Eating Disorder Treatment Explained: A Guide to Levels of Care and Recovery
Eating disorders are serious, complex mental health challenges that require specialized care for effective, lasting recovery.
In addition, because eating disorders can result in medical complications, it’s important to choose the right level of care and type of treatment to ensure both safety and healing.
What Are The Levels of Care In Eating Disorder Treatment?
The term “levels of care” in mental health treatment refers to the various intensities of support available. For eating disorder recovery, the levels of care include inpatient, residential, partial hospitalization/day treatment (PHP), intensive outpatient (IOP), and outpatient.
At each level of care, there are different goals and treatment plans based on severity of behaviors, as well as any co-occurring mental health conditions a client is experiencing.
Levels of Care Explained
Inpatient
Inpatient treatment is the highest level of care and involves 24/7 medical and psychiatric monitoring. Individuals in inpatient treatment typically have critical medical needs or severe psychological distress, such as active suicidal ideation. In inpatient treatment, clients can expect hospital-based care, primarily focused around medical stabilization. While there is therapeutic support at this level of care, it is not as comprehensive as other levels of care.
The length of stay for inpatient care can range from a few days to several weeks depending on the severity of symptoms.
Residential
Residential treatment is a step below inpatient care. Clients live at the treatment center 24/7, and residential treatment centers are often in a home-like setting vs. a hospital setting. There is round-the-clock mental health monitoring and nursing support, however, the level of medical oversight isn’t as intense as it is in inpatient care.
Clients in residential care are medically stable, however, they need round-the-clock support in order to not engage in eating disorder behaviors or self-harm behaviors.
In residential treatment, clients can expect to have several therapy groups each day, as well as individual therapy, family therapy, individual dietitian sessions, sessions with a psychiatrist, and monitoring by a medical doctor. The frequency of individual sessions differs depending on the particular treatment facility, ranging from once a week to daily. Family therapy, nutrition therapy, psychiatrist sessions, and check ins with a medical doctor are typically once a week, but this can also vary. Some additional offerings can include art therapy, music therapy, and yoga therapy.
In residential programs, clients often go on outings with staff to engage in activities like meals at restaurants, grocery shopping, and clothing shopping. These kinds of activities can often be triggering for people struggling with eating disorders, so outings provide an opportunity for getting more comfortable with them in a supportive environment.
At the residential level of care, weights and vitals are taken daily to ensure medical safety, as well as monitoring progress for clients who need to weight restore.
The typical length of stay at the residential level of care is between 30 and 90 days, however, sometimes it is longer or shorter depending on severity of symptoms, progress, and insurance benefits.
Partial Hospitalization (PHP)/Day Treatment
At the PHP level of care, clients typically live at home and go to a treatment center during the day. However, some clients live in supportive housing with other clients and a clinical staff member. There are also virtual PHP programs that allow clients to receive a high level of care while in the comfort of their own home.
At this level of care, clients typically are in programming for approximately 8 hours per day, 5-7 days per week.
PHP may be the first level of treatment someone engages in, or it can be a step down from residential or step up from outpatient care.
At this level of care, clients are often still struggling with engaging in eating disorder behaviors. However, the severity of symptoms is not as intense as clients who require residential or inpatient care. In addition, the symptoms are severe enough to not be successfully managed with outpatient support.
The majority of support in PHP is group therapy, however, clients typically also receive weekly individual therapy, dietitian sessions, and medication management. Family therapy is offered by some treatment programs at this level of care. Vitals and weights are often taken daily, however, this may be less frequent depending on level of progress. In PHP, clients typically have at least one supported meal and snack at the treatment facility.
PHP allows clients to still receive an intense level of support while also having the ability to practice their recovery skills in “the real world.”
Intensive Outpatient (IOP)
At the IOP level of care, most clients are living at home and then go to the treatment facility for programming. However, some clients may live in supported housing. In addition, like PHP, there are virtual IOP programs that clients can attend from home.
At this level of care, clients are typically in about three hours of programming, between 3 and 5 days per week. The majority of programming is groups, however, it’s not uncommon for clients to meet individually with a therapist and dietitian. There is typically one supported meal or snack per day during IOP, with clients being responsible for completing the rest of their meals and snacks at home.
In IOP, clients are likely still struggling with eating disorder behaviors, but not to a level where there are worries about medical stability. In addition, clients are usually able to manage basic self-care and daily responsibilities on their own, but need structured support in order to properly nourish themselves and decrease/maintain abstinence from eating disorder behaviors.
It is fairly common for clients in IOP to be stepping up from the outpatient level care, however, it is also a part of the step down process from PHP to outpatient. While most clients can’t work while in PHP, most clients are able to work while doing IOP.
Outpatient
Outpatient treatment for eating disorders ideally consists of a full treatment team, including a therapist, dietitian, medical doctor, and psychiatric provider. Recovery coaches who offer daily, in-the-moment support can also be a great addition to an eating disorder treatment team. At the outpatient level of care, clients may see all of their providers weekly, multiple times a week, or less frequently depending on severity of symptoms. Outpatient treatment can also include group therapy or support groups. Outpatient care can happen in person or virtually.
How To Choose The Right Level of Care
The assessment process for determining the most appropriate level of care looks a bit different depending on the provider or facility completing the assessment. In general, it consists of exploring a client’s level of medical stability, safety risks, severity and type of behaviors, motivation/willingness for recovery, support system, and barriers to accessing care.
One of the most significant factors is the severity of a client’s symptoms, including medical stability and safety risks. For example, if a client is experiencing acute medical complications, inpatient treatment is likely the most appropriate option.
Another factor is treatment goals. At the inpatient level of care, treatment goals typically involve achieving medical stability and adequate food intake. There typically isn’t a focus on addressing underlying causes of the eating disorder, but this can vary depending on the particular facility. If a client is medically stable and either isn’t engaging in eating disorder behaviors or is only engaging in them sporadically, outpatient care where the primary focus can be the roots of their struggles is likely most appropriate.
Motivation and willingness to engage in treatment and recovery is an additional factor. If a client is in a place where they are unable to or don’t want to interrupt eating disorder behaviors on their own and has been experiencing that level of struggle for an extended amount of time, they likely need a residential level of care. However, if a client is highly motivated and willing to engage in recovery focused behaviors, a lower level of care may be appropriate. This is a nuanced topic as clients in the inpatient or residential level of care may also be highly motivated to engage in recovery, but their level of motivation alone may not be enough to support their goals.
It is also important to assess a client’s support system. If a client has a strong support system at home, they may be able to engage in a lower level of care more successfully than someone who doesn’t have a support system. In addition, if someone is in a chronically invalidating environment, engaging in a higher level of care where they aren’t living at home may be more effective.
Age is another factor in determining the appropriate level of care. For children and adolescents, the gold-standard of care for eating disorders is Family Based Treatment (FBT), also known as the Maudsley Method. This type of treatment is carried out at home on an outpatient basis, which is often more developmentally appropriate and helps families feel equipped to aid their loved one in the recovery process. While there are treatment facilities with higher levels of care that specialize in adolescents, there are times where teens “learn” other eating disorder behaviors from fellow clients or may get competitive.
Barriers to Eating Disorder Treatment
It is also important to consider barriers to care when determining the appropriate level of care. Some of these barriers include finances, insurance, geographic location, gender identity, racial background, family responsibilities, pre-existing health conditions such as food allergies, religious or ethical beliefs, and past treatment trauma.
Project HEAL is a non-profit that helps fight eating disorder treatment barriers, both in terms of helping folks access treatment and educating the public on these barriers.
So, how do I actually know the right level of care for me?
The ideal level of care is the one that is least restrictive while also clinically appropriate. Many factors go into determining the right type of treatment for eating disorders, and even with the same presenting symptoms, the level of care that is right for one person may not be the same for another. We encourage seeking a professional assessment to get insight on what level of support may be most clinically appropriate, but it is also important to consider your own feelings and needs in the process.
Eating Disorder Recovery Support in Nashville, TN
At The Gaia Center for Embodied Healing, we offer outpatient therapy for adolescents and adults. Most of our providers work with clients ages 13 and up, however, some of our providers also work with pre-teens. We provide individual, family, couples, and group therapy.
We work from a systemic, trauma-informed perspective, considering all of the factors that impact eating disorder recovery. We focus on not only helping clients eating disorder behaviors, but also on exploring the underlying roots that have contributed to a client’s struggles so that they can find true, lasting recovery – not just looking at surface level symptoms.
Our clinicians are highly experienced with a variety of eating disorder diagnoses, including anorexia, bulimia, binge eating disorder (BED), avoidant-restrictive food intake disorder (ARFID), and OSFED (other specified feeding or eating disorder). In addition, we practice from a weight-inclusive, Health At Every Size (HAES) lens, where we don’t pathologize weight/size, don’t determine diagnoses based on weight, and don’t encourage intentional weight loss.
We also specialize in other mental health struggles that may co-occur with eating disorders, including trauma, depression, anxiety, addiction/substance use, sexual challenges, bipolar disorder, and grief. Our therapists are all neurodivergent affirming.
Some of the modalities we offer include DBT (Dialectical Behavior Therapy), ACT (Acceptance and Commitment Therapy), EMDR, Brainspotting, IFS/Parts Work, CBT (Cognitive Behavioral Therapy), art therapy, music therapy, somatic therapy, hypnotherapy, and experiential therapy. We also offer meal support and supported outings including grocery shopping and clothing shopping, whether you’re seeing one of our therapists or have a different therapist.
We are happy to collaborate with any existing treatment team, and if you don’t have a treatment team, we are happy to help you build one with some of our trusted referral partners.
We always value client autonomy and view therapy as a collaborative process because you are the expert on yourself! When appropriate, we work from a harm reduction perspective, while also maintaining ethical standards.
While we are not in-network with any insurance providers, all of our clinicians hold several reduced-fee spots for clients with financial need. In addition, we offer a pay-what-you-can program ranging from $0-$70 per session with our graduate interns who are supervised by licensed therapists who specialize in eating disorders.
