How to Know if I Need a Higher Level of Care during the Holidays

Contributor: Leigh Bell, BA, writer for Eating Disorder Hope

Lake in FallThe holidays are probably not the time someone wants to intensify treatment for an eating disorder – but it’s when some people should.

The stretch from Halloween to New Year’s Day is challenging for many with or recovering from an eating disorder.

The season hails hectic shopping, holiday travel, busy social schedules, and family functions colored by family dynamics – and it’s all laced with holiday food and goodies.

For these reasons, eating disorder treatment professionals frequently see during the holidays an increase in eating disordered behaviors and thoughts, as well as slips and relapses, according to an article written for CNN by Kenneth Weiner, a psychiatrist who’s worked with eating disorder from more than 30 years.[1]

Now, it’s not unusual to feel stressed over the holidays. Most of us do, at some point. But people suffering or recovering from an eating disorder are likely more sensitive to it.

“It is important to remember that the people struggling with eating disorders are biologically ‘wired’ to experience higher levels of anxiety than the rest of us,” Weiner writes, “and their go-to tools to manage their anxiety – including starvation, bingeing, purging or over-exercising – can be unhealthy and sometimes even life-threatening.”

A higher level of care is needed if you’re sliding back into eating-disordered behavior and/or thoughts. More intensive care – maybe the emergency room – is certain if you’re experiencing physical side effects of the eating disorder, such as weight loss, dizziness, dehydration, irregular heartbeat, and any other unusual symptoms.

Eating disorder treatment comes in many forms, depending on the intensity of your symptoms.


People on LaneOutpatient treatment is usually for people beginning to struggle with an eating disorder or those transitioning from more intensive treatment, like residential or intensive outpatient treatment (IOP).

It’s not unusual for someone who has transitioned into outpatient treatment to return to higher levels of care. So, if this is the case for you during the holidays (or any time of year), don’t beat yourself up.

Outpatient treatment involves as the treatment base either the family or a variety of professionals working together toward the client’s recovery.

The family based method puts family members in charge of the client’s food intake, weight, etc., and is normally used for adolescents. The multidisciplinary method creates a treatment team of professionals, such as a psychotherapist, dietician, medical doctor, and psychiatrist.

Obviously, someone seeking recovery with this plan must be dedicated to recovery. Many or most meals are solo and binge-purge temptations must be self-regulated.


Girl sitting in grassThe next step is the IOP track. Intensive outpatient occurs at a treatment center but clients spend nights at home. There are two types of IOP: partial outpatient and partial hospitalization.

Partial outpatient clients are transitioning from higher levels of care or people who need treatment but aren’t prepared for or don’t require something more intensive.

These programs vary and are usually based on the client’s schedule, of which weekly may include some full days or just a few hours.[2] One meal is normally supervised.

If you’re medically and emotionally stable, partial outpatient would allow you to spend most of the holidays at home while receiving additional support.


Partial hospitalization, or day treatment, provides a high level of structure with daily supervised meals up to several times a day and therapy in a group setting up to seven days a week.[3]

Partial hospitalization is intensive, but allows the client to spend evenings and sometimes weekends at home during the holidays. For this same reason, the client must have some stability.

Residential Treatment

Residential treatment is a very high level of care in which the client, who must be medically stable, spends 24 hours a day in treatment. The days are filled with group therapy and individual sessions with various professionals.

Entering residential treatment during the holidays may be difficult because you want to be with family, but if you’re seriously struggling, it may be necessary.

Inpatient Treatment

Group TherapyInpatient treatment is the most intensive and usually occurs at a hospital for people who are at risk for harming themselves or are medically unstable due to their eating disorder.

The decision to enter inpatient treatment is based on need, not desire.

Eating disorders manifest differently in each and every individual, so treatment options must be considered on this basis.

However, it is common for eating disordered thoughts and actions to increase during the stress of holiday season. If you are struggling, don’t be afraid to ask for help.

Chances are things won’t improve after you ring in the New Year.

Community Discussion – Share your thoughts here!

What steps have you taken towards recovery from disordered eating during the holidays?

[1]: Weiner, K. (2012, December 20). Eating disorder recovery during holidays – Retrieved October 19, 2015.
[2]: Center for Young Women’s Health. (2014, May 7). Retrieved October 20, 2015, from

Leigh BellAbout the Author:  Leigh Bell holds a Bachelor of Arts in English with minors in Creative Writing and French from Loyola Marymount University in Los Angeles. She is a published author, journalist with 15 years of experience, and a recipient of the Rosalynn Carter Fellowship for Mental Health Journalism. Leigh is recovered from a near-fatal, decade-long battle with anorexia and the mother of three young, rambunctious children.

The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer 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.

Last Updated & Reviewed By: Jacquelyn Ekern, MS, LPC on November 17, 2015
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