Face-to-Face with the Next Step: Levels of Care

Eating disorders, including anorexia nervosa, bulimia nervosa, and binge eating disorder, are conditions with far-ranging impact – psychologically, biologically, and socially – on the afflicted individual (and of course, his or her loved ones). In response to the complex needs of those struggling with eating disorders, and as a result of particularities of the current health care and health insurance system in the US, an array of treatment options exist.

Understanding what the treatment options are and how distinct they are from one another can be tricky for patients and families, who are newly navigating the terrain of eating disorders treatment. It can be difficult when a person is suffering from an eating disorder and wants to get better in the moment of crisis leading up to treatment. It is additionally difficult because of the very real complexities of finding your way through the health care system – knowing the rules, and how to bend them, has perhaps never been so challenging.

To help make the world of eating disorder treatment at least a little more intelligible and a little less overwhelming, here is a brief synopsis of the different types of treatment settings — commonly referred to as levels of care — and their most common offerings. Treatment settings vary based on length of stay or number of visits, supervised meals or groups, and more. The various treatment options include: outpatient treatment, intensive outpatient programs, partial hospital programs, residential treatment centers, and inpatient programs.

Outpatient Treatment

Outpatient treatment for an eating disorder varies from person to person, often depending on diagnosis and individual circumstances. Treatment might involve individual psychotherapy (once or twice weekly) with a therapist (a social worker, psychologist, or psychiatrist) or family therapy. During phases of acute illness, eating disorder psychotherapy is commonly fairly structured, goal-oriented, and focused on issues related to normalizing eating (and weight, if applicable), improving body image, and enhancing self-esteem. As the recovery process unfolds, other topics are likely to be addressed including: building or repairing meaningful relationships with others, communicating effectively, clarifying and working towards life goals. Outpatient treatment for an eating disorder might also include nutritional counseling with a dietitian or medication management with a physician (typically, a psychiatrist); appointments may occur weekly, monthly, or less frequently, again depending on an individual’s particular needs and stage of recovery. If multiple clinicians are providing treatment to one individual, all are likely to benefit from a team approach.

Intensive Outpatient Programs

Intensive outpatient programs are commonly referred to as IOPs. Generally, an IOP that specializes in eating disorders is a group-based treatment that includes multiple visits to a non-residential facility during the day, usually at least three times a week. IOPs also offer supervised meals for individuals that are accompanied by counseling and education. An IOP is best suited for individuals who are able to function in their school, work, or home environment but may benefit from the structure that IOPs provide. IOPs are commonly used to help individuals transition from higher levels of care or to reduce the likelihood that individuals require a higher level of care, if standard outpatient treatment has not been successful in helping to restore an individual to health.

Partial Hospital Programs (or Day Treatment Programs)

The terms ‘partial hospital program’ and ‘day treatment program’ can be used interchangeably. Currently, this type of program is more common than an IOP. Partial hospital programs are more intensive than IOPs; they provide structure for individuals four to seven days a week, with two or three supervised meals on each of those treatment days. Partial hospital programs are appropriate for individuals transitioning from inpatient to outpatient care, or to help individuals avoid 24/7 hospitalization.

Residential Treatment Centers

Residential treatment centers provide 24/7 treatment, including support during all meals and snacks and parts of the program. They are meant for individuals who need treatment in a full time setting, but are medically and psychiatrically stable to the extent that hospital-based care is not required. Most residential treatment centers occur in unlocked settings, meaning that individuals can leave at any time, although they are expected to stay for the entire program.

Inpatient Programs

Inpatient programs, or psychiatric hospitalizations, are the most intense level of care available for individuals with eating disorders. This level of care is indicated if an individual is medically or psychiatrically at risk. Individuals who have been unresponsive to lower levels of care may also be appropriate for inpatient programs. In this 24/7 hospital setting, medical, psychiatric, and behavioral issues are monitored continuously during one’s stay.

Despite the differences among the treatment options, they all have the same goal: to improve and normalize eating behaviors, and to help underweight individuals with weight restoration. The time it will take to accomplish this goal depends on the individual, and for many people with eating disorders treatment occurs over a course of different chapters.

As you pursue treatment for yourself, or on behalf of a loved one, make sure that you understand all of the options before you. If the options are unclear, ask questions or ask for help from those who know the system well, including organizations like the National Eating Disorder Association.

For more information on eating disorder treatment at the Columbia Center for Eating Disorders, call our main line at 646-774-8066.

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