Eating disorders are complex illnesses with biological, genetic, psychological, social and developmental roots. There is never a single cause for someone’s eating disorder and effective treatment must address this entire range of factors. The treatment of eating disorders is equally complex. It involves a number of different treatment disciplines, and usually a number of different levels of care. Effective treatment and recovery involves an ongoing collaboration between patients, their families and loved ones, and clinicians. Families, especially for younger women with eating disorders, are essential partners in the treatment team.
Levels of Care
In an effort to help families understand the various levels of care a loved one can access treatment for their eating disorder, we have compiled some simple definitions that explain in a way that is simple and straightforward.
- In-patient / Hospitalization: Overnight, medically or psychiatrically at risk, harm reduction goals, intensive therapy
- Residential Treatment Center (RTC): Overnight, medically stable, requires daily assessment, needs 24 hour supportive environment
- Partial Hospitalization Program (PHP): Not overnight, medically stable, requires frequent assessment, needs more structured environment and/or supervision – 5-7 days/week; 6-10 hours/day; 2-3 meals/day
- Intensive Outpatient Program (IOP) 3-5 days/week; 3-5 hours/day; 1-2 meals/day
- Outpatient Therapy Individual clinician or team, one to several appointments per week
Recovery takes place in phases or steps and a patient’s motivation to recover is a critical element in the recovery process. Healing and motivation are sustained and nurtured through involvement in a community. As patients gradually regain their physical and nutritional health, treatment begins to focus on other aspects of successful recovery such as self esteem and broader aspects of the quality of life. Most patients will fully recover from their eating disorders. Full recovery, however, often takes considerable time and effort. Patients with anorexia nervosa who are able to restore their weight to healthy levels have a much lower relapse risk than those who regain some, but not all, of their lost weight. Patients with bulimia nervosa who are able to completely eliminate their binge and purge behaviors have a lower risk of relapse than those who continue with even sporadic episodes.
Transitions to Day Treatment
Eating disorders are serious, potentially chronic and life threatening illnesses and they require your full focus if your loved one is in residential treatment. Research shows that patients and families who make their treatment and recovery their primary focus have the best outcomes. As their need for structure and support decreases, patients can step down to lower levels of care. The research on the treatment course of patients with anorexia nervosa indicates that many patients will require some degree of psychotherapeutic treatment for two years or more. It is important for you and your family to look at the full course of recovery. Many insurance policies cover only an acute phase of treatment, whereas the clinical, or treatment, recommendations are more likely to address the issues involved in maximizing the chances for full recovery. The gap between covered care and recommended care, between medically necessary care and clinically indicated care, is important to consider as you plan for your, or your child’s, treatment needs.