Get the Right Level of Eating Disorder Treatment

Due to the complexity of treating eating disorders and the need for a comprehensive treatment team, choosing a treatment site can be confusing. You want the appropriate level of care with minimum cost and inconvenience.

The American Psychiatric Association (APA) has produced guidelines for choosing an appropriate treatment site. Here's a tour of their recommendations:

Considerations When Choosing an Eating Disorder Treatment Site

The APA recommends considering several variables when recommendations for a particular level of care are made:

• Medical status: Eating disorders affect the body in both anorexia and bulimia. In some cases, problems can be life-threatening and require more intensive care.
• Suicidality: Suicide is not uncommon in eating disorders; it's particularly common in anorexia. If there is significant suicidal risk, inpatient care may be required.
• Weight: In eating disorders where weight loss is considerable, weight is a noteworthy metric to watch. The lower the weight, the greater level of care required.
• Motivation to recover: Some who enter treatment want to beat their disorders. Others make no secret that they don't want to give up their behaviors.
• Other disorders present: Even if an eating disorder is not severe, other problems -- such as depression, bipolar disorder, substance use or other psychological issues -- may require hospitalization for better monitoring.
• Structure needed for weight gain: Some need more monitoring to ensure weight gain than others. Resistant patients need more structure to ensure that they do not sabotage weight-gain efforts.
• Level of compulsive exercising: A lack of control over this compulsion in some patients can contribute to a decision for an increased level of care.
• Purging behavior: Some can curtail their purging without supervision. Others require the structure of near-constant (including bathroom) monitoring.
• Environmental stress: What is the patient's level of family and social support? If there is little help, or if current relationships do more harm than good, recommendations will trend toward more structured care.
• Geographic location: If a person lives too far away from good outpatient care to commute daily, then inpatient care may be the only good alternative.

APA Levels of Care

The APA care guidelines incorporate these variables into five levels of care. In general, they include:

• Level 1: Outpatient Care for the most manageable symptoms
• Level 2: Intensive Outpatient as weight and motivation to recover begin to drop -- and the tendency to compulsively exercise begins to rise
• Level 3: Partial Hospitalization (Full-Day Outpatient) when there is lesser motivation to recover, less social support and/or a higher need for structure to gain weight
• Level 4: Residential Treatment Center for those of still lower weight and whose medical status and social support suffer significantly; these patients may need supervision to guarantee caloric intake and to guard against purging
• Level 5: Inpatient Hospitalization is required when certain health concerns are present or there is significant suicidal risk; weight is very low or falling very fast (potentially requiring tube feeding); the patient fights treatment efforts and needs supervision to avoid restriction and/or severe purging

I believe that it pays to err on the side of caution. If you receive a recommendation for a more intensive level of care than you expect, it may be wise to follow the recommendation. Ask good questions of potential treatment providers, though, to avoid surprises.