When I initially sought treatment for my eating disorder, I had to get a crash course on the ABCs of options. Within a week of asking my doctor for guidance, I received a quick education on RTCs, PHPs, and IOPs (Residential Treatment Centers, Partial Hospitalization Programs, and Intensive Outpatient Programs, respectively) in addition to outpatient care. To say that flood of information was a lot to take in would be an understatement; I was totally lost and unsure which path to choose.

What I learned the hard way is that while each of these traditional treatment options have their merit, all of them include significant financial, geographical, and logistical barriers. Not only can it be challenging to locate and access traditional treatment, but it can often prove fruitless as there is limited evidence to demonstrate their long-term effectiveness.

I wished I knew earlier that these traditional forms of treatment are not the end-all be-all. Let’s break down what traditional treatment is, why it often fails its patients, and what alternatives can look like.

What is “traditional” eating disorder treatment?

Historically, eating disorder treatment has been divided into RTCs, PHPs, and IOPs, in addition to outpatient care. Here’s a quick guide to what those acronyms mean:

  • Residential Treatment Center (RTC): An RTC requires patients to live at a center 24 hours a day for a set period of time (usually 30 days or more) and in addition to full-time housing, typically offers meal support, individual and group therapy, and some recreational activities. An RTC is usually appropriate for patients who require more intensive care than outpatient facilities can provide and may act as a bridge between hospital‐based inpatient treatment and traditional outpatient services.
  • Partial Hospitalization Program (PHP): Sometimes known as Day Treatment, a PHP offers patients support for 6-10 hours a day, 5-6 days per week. Unlike patients in RTCs, those in PHPs usually live at home and may gradually decrease the hours they spend in treatment each day as they progress in recovery.
  • Intensive Outpatient Program (IOP): A lower level of care than a PHP, IOPs usually provide about 3-4 hours of treatment per day for 3-5 days a week. Patients in IOPs can typically continue to go to school or work and participate in other activities while participating in treatment.
  • Outpatient: Unlike the structured programs mentioned above, outpatient care involves a patient seeing a team of providers (including psychologists, psychiatrists, dietitians, etc.) on their own time, for approximately 1 hour each week.

While costs of all these options can vary widely, including location, insurance coverage, and length of stay, the prices attached to traditional eating disorder treatment are quite high. According to Project HEAL, IOP treatment costs an average of $1,500 per week while RTC and inpatient treatment can cost an average of $2,000 per day. Overall, estimates put the average cost of a single eating disorder treatment episode around $80,000 and the cost of full healing to be around $250,000 over the span of two years.

None of the traditional options were accessible for Equip Lead Peer Mentor Mak Dowell, who was raised by her grandmother who worked 60-hour weeks and had little time or money for conventional treatment. “Medicaid had a hard time approving any type of treatment for me so my recovery came together with a combination of support from my resilient grandmother, my best friends, and my therapist” Dowell says. “Money, time, and energy are all privileges we aren't equally afforded. It’s important to explore what treatment options are available to you and what would be not just effective, but also sustainable.”

The potential shortcomings of traditional eating disorder treatment

While traditional treatment options may offer real, long-lasting recovery to those who can afford them, the evidence supporting the success of these paths is mixed. As one 2020 systematic review on RTCs found, there’s significant variability in program characteristics and efficacy.” An earlier paper demonstrated that the long-term success rate (defined as 3-5 years or more of abstinence from disordered behaviors) of conventional treatments “is in the 40% to 50% range, at best.” And according to a 2016 report, eating disorders are not only “the least covered psychiatric conditions in the American health insurance system,” but “Fewer than 1 in 10 people with an eating disorder will access mental health care, and only half will fully recover.” Let’s explore some of the limits to traditional treatment that may be causing these mixed results.

Creating geographical and financial barriers

“The nearest eating disorder treatment was two and a half hours away from my town,” Dowell says. “These traditional treatments remain unattainable due to the fact they are expensive, located mostly in metropolitan cities, have long waitlists, and only accept commercial insurance or cash.”

Removing patients from their motivation

As Equip’s Director of Program Development, Tana Luo explains, “Traditional eating disorder treatment settings tend to take people out of their lives. They’re not able to connect with the things that are meaningful to them — friends, family, work, school, and activities. Those are often the very things that motivate people to recover, so it can be really challenging to hold on to that drive to recover if there isn’t access to motivators.”

Using therapies that may work better at home

While enhanced cognitive behavioral therapy (CBT-E) is considered the leading eating disorder treatment for treating adults, and family-based therapy (FBT) is the gold standard for adolescents, these treatments don’t always work as well when administered inpatient. “FBT and CBT-E were designed to be delivered on an outpatient basis,” Luo says. “Therefore, outpatient treatment with a modality that’s backed by research is a great alternative to traditional treatment.”

Forming a “treatment bubble”

The “treatment bubble” refers to the feeling of safety and escapism patients often feel in traditional treatment settings. “It’s so great that people sometimes have that experience of feeling safe in treatment, and the drawback is that there can then be a lack of motivation to recover and get out of treatment,” Luo says.  “It may be triggering to be around other people who are struggling with eating disorder behaviors, and it’s not uncommon for people with eating disorders to compete with each other.”

The evidence-based treatment alternatives you may not be aware of

While the many forms of traditional treatment may be right for some people, others may benefit from support outside of typical treatment settings. There are virtual treatment programs, like Equip, that allow patients to receive evidence-based care from the comfort of their own home.

“The best part of this type of treatment is that you have options,” Dowell says. “The eating disorder field and research has expanded in the last year and more studies indicate that virtual treatment programs are just as effective.”

Dowell says that through her own recovery and her experience at Equip she’s seen the power of innovative treatment models in action. “What I can say is that non-traditional treatment is not only effective, but sustainable. Non-traditional treatment meets a patient where they are. They are able to meet providers in spaces they feel comfortable with, don’t have to worry about the time strain of treatment, and can maintain this modality for several months with effective outcomes.”

Luo agrees, noting she’s seen many examples of families who have engaged in and benefited from outpatient FBT. “The beauty of FBT is that it combines the training and expertise of the provider with the wisdom and experience of the family,” she says. “So the efforts to work towards recovery are highly individualized and draw from what the family knows can be effective for their child.”

While many people associate virtual or outpatient care as being less intensive, Equip can be an effective alternative for RTCs, PHPs, and IOPs alike, without the strain of driving to appointments or digging a financial hole. At Equip each patient is matched with a trained, comprehensive care team who build a specialized treatment plan to give you the best chance of achieving lasting recovery. Schedule a free consultation to learn more.

References
  1. Steinberg, Dori, Taylor Perry, et al. “Effectiveness of Delivering Evidence-Based Eating Disorder Treatment via Telemedicine for Children, Adolescents, and Youth.” Eating Disorders 31, no. 1 (2022): 85–101. https://doi.org/10.1080/10640266.2022.2076334.
  2. Couturier, Jennifer, Melissa Kimber, et al. “Efficacy of Family-Based Treatment for Adolescents with Eating Disorders: A Systematic Review and Meta-Analysis.” International Journal of Eating Disorders 46, no. 1 (2012): 3–11. https://doi.org/10.1002/eat.22042.
  3. Arts & Sciences. “Why We Still Fail Those with Eating Disorders.” Arts & Sciences, November 4, 2019. https://artsci.wustl.edu/ampersand/why-we-still-fail-those-eating-disorders.
  4. McAleavey K. “Ten years of treating eating disorders: what have we learned? A personal perspective on the application of 12-step and wellness programs.” Adv Mind Body Med. 23(2) (2008): 18-26. PMID: 20664141.
  5. Peckmezian, Tina, and Susan J Paxton. “A Systematic Review of Outcomes Following Residential Treatment for Eating Disorders.” European Eating Disorders Review 28, no. 3 (2020): 246–59. https://doi.org/10.1002/erv.2733.
  6. “Cost of Treatment.” Project HEAL. Accessed October 18, 2023. https://www.theprojectheal.org/cost-of-treatment.
Michelle Konstantinovsky, MJ
Equip Contributing Editor
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