Determining the Best Level of Care for Eating Disorder Treatment

Acknowledging that one needs treatment for their eating disorder is the first big step toward recovery. It is an incredible and challenging step that, unfortunately, can also lead to a great deal of stress when looking into different programs, specialists, and levels of care. Below are the various eating disorder levels of care and some predominant factors for individuals at that level of treatment.

Different Eating Disorder Levels of Care

Medical Hospitalization

This is the first step toward attending treatment for those whose disordered eating behaviors have rendered them medically unstable and in danger of severe health consequences if they do not receive round-the-clock medical monitoring. Medical hospitalization often includes being given intravenous fluids, tube feeding, and monitoring of vital signs [1].

Inpatient/Residential Treatment

This is the most serious and strenuous level of eating disorder treatment. It involves temporarily living in a facility day-in-and-day-out and using that time to work with an integrated treatment team, attend group, individual, and possibly family therapy, engage in weight restoration, and possibly meet with a psychiatrist if there are any co-occurring disorders.

Individuals that meet the criteria for inpatient treatment are medically stable but still require round-the-clock monitoring of meals and behaviors. The National Eating Disorders Association provides a helpful chart of each level of care and specifies that individuals in Inpatient Treatment often have [2]:

• Less than 85% acute weight decline with food refusal
• Very poor to poor motivation
• Individual struggles with intrusive, repetitive, disordered thoughts
• Individual is uncooperative with treatment or only cooperative in a highly-structured environment.
• Needs supervision during and after meals
• Has trouble controlling compulsive exercising without structure.
• Unable to control purging episodes.

Inpatient is also helpful for those that live in a chaotic or triggering family situation to begin their recovery process in a more supportive and recovery-focused environment. Additionally, one may choose inpatient if another treatment program is too far away from their geographic location to attend from home.

Partial Hospitalization Program (PHP)

Partial hospitalization is the next level down from inpatient and allows individuals to attend treatment at an inpatient facility for approximately 5 hours a week, 6 to 11 hours each day [1]. Individuals can sleep at home and come to the facility during the day.

Individuals in PHP have made progress in their eating behaviors to the point where they still eat most meals at the facility but have a few at home. PHP can be a step-down from inpatient or an alternative option if an individual does not need 24-hour monitoring and has a supportive environment in place at home.

Individuals in this level of care often have [2]:

• Greater than 80% of weight as a percentage of healthy body weight
• Partial cooperation
• Pre-occupied with intrusive thoughts 3 hours a day or more
• Can greatly reduce instances of purging in an unstructured setting
• Needs some structure to gain weight

Intensive Outpatient Program (IOP)

Individuals in intensive outpatient programs often have a fair motivation to recover and are cooperative with treatment recommendations, even in an unstructured setting.

Those in IOP go to treatment for approximately three hours a day, three days a week, making it possible for them to maintain a job or school should they choose [1]. These individuals often still need some form of structure or treatment to engage in self-control over compulsive exercising and disordered thoughts and behaviors.

Outpatient

This is the least strenuous level of care and involves individual meetings with a therapist or dietitian approximately once or twice a week.

These individuals are self-sufficient at weight gain and controlling compulsive or disordered behaviors, do not eat meals in treatment (although they may have small snacks), have fair to good motivation, and greater than 85% weight as a percentage of healthy body weight [2].

An important thing to consider is that you do, alone, do not need to shoulder the burden of deciding what level of care is appropriate for you. Reaching out to a medical or eating disorder professional can help provide you with the experienced and educated support needed to learn what is the best fit for you.

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Resources:

[1] Muhlheim, L. (2019). Which level of eating disorder treatment is right for me. Very Well Mind. Retrieved from https://www.verywellmind.com/levels-of-eating-disorder-treatment-4134267.

[2] Unknown (2018). Level of care guidelines for patients. National Eating Disorders Association. Retrieved from https://www.nationaleatingdisorders.org/toolkit/parent-toolkit/level-care-guidelines-patients.

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About the Author:

Margot Rittenhouse, MS, PLPC, NCC is a therapist who is passionate about providing mental health support to all in need and has worked with clients with substance abuse issues, eating disorders, domestic violence victims, and offenders, and severely mentally ill youth.

As a freelance writer for Eating Disorder Hope and Addiction Hope and a mentor with MentorConnect, Margot is a passionate eating disorder advocate, committed to de-stigmatizing these illnesses while showing support for those struggling through mentoring, writing, and volunteering. Margot has a Master’s of Science in Clinical Mental Health Counseling from Johns Hopkins University.

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The opinions and views of our guest contributors are shared to provide a broad perspective on eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer a discussion of various issues by different concerned individuals.

We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.

Published March 5, 2020, on EatingDisorderHope.com
Reviewed & Approved on March 5, 2020, by Jacquelyn Ekern MS, LPC