There’s a lucrative cottage industry in the U.S. for the residential treatment of almost anything you can imagine. Everything from “Internet addiction” and drug and alcohol problems, to eating and mood disorders. If you can treat it in an outpatient setting, the thinking goes, why not treat it in a “residential” setting for 30 or more days where you control every aspect of the patient’s life?

The “residential” treatment approach has long been available for eating disorders, since the treatment of these disorders tends to be long and complicated. Andrew Pollack writing for the New York Times notes how these kinds of programs have now become the focus of insurance companies looking to cut back on treatment options.

It’s no surprise, really. With the rollout of mental health parity — requiring that insurance companies can no longer discriminate against people with mental disorders for their treatment options — those companies are looking for other places they can cut costs. Residential treatment for eating disorders appears to be one obvious area.

So is residential treatment a legitimate modality for helping people with eating disorders? Should insurance companies cover the costs of such care?

6:05 am: You lie awake in your tiny bed, underneath the salmon covers, your neck sore from sleeping on one pillow (you asked for another but you’ll need a doctor’s order to have more than one.) Your sleep medicine has worn off and you are now once again a prisoner to your insomnia.

All there is to do now is listen to your roommate snore and mutter to herself in her sleep and the sounds of the nurses talking and phones ringing at the nurses station. You remember a Seroquel-induced nightmare you had previously in the night in which you were trapped in a house that was filling with water, drowning and gasping for air. You make a mental note to mention the dream to your doctor later on.

7:00 am: Morning checks. A tech bangs on your door just as you have started to drift off into a sweet sleep again and informs you that you must be up for breakfast in thirty minutes. You incoherently moan something that resembles an “OK,” roll over and close your eyes again.

Take a minute and answer this question: Is anyone really normal today?

I mean, even those who claim they are normal may, in fact, be the most neurotic among us, swimming with a nice pair of scuba fins down the river of Denial. Having my psychiatric file published online and in print for public viewing, I get to hear my share of dirty secrets—weird obsessions, family dysfunction, or disguised addiction—that are kept concealed from everyone but a self-professed neurotic and maybe a shrink.

“Why are there so many disorders today?” Those seven words, or a variation of them, surface a few times a week. And my take on this query is so complex that, to avoid sounding like my grad school professors making an erudite case that fails to communicate anything to average folks like me, I often shrug my shoulders and move on to a conversation about dessert. Now that I can talk about all day.

Here’s the abridged edition of my guess as to why we mark up more pages of the DSM-IV today than, say, a century ago (even though the DSM-IV had yet to be born).

This week is National Eating Disorders Awareness Week, which is sponsored by the National Eating Disorders Association (NEDA).

Like I said in my post on Weightless, I believe that awareness means spreading accurate information about eating disorders.

One of the biggest misconceptions is that parents cause eating disorders. They don’t!

In fact, many complex factors are involved in predisposing a person to an eating disorder. According to eating disorder specialist Sarah Ravin, Ph.D:

“…the development of an eating disorder is influenced very heavily by genetics, neurobiology, individual personality traits, and co-morbid disorders. Environment clearly plays a role in the development of eating disorders, but environment alone is not sufficient to cause them.”

(Check out her blog post for more.)

But while parents don’t cause eating disorders, they can make a difference in their child’s life by creating a safe, diet-free and nurturing environment.

As Kenneth L. Weiner, M.D., co-founder and CEO of the Eating Recovery Center, said recently:

“Because eating disorders are genetic, an individual who has a family history is much more likely to be sensitive to others’ words and actions surrounding food and body image. It’s important for families to talk about these deadly diseases and avoid behaviors and actions that could act as eating disorder triggers.”

Below Dr. Weiner and other eating disorder specialists from the Eating Recovery Center share some of the ways you can help your child. (I think these tips are relevant for all kids):

Ginger Emas has written an interesting piece about men and eating disorders. It piqued my interest because a friend of mine once asked me if she should be concerned about her son’s eating habits. He counted calories, stayed away from sweets, and was a tad obsessive about a healthy diet. I told her not to sweat it, buying into the cultural myth that boys don’t get eating disorders. Now I know they do. To get to Ginger’s original article on ShareWIK, click here. I have reprinted it with permission below.

Usually when we talk about body image issues, we’re talking about girls. But did you know that more than one million boys and men struggle with eating disorders? More than 80 percent of 10-year-olds are afraid of being fat. More than 10 percent of middle school boys have used steroids. These are boys who don’t understand why they should brush their teeth every night; how can they possibly understand the repercussions of starving or using steroids?

I fear that I’m giving my daughter an eating disorder with intentions of teaching her how to eat right. Which begs the question: which is more harmful — obesity (and diabetes) or an eating disorder?

I’ve implemented a “one-treat rule” in our home, which simply means that if my kids get ice-cream after school, they have already had their treat and don’t get dessert after dinner. I try to explain as delicately as I can that too many sweets and too much junk food makes you sick. Fat too, yes. But, more importantly, sick.

“What happens when you eat more than one treat?” my daughter asked me awhile back. And, well, I’m not proud of this, but I think I said, while my mind was somewhere else: “You blow up.”

So yesterday she had a snow cone at the pool. That was supposed to be her treat for the day. But when we went to a lacrosse party later that day, a fellow mom trained at Le Cordon Bleu made these amazing cupcakes with the team’s logo designed with butter cream icing. Katherine instinctively grabbed one, but then ran to me, asking, “Will I blow up if I eat this?”

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