Eating Disorder Treatment: Levels of Care

By Paula Holmes LCSW

Eating disorders pose a significant health risk for the hundreds of thousands of people who struggle with them. Some people have a complicated relationship with eating and reduce their intake, which can be dangerous and even life-threatening. For those who opt for treatment, there are many levels of care available to help with recovery. 

When Is Eating Disorder Treatment Necessary?

The earlier an eating disorder is noticed and treated, the better the outcome. Untreated eating disorders tend to get worse, which can result in major health problems. Without adequate nutrients, our bodies cannot properly function. This can mean halted bone and muscle development, stunted growth, heart problems, circulatory issues and cognitive problems. 

When our bodies are deprived of necessary fuel, it puts our systems into lockdown; our metabolism slows so that resources are preserved. These bodily reactions are hardwired in all humans for self-preservation, but for someone with an eating disorder, these natural bodily responses can lead to long-term physical harm and even death. Getting help for an eating disorder can prevent further health risks and improve the person’s quality of life.

Eating Disorder Symptoms

Unfortunately, people with eating disorders often try to hide their symptoms from others to continue their disordered eating patterns and meet unhealthy weight loss goals. If your loved one might be struggling with an eating disorder, encourage them to be open about their symptoms and relationship with food. Some symptoms of an eating disorder include:

• Changes in eating patterns
• Severe restricted eating patterns
• Elimination of certain food groups
• Weight loss or preoccupation with weight, size or body shape
• Excessive or unwarranted use of diet products, laxatives or diuretics
• Lab tests that indicate malnutrition
• Loss in bone or muscle strength
• Cognitive changes

Eating Disorder Treatment Options

Fortunately, people with eating disorders have treatment options that can change the course of their illness and help with long-term recovery. Therapy, behavioral intervention treatment, nutritional counseling, psychoeducation about the impact of eating disorders, and medication to treat co-occurring issues like anxiety can be useful interventions to help restore physical and emotional health. These treatments are part of most recommended levels of care. 

Emergency Eating Disorder Treatment

When someone’s unsafe eating disorder behavior has compromised their health, emergency treatment may be necessary. Emergency care for eating disorders involves hospitalization where physical symptoms are monitored and treated. This often includes lab work and medical intervention. Emergency care is about stabilizing the patient’s physical health so they can continue long-term treatment. 

Inpatient/Residential Eating Disorder Treatment

Sometimes inpatient treatment, also called residential care, is needed to achieve long-term recovery. This level of care involves living at a treatment facility to re-establish a healthy relationship with eating. Residential care provides individual and group therapy, family work, monitoring of food intake and health measures. Inpatient treatment can be a valuable way to restore healthy eating patterns, learn one’s eating disorder triggers and build healthy coping strategies. 

Partial Hospitalization Eating Disorder Treatment (PHP)

Partial hospitalization programs are less intensive than inpatient care. Treatment takes place in a supported setting but with fewer restrictions and more unstructured time. PHP offers individual and group treatment, as well as psychoeducation and continued monitoring of symptoms. PHPs are for people who are medically stable and have achieved a level of safety and recovery that warrants a step-down in care.

Intensive Outpatient Eating Disorder Treatment (IOP)

When a person with an eating disorder has achieved stability in their recovery, they often transition to intensive outpatient care. IOP is great for people who have learned skills to manage their eating disorder while at home, work or school. They’ll receive between nine and 20 hours per week of ongoing therapy and symptoms monitoring.

Outpatient Eating Disorder Treatment

Outpatient care is the lowest level of treatment for eating disorders. In outpatient care, the patient attends therapy and psychiatry appointments regularly, lives at home, and only goes to a facility when appointments are scheduled. During this phase of treatment, the eating disorder is being managed and their immediate health is not at risk. Outpatient therapy is a place to process challenges, successes and risks as they manage their long-term recovery. 

American Psychiatric Association Level of Care Guidelines

The APA recommends that eating disorders be treated by level of severity. Assessments and screening tools are the first step to determine the type of treatment needed. During these assessments, medical professionals will consider: 

• Weight patterns
• Behavioral changes, such as purging behaviors, use of medications for weight loss or excessive exercise
• Preoccupation about weight
• Body size or shape
• Family history of eating disorders
• History with trauma
• Co-occurring emotional health conditions, like depression or anxiety

The APA also recommends that people being assessed have physiological testing to determine the risk of harm, including testing for cardiac issues, liver function, and completing a metabolic panel. 

Choosing the Right Level of Care

People dealing with an eating disorder need the right kind of care to be successful in treatment. It can be challenging to determine what level of care is needed on your own. Talking to a trained professional is an important step, whether it’s your doctor, a therapist, or a local treatment facility. 

Additional resources like the Nobu app can offer support in your daily life regardless of where you are. You can learn healthy, mindful eating habits, address triggers that may pose a challenge in daily life, or schedule an appointment for online therapy. Nobu can offer support at any level of care and can help you along your recovery journey.