Eating Disorder Treatment Levels
Recognizing and accepting that one is in need of treatment for their eating disorder is the most important step toward recovery. Despite its importance, coming to terms with the decision to seek treatment can, unfortunately, lead to a great deal of stress when looking into different programs, treatment professionals, and levels of care. When exploring treatment options for an eating disorder, it can be helpful to have a clear picture of what types of programs are available and the predominant factors for each level of treatment.
by: Sadie Grant
If you or a loved one have ever experienced living with an eating disorder, you likely understand that committing to recovery can be incredibly difficult. Choosing to treat an eating disorder often means choosing to confront deep fears. To top it off, selecting a treatment program can also be quite confusing. With so many acronyms - IOP, RTC, PHP - and so many variables to consider, how do you choose the appropriate level of care?
Today we are going to break down the different levels of eating disorder treatment. We will delve into the different structures, benefits, and general criteria for each level. If you still feel confused after reading this post, that’s okay. There are so many factors to consider when choosing the right level of care, and we are here to help.
What are the different levels of treatment for eating disorders?
Treatment for eating disorders can range from a weekly commitment to talk with a therapist and/or a dietitian, to 24-hour care in a medical setting. The United States system has broken the levels of care for the treatment of eating disorders into five distinct categories. Ranked from least to most intensive, the levels of care are the following:
Outpatient Treatment usually involves meeting with a therapist and/or a dietitian a few times during the week. The frequency of therapy and nutrition counseling usually depends on the nature and severity of the eating disorder. Therapy for outpatient treatment may include a combination of individual counseling, family therapy, and/or group therapy sessions. Nutrition counseling often involves education, meal planning, and meal accountability. Many clients also see a physician to ensure that they are receiving the proper level of care.
Intensive Outpatient Treatment (IOP) is similar in nature to outpatient treatment (see above), but includes more hours of treatment and typically involves direct meal support. IOP allows the client to live at home and can usually continue attending work or school. Typically, IOP involves a few hours (i.e., 3-4) of programming during a few days out of the week. Meals or snacks are usually incorporated into each treatment visit.
Partial Hospitalization (PHP) allows the individual to spend nights at home and attend treatment during the day. Those in PHP usually spend 6 to 11 hours at a treatment center for at least 5 days out of the week. While the majority of meals are eaten at the treatment center, some of the meals are eaten at home.
Residential Treatment (RTC) involves continuous supervision and support around meals and behavior in a 24-hour care center.
Medical Hospitalization provides 24-hour care in a hospital setting for individuals who may need continuous medical support, which can involve monitoring vital signs and intravenous feeding.
How does one determine which level of care is appropriate?
The American Psychiatric Association has developed general guidelines for deciding which level of care would be most appropriate for individuals struggling with eating disorders. Although these guidelines are informative, the appropriate level of care should be determined by treatment professionals who can evaluate various factors such as motivation for recovery, comorbid conditions, and behaviors. Based on the guidelines established by the American Psychiatric Association, we have broken down some of the general criteria for each level of care:
Outpatient Treatment:
The individual is medically stable enough that more extensive medical assistance (as specified in levels 4 and 5) is not required
The individual has fair to good motivation to recover and is able to cooperate with the recovery process
The individual can follow structure for eating/weight recovery self-sufficiently
The individual can generally manage compulsive exercising using self-control measures
The individual can reduce purging behavior (i.e., self-induced vomiting, laxatives) and is not experiencing significant medical side effects from purging (i.e., cardiac abnormalities)
The individual has sufficient support from others in their day to day environment
The individual lives near treatment center
Intensive Outpatient Treatment:
The individual is medically stable enough that more extensive medical assistance (as specified in levels 4 and 5) is not required
The individual has fair motivation to recover and is able to cooperate with recovery process
The individual can follow structure for eating/weight recovery self-sufficiently
The individual may need some additional support to manage compulsive exercising beyond self-control
The individual can reduce purging behavior and is not experiencing significant medical side effects from purging
The individual has sufficient support from others in their day to day environment
The individual lives near treatment center
Partial Hospitalization
The individual is medically stable enough that more extensive medical assistance (as specified in levels 4 and 5) is not required
The individual has partial motivation to recover and is able to cooperate with recovery process; the individual experiences persistent, intrusive thoughts for at least 3 hours out of the day
The individual needs some external structure for eating/weight recovery
The individual may need some additional support to manage compulsive exercising beyond self-control
The individual can reduce purging behavior and is not experiencing significant medical side effects from purging
The individual has at least some support from others in their day to day environment
The individual lives near treatment center
Residential Treatment
The individual is medically stable enough that medical interventions such as tube feedings and frequent lab tests are not required
The individual has poor to fair motivation to recover and is able to cooperate in a highly structured environment; individual experiences persistent, intrusive thoughts for 4 to 6 hours out of the day
The individual needs supervision during all meals
The individual may need some additional support to manage compulsive exercising beyond self-control
The individual can use help from others or develop skills to prevent purging
The individual may not be able to do treatment in home due to absence of support system or family conflict
The individual may live too far away from treatment center to participate from home
Inpatient Treatment
The individual is experiencing significant medical complications, such as reduced heart rate, changes in blood pressure, low glucose, low potassium, electrolyte imbalance, low body temperature, dehydration, diabetes-related complications, or problems with the liver, kidney, or heart
The individual may be suicidal with a specific plan or may have been admitted after an aborted or survived suicide attempt
The individual has experienced significant weight loss with refusal to eat
The individual has very poor to poor motivation to recover and is uncooperative or only cooperative in a highly structured environment; individual experiences persistent, intrusive thoughts
The individual may have a psychiatric disorder that requires hospitalization such as addiction or severe depression
The individual needs supervision during and after all meals or a medical feeding modality
The individual needs supervision throughout the course of eating and in bathrooms to prevent purging; the individual cannot control persistent, severe episodes of purging multiple times daily
The individual may not be able to do treatment in home due to absence of support system or family conflict
The individual may live too far away from treatment center to participate from home
What types of treatment programs are offered at BALANCE?
At BALANCE, we offer four levels of treatment programming, including a day program, weeknight program, outpatient groups, and individual nutrition sessions.
Our most intensive program, the Day Program, is a full-time program (Monday through Friday) for adults 18 years and older suffering from anorexia, bulimia, binge eating disorder, and disordered eating. We also have a highly customized, structured weeknight program that meets three times a week with a Saturday option and allows clients to continue to meet work or school commitments while getting support. We also offer Saturday sessions that can be added onto weekly programs for additional support or can function as stand-alone programs. We also offer an adolescent program that is designed for individuals ages 12 to 17.
We also offer a variety of outpatient groups that can provide recovery support or serve as a step-down from higher levels of care. We offer an Intuitive Eating Group, a Women’s (ages 35+) Group, a Men’s Group, a Body Image Group, a Food & Mood Group, a Coping for College Group, a Contemplating Recovery Free Support group, a Multi-Family Therapy Group, an RO DBT Skills Class, an Eating Disorder Relapse Prevention Group, and a Supporting a Loved One Group.
Finally, we offer Individual Nutrition Counseling with highly trained dietitians to help clients develop a better relationship with food, eating, and body image, as well as a Meal Support Group that provides exposure to various cuisines and helps clients foster a more neutral relationship with food.
Are you interested in learning more about eating disorder treatment for yourself or a loved one?
Seeking help for an eating disorder can feel frightening and confusing, especially when there are so many treatment options to consider. Here at BALANCE, we have a compassionate admissions team that specializes in helping individuals choose a treatment program that will meet their needs and be the most effective for recovery. We recognize that choosing to seek help takes a lot of courage, and we want to support you in the process of exploring treatment options.
First, you can reach out to our admissions team by booking an initial phone consultation (fill out the form below). Our admissions team will work with you to get a better understanding of your current situation and help you book an intake assessment. During the intake assessment, you will discuss current and past symptoms and treatment goals with one of our highly trained clinicians. We will then coordinate a treatment recommendation that we feel will best support you and your unique needs and goals.
If you would like to reach out to our admissions team, book a free consultation call below or send an email inquiry to our team here.
This post was written by BALANCE Blog Intern, Sadie Grant.
Sadie is a recent graduate of Oberlin College with a B.A. in psychology. After recovering from disordered eating, Sadie became passionate about eating disorder awareness, body neutrality, and destabilizing beauty standards that are established by social and cultural norms. While earning her Bachelor’s degree, Sadie conducted quantitative research, worked with populations experiencing barriers to essential services, and studied Spanish. Sadie hopes to use her developing research and interpersonal skills to work in the field of eating disorders and address the way in which expectations around eating and beauty vary across different populations.
References
Cowden, S. (2020, March 20). Outpatient Treatment for Eating Disorders. Retrieved July 01, 2020, from https://www.verywellmind.com/outpatient-treatment-for-eating-disorders-1138356
Level of Care Guidelines for Patients. (2019, August 22). Retrieved July 01, 2020, from https://www.nationaleatingdisorders.org/toolkit/parent-toolkit/level-care-guidelines-patients
Muhlheim, L. (2020, April 28). Which Level of Eating Disorder Treatment is Right for Me? Retrieved July 01, 2020, from https://www.verywellmind.com/levels-of-eating-disorder-treatment-4134267