A number of different variables will come into
play when choosing the appropriate level of care. These include weight, medical status, your
risk level of suicide, level of control over eating disordered behaviors,
motivation to recover, geographic location, and environmental stressors. Generally, the easier your symptoms are to
manage, the less the level of care required will be. Because patients tend to underestimate how
much care they really need, an evaluation performed with along with health care
professionals should be made to assist with the decision.
The follow are standard levels of care in the treatment of eating disorders
in order of progressively increasing intensity:
Outpatient Eating Disorder Treatment
The least structured form of treatment out there, outpatient care is
probably not intensive enough for those with eating disorders. In this treatment setting, patients live in
their own hole while they are visited by doctors, dietitians, therapists, and
psychiatrists in order to receive short periods of treatment. The criteria best suited for this level of
care, according to the American Psychiatric Association (APA) includes:
• A medically stable person who does not require treatment for medical
complications or medical monitoring.
• The individual is not at a high risk of suicide.
• The sufferer’s weight is greater than 85% of their clinically determined
“healthy body weight”.
• The man or woman is highly motivated to recovery and is not attempting to
resist treatment.
• The person has minimal effects of any co-occurring disorders, like substance
abuse, PTSD, depression, or other psychological issues.
• The individual is able and willing to monitor and gain weight, where
applicable, without additional supervision.
• The sufferer is able to control any purging or compulsive exercising
behaviors.
• Their environment at home has relatively low stress and they have a
pre-existing support system in place.
• They are within a short drive of an outpatient treatment facility.
Intensive Outpatient Eating Disorder Treatment
A level up from outpatient treatment in regards to support and structure,
intensive outpatient (IOP) treatment, does not yet resort to hospitalization or
residential treatment. Patients in IOP,
while still living at home, have to be stable enough to commute to a specific
site for several hours a day. The level
of care provided by IOP is appropriate if the patient fulfills the criteria
mentioned previously and in addition, their weight is above 80% of their
clinically determined “healthy body weight”, according to the APA.
Partial Hospitalization Eating Disorder Programs
The partial hospitalization program, which is also known as “day” or
“full-day” outpatient care, is a step-up in intensity from the IOP treatment
program. This level of care is
appropriate in situations where the individual has less social support, has a
greater need for structure, and is oftentimes less motivated to recover. Partial hospitalization programs typically
have patients spend between three to twelve hours a day receiving treatment
before going home to live.
The APA specifies that those in these programs should be medically stable,
are generally cooperative with treatment, do not require constant monitoring to
prevent suicide, and have exceeded 80% of their healthy body weight. In addition, they need some structure in
order to control eating disorder behaviors and to gain weight, but do not
require constant supervision.
In this level of treatment, most individuals begin the program by receiving 12 hours of treatment a day and steadily lower that amount to eight or sex hours of treatment per day. Individuals are supervised by staff members as they share two meals per day, so that their progress is closely monitored by eating disorder specialists.
Residential Eating Disorder Treatment
A more intensive level of treatment compared to the ones already mentioned,
residential treatment involves the sufferer living onsite rather than going
home during the evenings and weekends.
For most of their day, individuals spend time in recovery-related
appointments and activities with staff members like therapists, dietitians, and
doctors, while receiving a greater level of personalized care, monitoring, and
structure. The APA specifies that this
level of care is appropriate for those that fit the following criteria:
• Relatively speaking, the patient is medically stable and does not require
hospitalization for medical complications, although medical monitoring is
available.
• The individual does not need constant monitoring due to high risk of
suicide.
• The man or woman’s weight is lower than 85% of their “healthy body
weight”
• The sufferer requires a treatment environment that is highly structured
and he or she is not highly motivated on their own to recover.
• The person needs monitoring to avoid purging, compulsive exercise and/or
restricting.
• The individual does not have a sufficient social support system from
friends and or/ family.
• The patient is too far away geographically from less structured treatment
options.
Every patient that comes to The Victorian for its residential eating
disorder treatment program receives a thorough evaluation, then is presented
with a personalized treatment plan, and is provided round-the-clock nursing
care and supervision. Activities related
to eating disorder recovery include educational courses, therapeutic
recreation, individual, family, and group therapy, yoga or meditation, nutritional therapy, restaurant
outings, and more.
Individuals in these treatment programs attend up to twenty-three group
therapy sessions a week, including specialized groups such as spirituality
group, Cognitive-Behavior Therapy (DBT), expressive
art therapy, body image group, Cognitive-Behavioral
Group, and various others. They also
schedule weekly appointments with the dietitian and medical doctor and attend
two sessions a week with their primary therapist.
The Victorian’s staff members believe that family involvement is
essential. It is even more critical when
adolescents with eating disorders are treated.
Once a month, the program offers “family intensive weekends”, which
provide education and support to patients’ family members and concentrates on
improving communication within the family structure. In addition, the program offers family
therapy sessions, which occur twice a month.
Utilizing a “step-down” level of care system, patients are slowly
reintroduced into daily life after formal treatment ends. For those that choose to enroll in them, the
residential eating disorder treatment program offers extensive discharge planning and assistance with
the patient’s conversion to less structured care after their residential
treatment program has ended. This is
through an innovative online continuing care program that includes weekly
organized support groups to help in long-term recovery.
Inpatient Hospitalization
Known as the most intensive level of care out there, inpatient hospitalization provides patients with 24-hour monitoring of their eating disorder behaviors in a hospital setting while receiving lifesaving medical care. The APA recommends that level of care for patients that fit the following criteria:
• The individual is in severe medical risk with health complications that range from dehydration, low blood pressure, and irregular heart rhythm to acute problems of the kidneys, liver, lungs, or heart.
• He or she has attempted suicide in the past or is planning to commit suicide.
• The eating disorder sufferer’s weight is less than 85% of their “healthy body weight”. Most of the time, they are refusing to eat and is quickly losing weight.
• They are uncooperative or resistant to treatment no matter how much structure is provided to them.
• The patient has co-occurring disorders such as anxiety or depression that is severe enough that hospitalization is needed, even if having the eating disorder by itself wouldn’t.
• The individual needs constant monitoring to avoid compulsive exercise, purging, and restricting behaviors.
• They do not have friends or family members that are able to offer even basic emotional support. However, even with this support, hospitalization is required for some patients.
• The patient is too far away geographically from less structured treatment options.
Those with serious eating disorder symptoms usually begin treatment in a inpatient hospitalization program or a residential treatment center and steadily transition to a less intensive level or care as their symptoms decrease. At every single level of care, the patient should be seen as a vital component of a multidisciplinary treatment team who is also diligently involved in his or her own care.
We realize that it is often very difficult just to make the decision of seeking help for your eating disorder. The good news is that you do not have to decide on your own regarding the treatment option that best fits you. There are specialists at treatment centers like The Victorian that are trained at evaluating your specific circumstance.
Please give them a call at (888)268-9182