Eating disorder treatment is going to look different for everyone. There are different levels of care depending on how much support someone needs in order to make progress and keep themselves safe. Residential treatment is one option. This post will cover the ins and outs of residential eating disorder treatment.
Is Eating Disorder Residential Treatment a Good Fit?
Residential treatment is 24/7 care. This is very intensive care and because of this, there are certain requirements that someone must meet in order to qualify for residential care.
According to the National Eating Disorders Association (NEDA), someone with the following symptoms is a good match for a residential treatment center (RTC):
- Medically stable enough to where they do not need an IV, tube feedings, or multiple labs have done daily
- Under 85% of healthy body weight. This percentage will vary for each person depending on their age, height, and gender
- Is poorly or only fairly motivated to make changes
- Pre-occupied with obsessive or intrusive thoughts about food, body image, or exercise for at least 4-6 hours a day
- May have a co-occurring disorder, such as substance use, depression, or anxiety), but this condition doesn’t require them to be hospitalized
- Needs supervision at all meals in order to avoid restricting
- Needs external structure and accountability in order to control compulsive exercise
- Able to use support system or coping skills to avoid purging
- Lack of family support at home 
It’s important to note that residential treatment is not appropriate for people who are at immediate risk of self-harm or suicide. RTC is also not appropriate for people who can’t control their purging or restrictive behaviors and require 24/7 support in order to prevent or limit these behaviors.
What is Residential Treatment for Eating Disorders?
Residential treatment is 24/7 care. Someone in RTC lives at the facility and receives care at all times. RTC is highly structured. People are usually in RTC on average for 30-45 days. However, it may be longer depending on individual progress.
What is Eating Disorder Residential Treatment Like?
A typical day is very structured and may look something like this: therapeutic meals and snacks with supervision and emotional support from staff, group therapy, recreational groups, nutritional counseling, and individual or family therapy.
This tends to be the core of all eating disorder programs. Each treatment center may be different in how many therapy sessions someone has in a week or what types of groups they offer. This is why it’s important to talk with a treatment center before you attend.
Rules and Requirements for Eating Disorder Residential
Even though someone is in residential treatment, there are still certain standards that someone must abide by in order to receive care. For example, someone may not be able to stay in treatment if they are violent with others or if they bring substances into the facility. These standards will be communicated to you before admitting.
Also, after a certain amount of time in residential, if someone isn’t making progress they may have to be referred to a higher level of care or a different program. This is because it’s actually unethical to keep someone in treatment that they aren’t benefitting from.
Meal plans are not the same as a diet. They aren’t designed to change someone’s body shape or size. They are meant to help someone get enough nutrition.
These plans provide structure and guidance in relearning how to eat. This is especially important because many times, people with disordered eating have lost touch with their hunger and fullness cues.
For example, someone who has been restricting may feel full after a few bites. However, their body needs more fuel than this. Having a meal plan that outlines appropriate portion sizes and balances the different food groups can help someone retrain their body and mind.
People in residential need structure. For this reason, these meal plans may be more structured at first. As someone recovers and is more in touch with their own body signals and can eat intuitively, the meal plan can become more flexible. However, this doesn’t tend to happen in RTC. RTC is about stabilizing and making sure someone has enough motivation and structure to eat appropriately before they discharge to a lower level of care.
There is a lot of staff that works in residential treatment! There is support staff who are with clients throughout the day and night. This support staff provides supervision and accountability to each client to make sure they are safe and feel supported.
Within an RTC, there is a treatment team that is responsible for providing direct treatment for clients. These teams tend to have the following team members:
- Medical team: One of the main differences between hospitalization and RTC is that there isn’t a doctor on-site 24/7 in an RTC. A doctor will come by periodically during the week for check-ups and run lab work. An RTC will also have nurses on site.
- Psychiatrist: Psychiatrists are part of eating disorder treatment because they can prescribe medications that can reduce some of the mental health symptoms that feed into someone’s eating disorder. For example, some people with eating disorders struggle with mood swings or impulsive behavior. There are medications that can help with these symptoms. Also, the majority of people with disordered eating have other mental health conditions like depression or anxiety. Medication for untreated mental health diagnoses can help the recovery process.
- Mental health therapist: A mental health therapist will provide individual and group therapy. Some treatment programs may also include family or couple’s counseling in the treatment process. A therapist can help some develop coping skills so they are able to withstand the urge to act on their disordered eating. They may also help someone work through any unresolved emotional issues that contributed to the development of their eating disorder.
- Registered dietitian: A registered dietitian (RD) provides nutritional counseling. Nutritional counseling provides residential clients with the opportunity to work through any disordered beliefs about food. As mentioned earlier, RDs also create meal plans to help someone get back on track with healthy eating patterns.
How to Choose the Best Residential Eating Disorder Treatment
There are a lot of treatment centers to choose from! It can be overwhelming to choose or to know how to pick one. A good first step is to contact the admissions department for a treatment center. They will be able to provide an assessment to see if you’re a good fit, can answer any questions you may have about their program, and run your insurance benefits.
Eating Disorder Residential Treatment Cost
Treatment can be very expensive. Most people are not able to afford the cost of treatment without using their insurance. You can call your insurance to see what your benefits are and to see if which treatment programs are covered under your insurance plan.
If you do not have private insurance, it may be easier to contact a treatment center and see if they take the insurance you have.
Some treatment centers may also offer scholarships depending on financial need. You can inquire about this and see if it’s an option. For people who do have to pay out of pocket, there may be payment plans available.
Resources National Eating Disorders Association. (n.d). Level of care guidelines for patients. Retrieved November 14th, 2021 from https://www.nationaleatingdisorders.org/toolkit/parent-toolkit/level-care-guidelines-patients
Author: Samantha Bothwell, LMFT
Page Last Reviewed and Approved By: Jacquelyn Ekern, MS, LPC 12.21.21