The Path to Eating Disorder Recovery
Understanding the different levels of care for eating disorders
Eating disorders — anorexia nervosa, bulimia nervosa, binge-eating disorder, and avoidance restrictive food intake disorder (ARFID) — can be serious and life-threatening conditions, with significant impacts on an individual’s medical state and psychological well-being. Navigating treatment options and understanding their differences can be confusing for patients and families.
Below is an overview of the different types of treatment settings, often referred to as levels of care. Treatment settings vary in intensity and include outpatient treatment, intensive outpatient programs, partial hospital programs, residential treatment centers, and inpatient programs.
Outpatient Treatment
Typically, outpatient treatment can be considered before pursuing more intense levels of care. Outpatient treatment allows individuals to receive care while staying in their lives — continuing in school or work and staying at home with their loved ones.
Treatment may involve a team made up of different types of professionals — a therapist (a social worker, psychologist, or mental health counselor) provides individual psychotherapy (once or twice weekly) or family therapy; a dietitian provides nutritional counseling; a primary care provider or psychiatrist (physician, physician’s assistant or nurse practitioner) may provide medical monitoring and / or medication management. The makeup of the team and frequency of appointments varies depending on an individual’s particular needs and stage of recovery. If multiple providers are part of the team, all are likely to benefit from coordinating and collaborating with each other.
The Academy for Eating Disorders, the American Academy of Pediatrics, and the American Psychiatric Association, recommend the following first-line treatments for eating disorders:
Family-based Treatment (FBT) is a family therapy that empowers parents to help their child or adolescent overcome anorexia nervosa and other restrictive eating disorders by focusing on weight restoration through supervising and offering compassionate support during meals.
Find a certified FBT therapist
Enhanced Cognitive Behavioral Therapy (CBT-E) is the first-line treatment for adults with eating disorders, including anorexia nervosa, bulimia nervosa, and binge-eating disorder. This treatment is also recommended for adolescents with bulimia nervosa and binge-eating disorder. CBT-E is an individual therapy focusing on the connection between our thoughts, feelings, and behaviors focused on normalizing eating through identifying and changing thoughts and behaviors that interfere.
Find a CBT-E therapist
Because ARFID is a newer diagnosis when compared to other eating disorders, it does not currently have a recommended first-line treatment, but research is underway. Clinicians at Harvard are currently studying a treatment similar to CBT-E, specifically for ARFID — CBT-AR. Researchers at Duke are studying a therapy for children (ages 4-10 years old) and their parents focused on helping children with ARFID identify and reinterpret sensations in their bodies from a place of curiosity.
If an individual experiencing medical or psychiatric complications which require hospitalization, outpatient therapy is not appropriate.
Intensive Outpatient Programs (IOP)
Intensive outpatient programs are often referred to as IOPs. An eating disorder IOP is a group-based treatment that includes meetings at least three times a week. These meetings may include individual, group, or family therapy as well as care from medical and dietetic professionals. IOPs also offer meal support for individuals and are commonly used to help individuals transition from a higher level of care or as a next step if outpatient treatment has not been successful in decreasing the severity of eating disorder symptoms.
Partial Hospitalization Programs (PHP)
PHPs are also referred to as day treatment programs and provide more support than an IOP. This level of care provides structured programming for five to seven days a week, with two or three meals and snacks included each day. Similar to IOPs, individual, group, and family therapy is included in the program, as well as support from an interdisciplinary team. Partial programs are helpful for individuals who need more support but are not in need of 24/7 support or are transitioning from a residential treatment center.
Partial hospitalization eating disorder programs in Charlotte include:
Residential Treatment Centers
Residential treatment centers provide 24/7 care, including support during all meals and snacks. This level of care is appropriate for individuals in need of full-time care and are medically and psychiatrically stable such that they are not in need of hospital-based care. Treatment is provided by an interdisciplinary team of eating disorder professionals.
Currently, there are no residential treatment centers for eating disorders located in Charlotte, NC.
Inpatient Programs
Inpatient programs are the most intense level of care for individuals with eating disorders. Eating disorder hospitalizations may take place on a medical or psychiatric unit and are indicated if an individual has medical or psychiatric risks that require continuous monitoring. Individuals who have not made progress in lower levels of care may also be appropriate for an inpatient program.
While differences between the treatment options exist, they share the same goal: to normalize eating, disrupt binge-eating and behaviors to compensate for eating, and help underweight individuals return to health with weight restoration.
As you navigate the eating disorder treatment landscape for yourself or a loved one, make sure you understand what is being recommended and why. Consider consulting one of the following organizations that may be able to provide guidance:
