Discovering a loved one has an eating disorder is painful and challenging. The next step, navigating treatment options, can feel even more confusing and overwhelming. There is a lot of new terminology to learn, including medical jargon and an alphabet soup of unfamiliar acronyms.
As you start your search for treatment, it can be helpful to understand the overall landscape of options to help you determine where to begin–or at least know what questions to ask.
What Are the Different Levels of Care?
Eating disorder treatment exists on a spectrum to address a wide range of medical and psychiatric illness severity. Below you will find an overview of different levels of care.
Outpatient vs. Inpatient
Most eating disorder treatment options exist under two main umbrellas: outpatient and inpatient.
The patient is living at home and receiving treatment by participating in individual sessions with a mental health professional or by attending a day program. Outpatient treatment may also include meeting with a dietitian and seeing a medical provider. Treatment may be in person or virtual.
The patient is away from home because they have been admitted to a hospital either for medical or psychiatric reasons (or both).
Residential treatment doesn’t fit neatly into the division between inpatient and outpatient. In residential treatment for eating disorders, patients are not living at home, but the level of monitoring and support is not as intense as in inpatient hospitalization.
Higher Levels of Care
In eating disorder treatment, there is a range of options that vary in the level of support patients receive. Anyone needing more than weekly sessions with eating disorder treatment professionals is often referred to what is called a “higher level of care” (HLOC).
These HLOC options are arranged in a hierarchy, listed here in order of least to greatest levels of support:
- IOP: Intensive Outpatient Program
Typically requiring 3-9 hours a week, IOP often includes some meal support and group therapy. IOPs generally take place in the late afternoon or evening to accommodate someone working or attending school. IOP may be virtual or in person.
- PHP: Partial Hospitalization Program
PHP is a day program where patients generally spend anywhere from 6-10 hours a day, 5-6 days a week. The term “partial hospitalization” can be misleading because most PHPs aren’t located at a hospital. At PHPs, patients have some meals at the program and receive both individual and group therapy. Patients may also meet with a dietitian and psychiatrist. Because there are so many hours spent in treatment, most patients cannot work or attend school while at a PHP. Patients may spend weeks or months in a PHP, which may be virtual or in person.
- RTC: Residential Treatment Center
Residential treatment involves the patient living on site at the treatment center where they are closely monitored and receive both individual and group therapy. RTCs can be in a home in a residential neighborhood, within a hospital complex, or at a resort-like center in a more remote area. Patients may spend weeks or months at a residential treatment program. Time for some limited online learning or individual study may be available to some patients.
- Inpatient Hospitalization
Inpatient hospitalization may last from a few days to weeks or months, depending on the severity of someone’s illness. Hospitalization for someone with an eating disorder may include any of the following:
- Medical Stabilization: a shorter-term stay (typically days to weeks) in a hospital where close medical monitoring takes place while a patient is treated for the medical complications from malnutrition and/or purging. Patients typically need to meet specific medical criteria to qualify for a medical stabilization admission. Some hospitals have specialty units for patients with eating disorders, whereas others admit patients to a general medical unit.
- Inpatient Psychiatric Hospitalization: patients with acute psychiatric symptoms may spend time in a hospital psychiatric unit in order to stabilize mood and address safety concerns.
- Inpatient Eating Disorder Medical-Psychiatric Hospitalization: some hospital programs, often those affiliated with a university, not only provide the medical stabilization/monitoring and renourishment but also address acute psychiatric symptoms associated with the eating disorder.
What Does It Mean To “Step Up” or “Step Down” in Care?
It’s common for someone in a HLOC setting to “step down” one level at a time, say, from a residential program to a PHP and then to an IOP. Or a patient may discharge from the hospital and step down to a residential treatment center. Similarly, patients who are struggling to make progress at a lower level of care may “step up” to the next higher level of care unless there is an acute medical issue that necessitates hospitalization.
Where Does Family-Based Treatment (FBT) Fall in the Treatment Option Landscape?
FBT is an outpatient treatment that involves the patient’s family taking an active role in treatment. The patient is living at home, and the whole family meets regularly with an FBT therapist either virtually or in their office. The ongoing treatment of the eating disorder occurs within the home between sessions--with parents, guardians, or other caregivers supporting the patient one meal at a time.
FBT is considered the gold-standard treatment for children, adolescents, and young adults living at home. Research shows that FBT is the treatment with the best outcomes in these age groups, with the added benefit of allowing patients to live at home and participate in their lives through school, work, and other activities while in treatment. FBT generally lasts one year and includes developing a relapse prevention plan.
At What Stage of Treatment Can You Do FBT?
Because of the evidence supporting it, FBT is often recommended as the first line of treatment for children, adolescents, and young adults who are medically stable. For those discharging from a higher level of care, FBT can also be the next stage of treatment, without having to “step down” to another level of care first. Some HLOC facilities include families in training and education programs in order to help prepare them to continue treatment with FBT once the patient is discharged.
Where Does Equip Fit Into the Various Treatment Options?
Equip’s treatment model offering a virtual 5-person care team is unique in that it offers more support than typical outpatient therapy but doesn’t require as many hours a week as most higher levels of care. FBT can be an alternative to HLOC options for many patients.
Equip meets patients and families where they are. Patients who are medically stable can get outpatient treatment at Equip upon initial diagnosis. Equip has also successfully treated many patients who have been in all levels of care previously. Many patients start treatment with Equip after being discharged from a hospital or HLOC. Because Equip offers virtual FBT, patients can often work or attend school while in treatment.
Could Virtual Treatment Be Right for Us?
Many families wonder whether telehealth can be as successful as in-person treatment. The good news is that research shows virtual eating disorder treatment is as effective as in-person treatment.
There are also many benefits to virtual treatment. Not having to commute to appointments means that virtual treatment can be much more convenient for busy families. For those who don’t live in an area with eating disorder professionals, virtual treatment increases access by bringing expert care to people who need it. In addition, with virtual treatment, families and patients have more time to do the other things–work, attend school, socialize–that help build a life worth living.
How Do We Decide Which Treatment Is Right for Our Loved One?
Many families find it helpful to get started by asking their loved one’s primary care physician for referrals. Another option is to contact your health insurance to find out what options are in network and what, if any, out-of-network coverage you may have.
As you are considering treatment providers or programs, here are some of the questions you might want to ask to help guide your decision:
- What experience do you have with treating eating disorders? (i.e., have they treated a few patients or is it the focus of their practice?)
- What credentials or special training do you have related to eating disorders?
- Do you belong to any eating disorder treatment professional organizations, such as the Academy for Eating Disorders (AED) or the International Association of Eating Disorders Professionals (iaedp)?
- How long will treatment last, and what will it cost?
- How do you set treatment priorities and goals?
- How do you measure progress in recovery?
- What is the role of family or other loved ones in treatment?
- What is your readmission rate? (for PHP, residential, and inpatient programs)
- Do you provide the option of virtual sessions?
Keep in mind that there isn’t one “right” way to get started with eating disorder treatment. And even after extensive research, your family might still go through some trial and error to find the right fit. The recovery process isn’t usually simple or linear; it’s hard work, but it’s worth it.