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Learn more about the results we get at Within
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Mental health conditions of all types, including eating disorders, occur on a spectrum of severity. Likewise, there are several levels of care for treating these conditions, meant to address the varying levels of symptom severity.
Eating disorder inpatient treatment is considered the highest level of care on this spectrum. There are several forms of this type of care, but all of them involve patients living and sleeping at eating disorder treatment centers, so the treatments are more restrictive, but they offer 24-hour access to medical staff and treatment.
At its highest level, inpatient care is for patients who require medical stabilization, and the primary goal is getting them to that point. Once this is achieved, a patient can step down to less-intensive types of care, including lower levels of inpatient care.
Inpatient eating disorder treatment is the most intensive level of care for eating disorders, usually taking place in specialized hospital units or residential treatment facilities. It's generally reserved for patients with the most severe symptoms, and particularly those who are considered medically unstable—or those considered at immediate risk of death.1
Residential treatment for eating disorders is a lower level of inpatient care. Patients at this point may be considered medically stable but still experience severe eating disorder symptoms and distorted thoughts connected to their diagnosis.3
In any case, patients receiving inpatient eating disorder treatment temporarily live at a facility, where they have 24-hour access to many types of medical and psychological care. Goals are usually restoring a patient to medical stabilization and at least initiating weight restoration through refeeding.3
How are eating disorders treated with inpatient care?
For patients entering inpatient care due to medical instability, the primary focus is restoring their health beyond the point of any life-threatening mental or physical concerns.4 This is typically done through a number of medical interventions, including tube feeding, intravenous feeding, monitoring of vital signs, lab testing, and other treatments.6
Patients beyond these life-threatening issues may receive further care for issues related to malnutrition. This generally includes nutritional rehabilitation, which is often achieved through a practice called refeeding, where patients are introduced to increasing levels of calories and nutritional supplements to aid in weight restoration.5,6
Once a patient is well enough to enter residential treatment for eating disorders, they can begin to address issues outside of immediate physical threats. At this point, different types of therapy can be used to help interrupt disordered eating behaviors, normalize healthier habits, and start challenging and dismantling the disordered thoughts that uphold these conditions.4
Most patients at residential facilities are assigned treatment teams, made up of a group of multidisciplinary experts, including primary care physicians, psychiatrists, psychologists, nutritional therapists, nurses, and other medical staff, to address these various issues.4 Depending on their case, patients also sometimes receive specialized treatment from neurologists, cardiologists, dentists, and gastroenterologists, among other medical experts.3
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Types of inpatient treatment for eating disorders
The type of inpatient care received depends on the individual’s specific needs and medical stability.
Inpatient hospitalization is the highest level of care for an eating disorder. It usually takes place at an acute care hospital, sometimes one with specialized eating disorder facilities.
Patients may be recommended to inpatient hospitalization care if they are experiencing:2
Suicidal ideation
Signs of life-threatening health complications
Abnormal vital signs, such as bradycardia (slower than normal heartbeat), hypotension (very low blood pressure), hypothermia (the body losing heat faster than it's produced)
Extreme low body weight (usually considered below 85% of what is considered a healthy body weight)
It's also possible for some patients not presenting with these symptoms to be checked into an inpatient hospitalization program if there are no lower-level programs nearby.3
Once vitals are stabilized, a patient has started eating on their own with structure, and/or gained some weight, they may be transferred to residential treatment or a partial hospitalization program (PHP).
Like inpatient hospitalization, residential treatment involves living at a facility, giving patients access to medical care and monitoring 24 hours a day. But unlike eating disorder facilities used for inpatient hospitalization, residential programs often take place in a more comfortable, home-like environment, meant for longer-term stays.
Patients are usually medically stable by the time they enter residential treatment (and sometimes are required to be), but they still generally struggle with disordered thoughts and behaviors that are out of their control.
Partial hospitalization programs (PHP) are technically not a type of inpatient treatment, though they are often considered a higher level care for eating disorders, along with inpatient programs.7
PHPs are highly-structured day treatment programs, and while patients do live and sleep at home, they may attend treatment as many as 6 days a week, for up to 10 hours per day.1
Many patients who attend a residential treatment program are recommended to a PHP once their recovery has progressed enough to let them leave the full-time program. Though, in areas where residential treatment or inpatient hospitalization is not widely available, some patients may also be referred to a partial hospitalization program instead.3
What to expect in inpatient eating disorder treatment
What to expect at inpatient eating disorder treatment depends on which type of care a person is receiving.
Inpatient hospitalization is the strictest level of inpatient care. Patients are generally subject to round-the-clock medical monitoring and may undergo lifesaving interventions (if needed), as well as regular vital sign checks and lab tests.
Inpatient hospitalization may also include nutritional rehabilitation, where feeding tubes or other methods are used to increase the calories and nutrients a patient is receiving.5 This is a careful, calculated process, as reintroducing too many calories too quickly could trigger refeeding syndrome, a potentially deadly condition.6
Once a patient enters a residential eating disorder program, their environment will be more relaxed. They're still subject to 24-hour medical attention, but they're given their own room, or a shared room. Schedules are generally rigorous and involve regular medical check-ups, attendance at different types of therapy, and eating regular (and monitored) meals and snacks.
The length of these programs vary. Inpatient hospitalization is focused on medical stabilization, and usually only lasts a few weeks. Residential treatment for eating disorders is often a longer process, generally lasting 30 days or more.1
Inpatient treatment vs. PHP
On the surface, inpatient treatment and a partial hospitalization program may seem very different. Inpatient care requires a patient to live and sleep away from home, sometimes for months at a time, while patients participating in PHPs get to stay at home and commute to treatment.
Still, the programs frequently offer similar types of treatment, including individual and group therapy, nutritional counseling, and meal monitoring. The long hours involved in a PHP also offer a lot of structure to the level of care, similar to the highly-structured schedules that usually dictate a stay at a residential treatment center.
Someone attending a PHP may spend their day visiting different members of their treatment team—including therapists, nutritional counselors, doctors, and nurses—go to group therapy, have one or two supported meals and/or snacks while at treatment, and go home with more food to eat at home.12
At a residential treatment center, patients wake up and may start the day with a group exercise or breakfast. Throughout the day, they’ll see members of their treatment team for various therapy or treatment sessions, possibly meet with a doctor for medical evaluations, participate in group activities like yoga or breathing practices, and eat lunch, dinner, and possibly several snacks with nurses or other meal monitors.13 Depending on the program, additional activities or visiting hours with family may also be available.
As residential treatment involves more of a cohesive atmosphere—that is, the patient doesn’t leave, and is always surrounded by support staff—it’s generally recommended for patients who have a harder time controlling their eating disorder symptoms. But some professionals believe the intensive nature of a PHP makes it a suitable alternative for many patients in need of high-level care.1
What are the benefits of eating disorder inpatient care?
If someone is at the point of requiring inpatient eating disorder treatment, they often experience many benefits from these programs. Most notably, anyone experiencing medical instability can expect to have a safe environment to recuperate, and a caring treatment team of medical professionals to help bring them back to better health.
Residential programs often provide a number of benefits, as well. The individual therapy, nutritional therapy, and group therapy they offer can help patients better understand their own mental health and start making healthier decisions around food and eating. Some programs also include specialized treatment like art therapy or equine therapy, which many patients may enjoy.
One study showed that many patients went through similar "phases" during their stay at residential facilities, transitioning from reconciling with their situation to adjusting to and eventually accepting treatment. Even when patients expressed that they did not want to go to an eating disorder treatment center at the start, many came to see the program as a "safe environment" and some even said the experience made them want to have more faith in themselves.8
If in-person treatment is not available to you, remote care may be a viable option. Learn more about how remote treatment can help you or a loved one recover from an eating disorder.
Inpatient treatment for eating disorders tends to be significantly more expensive than outpatient treatment programs, due to the nature of living full-time at a medical facility. Health insurance may sometimes offer help with payment, but residential programs are historically difficult to get coverage for.
In these cases, it’s important to reach out to both the treatment center and your insurance company. Sliding scale costs and other payment solutions may be available.11
Difficult transition
Some individuals may find the transition from inpatient/residential care into lower levels of treatment challenging.
Losing the structure of residential care may leave some feeling unprepared for the triggers of everyday life. Likewise, entering into a residential treatment program can prove difficult, with some patients potentially struggling against the strict rules and schedules.8
Living away from home
For some people, living away from home may present complicating issues, especially if they have children or other significant social responsibilities. Even for those without these considerations, it can be difficult to be away from home.
In these cases, a patient may benefit more from a PHP or intensive outpatient treatment, which both allow them to live and sleep at home.
How effective is inpatient eating disorder treatment?
Research on inpatient care is limited. High drop-out rates, hesitation to experiment with types of treatment, and the nature of this intensive level of care make it difficult for researchers to gather appropriate types of information.
Still, there have been some studies on the subject. One suggested that inpatient treatment was more effective than day clinic treatment for patients with bulimia nervosa (BN), marked by higher rates of complete remission and partial remission of symptoms at discharge.9
Another study found both physical and psychological symptoms significantly improved with inpatient care, both for adolescents and adults. In this case, longer stays also correlated with increased weight gain.10
Learn more about our treatment program and care team.
Inpatient treatment for eating disorders at Within Health
At Within Health, we do not offer inpatient care for treating eating disorders, but we are providing a new form of virtual treatment that exists between PHP and intensive outpatient (IOP) levels of care.
In general, patients who have been in residential care programs, and return home for a PHP or IOP, often experience challenges with maintaining eating disorder recovery while in their home environments. These patients are moving from a recovery-oriented safe space at the facility, to life at home, which can feel very different.
Within Health has developed a treatment model that addresses this gap in care when it comes to eating disorders.
Remote treatment is an option
Using virtual technology, such as video calls through our app, we can keep in close contact with patients for up to twelve hours per day. Our team can sit with you while you’re cooking, eating, moving, or living, acting as a caring support system and advocating for your success.
Call our team today to learn more about first steps, and our commitment to creating clinically-superior, individualized care programs for people with eating disorders.
Disclaimer about "overeating": Within Health hesitatingly uses the word "overeating" because it is the term currently associated with this condition in society, however, we believe it inherently overlooks the various psychological aspects of this condition which are often interconnected with internalized diet culture, and a restrictive mindset about food. For the remainder of this piece, we will therefore be putting "overeating" in quotations to recognize that the diagnosis itself pathologizes behavior that is potentially hardwired and adaptive to a restrictive mindset.
Disclaimer about weight loss drugs: Within does not endorse the use of any weight loss drug or behavior and seeks to provide education on the insidious nature of diet culture. We understand the complex nature of disordered eating and eating disorders and strongly encourage anyone engaging in these behaviors to reach out for help as soon as possible. No statement should be taken as healthcare advice. All healthcare decisions should be made with your individual healthcare provider.
Resources
Levels of Care. University of California San Diego. Accessed August 2023.
