Notes from an eating disorder
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Eating Disorder Treatment: What are the Levels of Care?

Eating Disorder Treatment: What are the Levels of Care?

From the outside eating disorders may appear to some as identical. Take a deeper look, however, and it is clear that not only is every type of eating disorder diverse, but every person struggling with an eating disorder experiences their own unique manifestations of the disease. 

Complexities like these mean that the treatment for an eating disorder must be individualized to the patient’s situation. Thankfully, different levels of care have been established in order to treat people at various stages of an eating disorder and to provide the best possible patient care along the way.

Here you’ll find a general overview of the levels of care and what makes them distinct from one another. If you or someone you know is struggling with an eating disorder, a healthcare professional may recommend an evaluation for an appropriate level of care. Keep in mind that taking any step into treatment is a major accomplishment and something to be celebrated!

Outpatient treatment refers to a patient receiving healthcare treatment without being admitted to a hospital. This level of care offers the most independence to patients. When it comes to eating disorders, outpatient care is best for someone who is stable enough to not need daily monitoring and whose symptoms are under control enough for them to engage in normal activities (job, education, family life, etc.).1 Outpatient eating disorder treatment typically includes working with a registered dietitian, therapist, and primary care physician simultaneously. The timing of outpatient care varies greatly. Some patients could finish outpatient care in one year, while others see their outpatient providers for five or more years.

Individuals in outpatient care have sometimes progressed from a higher level of care and eased into outpatient work or they may only need outpatient monitoring from the beginning of their treatment. No matter how someone gets to outpatient care, it is a wonderful opportunity to engage in daily life while being supported by a treatment team.

Intensive Outpatient, or IOP, is used to provide nutrition and clinical therapy to patients while allowing them to have more autonomy than a higher level of care.1 Oftentimes patients will spend around three to four hours at treatment for three to four days per week and then spend their evenings at home or an off-campus living space. Intensive outpatient is appropriate for those who need more regular therapy and structure than an exclusively outpatient setting. 

In an intensive outpatient treatment, patients will still receive meal planning and support, group and individual therapy, and regularly see their healthcare providers. In IOP, patients may be encouraged to see their own outpatient medical team. This is a great option for someone who needs a flexible way to complete treatment while still being able to attend school or work.

Partial Hospitalization programming, or PHP, means spending most of the day in a structured treatment center, but not receiving around-the-clock monitoring. Treatment may range from six to twelve hours, five to seven days a week. A patient needing PHP may be medically stable but need psychological support due to the effects of the eating disorder. Alternatively, a patient may be psychologically stable but have eating disorder symptoms and behaviors that interfere with daily living.1

A benefit of doing treatment in a PHP setting is that it allows for a patient to go home in the evenings and sleep in their own bed. In many cases, someone may move through partial hospitalization when stepping down from a higher level of care.

Residential treatment offers patients a highly-structured treatment environment 24-hours per day. Patients receive around-the-clock monitoring and support from medical, psychiatric, and nutrition staff.1 Residential programming utilizes communal living with a recovery-promoting schedule including group meetings, individual therapy sessions, and gatherings that focus on recovery skills and relapse prevention. Therapy may also include mindfulness, art, movement, yoga, meal outings, and other activities that provide a sense of family and connection while in treatment.

Patients in a residential setting spend most of their time at the treatment center, but may also have day and weekend passes to promote real-world learning. Hopefully, a patient can progress to a lower level of care after spending time in residential treatment. 

Inpatient treatment is reserved for patients who are medically or psychiatrically unstable with acute symptoms requiring immediate medical attention.1 Ideally, patients move to residential treatment or PHP as soon as they are stable. Patients in an inpatient care facility receive constant medical and nursing support, psychiatric monitoring, and meal and snack support with highly structured meal times and plans. Care includes constant vital sign monitoring, intravenous fluids, and sometimes tube feeding.

Where to Start

In an effort to move past using weight as the main factor in determining the level of care needed, the American Psychiatric Association guidelines state that, 

“In determining a patient’s initial level of care or whether a change to a different level of care is appropriate, it is important to consider that patient’s overall physical condition, psychology, behaviors, and social circumstances rather than simply rely on one or more physical parameters such as weight.”2

Sometimes the level of care is decided by outside factors such as distance from a treatment center, home life and family support systems, and costs. In some cases, and unfortunately, one’s insurance company’s guidelines may dictate the level of treatment a patient has access to. 

No matter where a patient begins in their unique treatment process, what matters is that they get to recover. Recovery is a journey and takes longer for some than others since relapse can be a common part of the process. What counts in the end is getting through recovery and celebrating the little victories along the way!

Liesel Sumpter, RD, LD is a Registered Dietitian specializing in the treatment of eating disorders and disordered eating.

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