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While all eating disorders are serious mental health conditions, eating disorder symptoms may present at varying levels of severity, depending on how long someone has been struggling with the condition, their medical background, and a number of other factors. To address these variations, several levels of care have been developed for treating eating disorders.
These treatment programs span a spectrum of care, from 24-hour oversight from medical staff in a hospital setting to outpatient services that take place in a therapist's office once or twice a week, to remote programs.
The best level of care for you or your loved one depends entirely on your individual needs, symptoms, prognosis, and history. And, as with many patients, you may start at a higher level of care and step down toward less-intensive types of treatment.
What are the 4 levels of eating disorder treatment?
While there are arguably more than four levels of care for eating disorders, it's generally agreed that there are four higher level types of treatment for eating disorder behaviors.
From the most intensive to the least intensive, these levels include:2,3
Inpatient/medical hospitalization: The most intensive form of care, inpatient treatment is generally reserved for those experiencing a physical or mental health crisis. Patients undergo 24-hour medical monitoring and care, with a focus on medical stabilization.
Residential treatment: A patient at this level of care must be physically stable but may still be psychologically unstable. Residential treatment also involves 24-hour access to medical care, but programs are designed for longer-term stays.
Partial hospitalization: Also called a day program, partial hospitalization (PHP) involves commuting to treatment while living at home. Patients in a PHP may participate in significant amounts of treatment, but programs are usually stepped down as recovery progresses.
Intensive outpatient treatment: The patient is both medically and psychologically stable and has their eating disorder treatment under sufficient control. Patients at this stage are ready to add social responsibilities like work and school into their continuing recovery journey.
When determining a patient’s initial level of care, a multidisciplinary treatment team must keep a number of considerations in mind, including the patient’s overall physical condition, psychology, severity of disordered eating behaviors, and social circumstances. This is opposed to relying on physical parameters, such as weight, to make this determination.1
What level of eating disorder treatment do I need?
Now that we’ve gone over the basics of the four levels of eating disorder treatment listed above, you might be asking yourself “What level of eating disorder treatment do I need?”
While that decision is usually made between a patient and a doctor or therapist, taking a closer look at each of the four levels of eating disorder treatment in more detail may help you get a better idea.
Medical hospitalization is the most intensive setting for eating disorder treatment. It involves round-the-clock medical care, which may include tube feeding, monitoring of vital signs, intravenous fluids, necessary medications, and more.
This type of treatment is typically necessary for patients who aren’t medically stable or who require 24-hour monitoring, such as those experiencing:1,3
Suicidal thoughts or behaviors
Severe psychiatric symptoms
Malnutrition or dangerous weight loss
Food refusal
Electrolyte disturbance
Severe dehydration
Unstable blood pressure or heart rate
Extreme exercise behaviors
Medical hospitalization may also be necessary if someone needs immediate eating disorder treatment and there aren’t any appropriate treatment programs nearby. They can achieve stabilization at the hospital and receive referrals to the appropriate program when ready for discharge.
A step down from medical hospitalization is residential treatment, which provides care to eating disorder patients who are medically stable but still need 24-hour care due to emotional or psychological needs.
Residential treatment settings will appear more home-like, while inpatient can appear more like a hospital setting. Residential treatments may also involve a variety of treatment modalities, such as:
A residential treatment program may be right for you if you require structure, a high frequency of care, and monitoring to prevent disordered eating behaviors. This setting may also be appropriate if you have a co-occurring mental health disorder, such as depression, anxiety, post-traumatic stress disorder (PTSD), or borderline personality disorder.
Partial hospitalization or day treatment is a step down from residential care. You live at home while attending a high frequency of treatment sessions at a facility throughout the day. Partial hospitalization programs typically involve treatment between six to 10 hours per day, for three to seven days per week.
Throughout the program, you attend individual and group therapy, as well as regular meetings with a dietician. Patients also receive snacks and daily meals, which can ease the pressure of having to plan meals, especially so early in the recovery process; however, some meals may take place at home, depending on how many days you attend. At this level, a doctor also manages your psychiatric medications.3
Intensive outpatient programs are less intensive than partial hospitalization but still offer more care than a standard outpatient setting. Individuals with eating disorders attend treatment sessions for about three hours per day, for between two and five days a week, and then return home during non-treatment hours.
You receive individual and group counseling, nutritional counseling, medication management, and meal support, although you will be responsible for the majority of your meals. This level of care allows a bit more flexibility if you need to continue working, caring for loved ones, or attending school while recovering from your eating disorder.
Additional eating disorder treatment options
In addition to the four higher levels of eating disorder treatment, there are also additional methods of receiving care that can offer flexibility, and additional support.
Outpatient treatment and aftercare
Outpatient treatment or continuing care typically involves meeting with a therapist and/or nutritional counselor once or twice per week, for one to two hours. This is the least intensive level of eating disorder treatment, and in some cases can be a primary form of treatment.2,3
Patients who attend outpatient care should be medically stable and have motivation to recover. They should also be able to plan and prepare their own meals and snacks with little support due to the low frequency of treatment sessions. Ideally, patients attending outpatient treatment should have a strong support system of loved ones.1,3
Many people attend outpatient treatment after first completing a higher form of care, such as inpatient, partial hospitalization, or intensive outpatient. In this case, the outpatient program is known as continuing care and it allows someone to gradually step down to a less intensive treatment setting and adjust to lower levels of professional support.1,3
Remote eating disorder treatment
Remote eating disorder treatment is a method of care that can offer many benefits for those who choose to participate in it. For some people seeking eating disorder treatment, in-person care isn’t always possible. This may be due to geographical barriers, such as living in a rural area, or scheduling barriers, such as childcare or work. Other people may also feel intimidated by the in-person environment, especially if they’ve previously had a bad experience.4
There are many benefits to remote/virtual eating disorder treatment. Attending a remote care program for an eating disorder can help make it:4
Easier for those who have suffered “treatment trauma”
More accessible to underserved populations
Accessible from anywhere with an internet connection
Easier for families to participate in treatment together
More inclusive
More cost-effective
Quicker to find care
There can be a misconception that remote treatment couldn’t possibly be as effective as in-person treatment, but research debunks this myth. A 2021 study found no difference in treatment outcomes between in-person multidisciplinary eating disorder treatment and the same team-based treatment approach delivered remotely. At the time of discharge, both groups showed reduced eating disorder symptoms, improvement in mental well-being, positive weight outcomes and fewer perfectionist traits.4
Call us today to learn more about our virtual eating disorder treatment program.
Remote eating disorder care, such as the programs offered at Within Health, are an accessible form of professional treatment that allows patients to receive group and individual therapy, meal support, dietary counseling, and even remote medical care from wherever they’re most comfortable. In addition, our remote care program at Within offers an intensive outpatient program (IOP) and a partial hospitalization program (PHP) that we tailor specifically to each patient’s needs.
Within also has specialized eating disorder care programs including:
Finding the right eating disorder treatment programs
If you aren’t sure which level of eating disorder treatment is right for you, schedule an appointment with your doctor or a healthcare practitioner with experience in eating disorders. They can assess the severity of your eating disorder and perform a physical examination, using this information to determine the appropriate level of care for you.
By considering a variety of factors, such as your physical health, mental health, eating disorder symptoms and behaviors, length of condition, social supports and stressors, and family history they can recommend which of the eating disorder treatment is right for you.
Help is available
Regardless of the treatment setting you choose, it’s important to be patient and gentle with yourself. Recovery is a lifelong process, full of ups and downs, and it’s normal to experience a setback or a relapse. No matter what happens, don’t shame yourself for trying to heal. Give yourself the same compassion you would give a loved one. Contact Within today to discuss your personalized treatment plan.
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.
How do I know which level of care for eating disorders is best for me?
Usually, this determination is made between a patient and their care team, with a mind to a number of considerations, including medical history, the length of time someone has been struggling with their eating disorder, and severity of symptoms, among other concerns.
The best way to determine which eating disorder level of care is best for you is to speak with your primary care physician or a therapist.
When should I get eating disorder treatment?
Again, this question can be difficult to answer without the consultation of a doctor, but if you're having the thought about seeking out eating disorder care, it's likely a good sign that you may be in need of help.
If you feel you can no longer control your unhelpful thoughts or behaviors, it's another sign that you can likely benefit from treatment. And if you've experienced any severe symptoms, including rapid weight loss, or suicidal ideation, you should seek help immediately.
