if I’ll post every day or not, but today I need to talk about what happened.

Going in, I knew some of the program would not be relevant since I don’t have anorexia or bulimia or EDNOS—it’s something closer to Avoidant-Restrictive Food Intake Disorder (ARFID). I don’t worry about being fat, and I’m not afraid of weight gain. I can’t relate to the groups about body image and the discussions of “what are you afraid will happen if you let go of your eating disorder.” No, I’m trying hard to gain weight and want it to happen, and it hasn’t been working on my own.

Even so, I wasn’t prepared for what happened when I arrived this morning.

In case you have not read my recent post about anxiety and my health conditions, I’ll just say I often get panic attacks with medical procedures due to years of difficult experiences in hospitals and doctors’ offices. It doesn’t take much to send me back into the painful memories and constant fear I had when PANS was at its worst. I didn’t think my tendency to panic in medical situations would be relevant in a mental health setting, but I was in for a surprise.

This morning, I expected the program to begin with a hot breakfast and interesting conversation with fellow patients. Instead, one of the therapists ushered me into the group room and handed me a fat binder of therapy assignments. Okay, fine, I thought to myself at first. I guess I knew we’d have homework. And then my eyes grew wide as I opened it and saw the schedule and all the rules that I don’t need but have to follow to participate.

“Let’s go over a few things and what’s going to happen this morning,” she said.

PHP Rules

  1. No bathroom right after meals. Therapists always follow you to the bathroom, stand outside the stall, and then you talk to them while you’re going—and then show them your handiwork before you flush. This is to help people with bulimia not purge. For me, it feels embarrassing and unnecessary.
  2. You have thirty minutes to finish a meal and fifteen for a snack. If you can’t finish by the end of the hour, you have to drink an Ensure or a Boost.
  3. No cell phone use.

“Now, we’re going to give you a gown, and you’re going to put it on so we can weigh you,” the therapist continued. “And then we need to get your blood pressure.”

Suddenly, the clinic wasn’t safe anymore.

I felt exposed, vulnerable, like I was back in a hospital where so many bad things have happened to me. The tears began to well up, and I tried to pull myself back into the room while the therapist clarified that no one is changing in front of anyone else, but it was too late.

“I can’t do it,” I cried, shaking in fear, now in a full-blown panic in front of these strangers. “I will not put the gown on. I’m not going to do it, and you’re going to have to deal with that.”

“It’s okay,” the therapist said, alarmed at my defiance, but trying to calm me. “Everyone’s nervous about this.”

“No, I’ve been through things you can’t understand. I can’t put it on.” I tried to collect myself, wondering why I was so triggered, but then I realized I was too far gone to explain anything. “I can’t be here anymore.”

I dashed outside and called my mom, breaking rule #3 in the process.

I came close to having her pick me up and take me home, and abandoning the whole program before it had hardly begun. I was five minutes in and couldn’t handle it. How was I supposed to get through a whole day, let alone a whole week? And then there was the problem that having ME/CFS means I can’t participate in the grocery shopping outings because that’s too much walking, nor can I participate in most types of yoga because it gets my heart rate too high. I wasn’t sure I’d be up for the cooking groups, either, since I rarely cook at home—and when I do, it’s sitting down, and nothing that involves too much chopping or mixing.

It felt like the schedule and the rules were saying to me, “Your kind isn’t welcome here.”

But how am I going to turn around the weight loss if I leave? I thought to myself, standing outside on the sidewalk. I realized I had to go back in and try.

I trudged into the dietician’s office, still crying and shaking, and tried to explain myself. Fortunately, she listened, and she even let me have breakfast in there this time instead of having to face the group while I was still wound up. Because I don’t have some of the common issues in eating disorder clinics, but have others, she is going to weigh me in her office in my clothes twice per week—but I’m not allowed to tell the other patients that they’re making this exception for me. Shh!

So how does PHP work?

With PHP, you get a lot of the accountability and structure you’d have in a residential or inpatient program, but you get to go home/to your hotel in the evenings. They give us meals and snacks with an hour or so of therapy in between. You meet with their psychiatrist once a week, a therapist twice a week, and a dietician twice a week. It seems like there’s going to be a lot of one-on-one attention, which is good when you’re an atypical case like I am.

I only made it to one therapy group today because I had to do intakes with the dietician, my therapist, and the psychiatrist. To my surprise, the psychiatrist knew about PANDAS and seemed fascinated by and empathetic about my experiences with it. I like the people on my team—I really feel like they’re on my team and not out to get me or there to enforce arbitrary expectations. They listened and made me less anxious about the whole thing.

All in all, it was a challenging day in some ways because I was reminded so much of the medical problems that make me feel “different.” Nevertheless, I think this program might be alright. I’ve decided to give it a try for a week. I didn’t like having to finish all the meals because it’s physically uncomfortable, but I ate all of them without needing an Ensure today.

If I can get through today despite the panic attack, then surely I can get through the rest of it.


Image from: Dezeen

5 thoughts on “PHP Day 1: “I Won’t Put It On.”

  1. You have learned so much about yourself over the years so use what you know and be open to learning new skills and you will be triumphant! I am in your court! I am a grandma of two PANDAS grandkiddos who are doing well right now! PTL!❤️😁🎉

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  2. It’ I totally understand about the medical issues related to the eating disorder and how they can enter twine with each other. For me, it’s not only because of my eating disorder but I have possible underlying gastroparesis because of Ehlers-Danlos syndrome. You’re not alone.

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