Eating Disorder Treatment Options
Have you been told that you or your loved one need to seek eating disorder treatment? Unsure what that even means or where to start? Here’s a breakdown of the different levels of care and what kinds of clients can benefit from each one.
Inpatient
This is the most acute level of care for the most severe cases. Inpatient stays take place in a hospital, typically on an eating disorder unit, and last for no longer than a week or two. The purpose of an inpatient stay is to medically stabilize and benefit clients who are experiencing severe medical complications from their eating disorder, including significantly abnormal labs or low heart rate. Many people discharge from an inpatient unit to a residential treatment center, where they will receive more therapy (both emotional and nutritional) than medical treatment. While inpatient units often have social workers, their main purpose is medical stabilization and increasing caloric intake, so therapeutic work is minimal.
Residential
Residential treatment centers are not usually in hospitals. In fact, they’re often in lovely houses that have been converted into treatment centers, where each client has their own bed (sometimes with a roommate, sometimes without), and access to a kitchen and full medical and psychiatric staff. Residential treatment centers are usually small, limited to the number of beds they have available, and provide around-the-clock care. The benefits to residential treatment is its intensity. Clients are largely (though not entirely) cut off from the outside world with limited access to their phones and social media and designated days for visitation. Each day has a schedule, complete with meal support and nutrition support, group therapy, individual therapy, family therapy, psychiatry appointments, and medical check-ups. Clients often report developing close bonds with their peers and the staff because they’re around them 24/7. This is best for clients who need to be removed from their environment to kick-start recovery or who are not highly motivated to recover due to malnutrition or co-morbid issues (meaning - their anxiety, depression, or trauma makes recovery difficult to start working toward). Residential usually lasts a month or two and then clients step down to PHP, or day treatment.
PHP (Partial hospitalization program, or day treatment program)
Despite the “hospitalization” in the name, PHP programs are not usually in hospitals either, but in treatment centers that provide both PHP and IOP levels of care. PHP means that clients sleep at home but go to treatment for the day (hence the “day treatment” designation). Some programs are 6-7 hours per day, others are closer to 10-12 hours with weekends. If you’re considering a treatment center near you, definitely ask about that schedule! Like residential, clients receive meal support, individual therapy, nutrition therapy, group therapy, sometimes family therapy, and medication management. Each day has a schedule mixed with groups and meals and clients attend weekly individual and family therapy (the latter as needed). PHP is great for someone who is motivated but needs a significant level of support in order to maintain changes. Depending on the program, this means 2-3 meals per day with a dietitian or therapist, plus the group support. Groups really are critical to eating disorder recovery, so the more groups, the better! PHP often lasts 4-6 weeks before clients step down to IOP.
IOP (Intensive outpatient program)
IOP usually happens for a few hours a day, a few days a week. Some programs are during the work/school day while others offer evening options (something like 5-8pm three nights per week). Clients in IOP can usually complete most meals but need more accountability than outpatient therapy can provide and often report benefitting greatly from the group therapy component. It’s a great way for someone to maintain their daily lives while receiving additional recovery support. Each session day includes one meal and one or two groups, which provides the additional emotional support that many IOP clients are looking for. IOP usually lasts 8-12 weeks due to how infrequent it is (compared to the higher levels of care) and some programs allow clients to see their regular outpatient therapists while in treatment. Once clients are ready, they step down to their outpatient team.
Outpatient therapy
Outpatient therapy is what I call “regular therapy” - that once-a-week meeting with a therapist to do the long-term healing required for full recovery. I am an outpatient therapist and help clients develop long-term treatment goals around food, body image, emotions and mood, relationships, and trauma (if necessary). Clients are appropriate for outpatient therapy if they are motivated and trying to change. I personally will see clients who are actively in their eating disorder if they have insight into how it is negatively impacting them, are motivated to change, and are seeing a dietitian in addition to therapy. Don’t overlook nutrition! Dietitians are critical to eating disorder recovery, as they can focus more on food, exercise, and body image while clients do deeper emotional work in therapy. I’ve had clients who absolutely meet criteria for higher levels of care, but their willingness to change and obvious dedication to therapy and nutrition kept them out of treatment.
This is a lot of information right? If you’re still wondering what option is right for you, reach out for a treatment consultation. I can hear more about your specific circumstances and walk you through what options might be best. Sometimes outpatient really is enough, and sometimes more is required. I have experience with different treatment centers in the area and am familiar with what they offer, and sometimes end up seeing parents for therapy while their child is in treatment. I’m happy to be a resource during such a stressful time!
