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What Type of Eating Disorder Treatment Is Right for You
By Meghan Vivo
Every individual’s experience of an eating disorder is different, and not every form of eating disorder treatment will be effective for everyone. Once you’ve made the brave choice to get help, one of the first decisions you will need to make is what level of care is appropriate for you.
The level of care you will need depends on a number of variables, including medical status, weight, suicidality, motivation to recover, level of control over eating disordered behaviors, environmental stressors, and geographic location. In general, the more manageable your symptoms, the lower the level of care you will require. Of course, these decisions should be made with the guidance of health care professionals, as many patients underestimate their need for care.
In order from least to most intensive, the following are the standard levels of care in the treatment of eating disorders:
Outpatient Eating Disorder Treatment
Outpatient care, which is the least structured form of treatment available, is not sufficiently intensive for many individuals with eating disorders. In an outpatient setting, the patient lives at home while receiving short periods of treatment from dietitians, doctors, psychiatrists, and therapists. According to the American Psychiatric Association (APA), this level of care is appropriate when:
• The person is medically stable (without the need for medical monitoring or treatment for medical complications).
• The patient does not have a significant desire to commit suicide.
• The patient’s weight is above 85% of their clinically determined “healthy body weight.”
• The person is reasonably motivated to recover, rather than resistant to treatment.
• The effects of any co-occurring disorders, such as depression, PTSD, substance abuse, or other psychological issues, are minimal.
• The patient is self-sufficient in monitoring and gaining weight, as appropriate, without additional structure.
• The patient can control any compulsive exercise or purging behaviors.
• Stresses in the home environment are relatively low and the patient has a support system intact.
• An outpatient treatment facility is within commuting distance.
Intensive Outpatient Eating Disorder Treatment
Intensive outpatient (IOP) treatment is a step up from outpatient treatment in terms of structure and support, without resorting to residential treatment or hospitalization. In intensive outpatient care, patients must be sufficiently stable to travel to a site for several hours per day while still living at home. According to the APA, this level of care is appropriate when all of the above criteria are met but with the following difference: the patient’s weight is above 80% of their clinically determined “healthy body weight.”
One example of an intensive outpatient level of care can be found at Montecatini, a well-known eating disorder treatment program for adolescent and adult women near San Diego, California. Established in 1991, Montecatini offers a home-like setting for residential inpatient, partial hospitalization, and intensive outpatient treatment.
Patients in Montecatini’s IOP program receive treatment and participate in therapy three to four hours a day, with a great deal of flexibility to accommodate work and school schedules. Many individuals with eating disorders begin treatment at the IOP level of care, and because Montecatini offers a variety of treatment options, are able to transfer into a higher level of care, if necessary, without losing continuity in their treatment.
Partial Hospitalization Eating Disorder Programs
In a partial hospitalization program (also known as “day” or “full-day” outpatient care), the patient frequently is less motivated to recover, has less social support, and has a greater need for structure. These programs generally require patients to spend three to 12 hours per day in treatment while still living at home.
In addition to being medically stable, the APA guidelines specify that patients at this level of care do not require constant monitoring to prevent suicide; are generally cooperative with treatment; require some structure to gain weight and control eating disorder behaviors but not constant supervision; and have exceeded 80% of their healthy body weight.
Montecatini also offers a partial hospitalization program. Most patients start out receiving treatment 12 hours a day and gradually reduce their involvement to eight or six hours a day. Patients share two meals a day supervised by staff, allowing the staff of eating disorder specialists to closely monitor each patient’s progress.
Residential Eating Disorder Treatment
Residential treatment is more intensive than the previous levels of care in that the patient lives onsite rather than returning home during evenings and weekends. Patients spend the bulk of their days in recovery-related activities and appointments with doctors, dietitians, and therapists, and receive a higher level of structure, monitoring, and personalized care. According to the APA, this level of care is appropriate when any of the following are true:
• The patient is relatively medically stable (medical monitoring is likely available, but treatment for serious medical complications will usually require hospitalization).
• The patient does not require constant monitoring to prevent suicide.
• The patient’s weight is less than 85% of their “healthy body weight.”
• The patient is not highly motivated to recover and requires a highly structured environment to be cooperative.
• The patient requires monitoring to avoid restricting, compulsive exercise, or purging.
• Friends and/or family may be unable to provide social support.
• Less structured treatment options are too far away.
At Montecatini, patients in the residential eating disorder treatment program receive a thorough assessment, an individualized treatment plan, and 24-hour supervision and nursing care. Recovery-related activities include individual, group, and family therapy, educational courses, nutritional therapy, therapeutic recreation, yoga or meditation, restaurant outings, and more.
Patients attend up to 23 group therapy sessions per week, including specialized groups like expressive art therapy, spirituality group, Dialectical Behavior Therapy (DBT), Cognitive-Behavioral Group, body image group, and many others. Patients also participate in two sessions with their primary therapist each week and schedule weekly appointments with the medical doctor and dietician.
The staff at Montecatini believes family involvement is essential, particularly when treating adolescents with eating disorders. In addition to bi-weekly family therapy sessions, the program offers a monthly “family intensive weekend,” which focuses on improving communication within the family system and providing support and education to family members of patients in the program.
After formal treatment ends, patients are gradually reintroduced into daily life through a series of “step-down” levels of care. The program also offers extensive discharge planning and assistance with the transition to less structured care after residential treatment ends through an innovative online continuing care program that features weekly structured support groups to aid in long-term recovery.
Inpatient Hospitalization
Inpatient hospitalization is the most intensive level of care available, as patients have access to lifesaving medical care and 24-hour monitoring of eating disorder behaviors in a hospital setting. According to the APA, this level of care is appropriate when any of the following are true:
• The patient is in severe medical danger (with complications ranging from irregular heart rhythm, low blood pressure, or dehydration to acute problems of the liver, kidneys, heart, or lungs).
• The patient is planning to commit suicide, or has already attempted suicide.
• The patient’s weight is less than 85% of their “healthy body weight.” Often, the individual is refusing food and rapidly losing weight.
• The patient is resistant or uncooperative regardless of the level of structure provided.
• Co-occurring disorders like depression or anxiety are severe enough to require hospitalization, even if the eating disorder itself wouldn’t.
• The patient requires constant monitoring to avoid restricting, compulsive exercise, or purging behaviors.
• Family members and/or friends cannot offer basic emotional support (though some patients require hospitalization even if they have loving and supportive families).
• Less structured treatment options are too far away.
Patients with severe eating disorder symptoms often begin treatment in a residential treatment center or inpatient hospitalization program and gradually move to a less intensive level of care as symptoms subside. At all levels of care, the patient should be considered an important member of a multidisciplinary treatment team who is actively involved in her own care.
The decision to seek help for an eating disorder is difficult enough – you do not have to make decisions about treatment on your own. Specialists at programs like Montecatini can help assess your situation and determine which level of care is right for you. You can also call the National Resource Center at (877) 637-6237 to speak with a skilled advisor who can present you with a range of eating disorder treatment options available to you around the country.