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Deciding to Move to a Higher Level of Care

When Outpatient Treatment is Not Enough


Updated March 21, 2012

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

Ideally, all eating disorders could be treated on an outpatient basis with the ability for sufferers to continue with their normal school and/or work activities with full-time access to their families and support systems. However, because of the nature of eating disorders and the potential for serious complications, a higher level of care is often needed. This may come in the form of an intensive outpatient program, day patient or partial hospitalization, a residential treatment center or inpatient hospitalization.

Making the decision to seek a higher level of care is never an easy one and should be made with the input of your therapist, dietitian, and/or physician. If you think a higher level of care might be the right choice for you or your loved one, ask yourself these questions.

  1. Are you or your loved one suicidal?

    If you (or your loved one) are having suicidal thoughts, you need to be assessed as soon as possible by a mental health professional, such as a therapist, psychiatrist, or other physician. If you do not have your own treatment provider (or can’t get in touch with them), please do not hesitate to call 911, go to your nearest emergency room, or call a suicide hotline. You or your loved one may need to be hospitalized in order to keep yourself safe.

  2. Has your weight or your loved one’s weight dropped below 85% of their ideal body weight?

    Generally, outpatient treatment providers will have a "low weight cutoff" limit at which they will no longer see clients on an outpatient basis, and one of the higher levels of care will be indicated. This is usually somewhere around 85% of ideal body weight, although will be dependent on other factors as well, such as a willingness to regain weight and the absence of any physical complications.

  3. Are you or your loved one unmotivated to engage in the treatment process?

    The success of outpatient treatment relies on you being willing to attend appointments regularly and follow the recommendations of the treatment team without being supervised at home. Any time a person is unwilling to engage in the treatment process or is in complete denial about the existence of the eating disorder, a higher level of care may be needed.

  4. Do you or your loved one have other diagnoses that are complicating treatment?

    Other diagnoses that make treatment more complicated may be mental health diagnoses, such as depression, post-traumatic stress disorder or borderline personality disorder. They may also be medical diagnoses, such as diabetes or physical complications of the eating disorder. Although it is unlikely that any one of these diagnoses alone would mandate a higher level of care, it can make it more likely when combined with other factors.

  5. Are you or your loved one able to eat regularly and eat the amounts recommended?

    Being able to eat regularly and follow the recommended meal plan is necessary to remain in outpatient treatment. It isn’t expected that this will be perfect, but commitment and progress needs to be seen. Supported meals are something that intensive outpatient programs, day patient, residential treatment centers and inpatient units are able to provide.

  6. Are you or your loved one able to control urges to exercise?

    If you are not able to control urges to exercise on an outpatient basis, talk with your treatment providers honestly about how much you are exercising. Whether or not you need to have the additional support of a higher level of care will likely be determined by the severity of other eating disorder symptoms and any physical complications you may be experiencing.

  7. Are you or your loved one able to control urges to purge?

    Being able to control some to most of the urges to purge with only support of your family and outpatient treatment team will help you remain in outpatient treatment. However, any time someone needs monitoring and support after all meals or is experiencing physical complications from purging, a higher level of care may be needed.

  8. Are there other problems contributing to stress in your life right now?

    Family support can provide emotional support and structure to succeed on an outpatient basis. Generally, if you do not have a support system at home or there are severe family problems, a higher level of care may be the right choice.

  9. How close are you to your treatment providers?

    Physical proximity can determine what type of treatment a person needs. If you live so far away from treatment that you cannot make it to regular appointments, it may be appropriate to travel to and enter a higher level of care or a supported living arrangement while you are in treatment.

  10. Have you or your loved one been in treatment for awhile now and are not seeing the results you had hoped for?

    Many people see some success in outpatient treatment but reach a plateau or simply aren’t making progress. The additional support and therapies provided by a higher level of care can be the change needed to help spur you forward in recovery. Talk openly with your treatment team about what is realistic to expect.


American Psychiatric Association. (2006). Practice guidelines for the treatment of patients with eating disorders. (3rd ed.). Washington, DC: Author.

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