Eating Disorder Treatment

Intervention

Planning an intervention for a loved one struggling with an eating disorder is a methodical ritual that should be handled delicately. There are professionals educated specifically in the process of intervention planning, however, this may not be accessible to you or necessary. Even so, you should always have a mental health professional such as a counselor or therapist as a mediator for interventions.

The foundation of the intervention process is to approach the struggling individual with nonjudgmental, loving, and honest support. Each support person will be given the opportunity to express their perspective and the impact the individual’s behavior has had on them. As you plan for this, engage in your own therapy to express yourself authentically without becoming aggressive or vindictive.

The goal of an intervention is not to make the person feel ashamed but to help them see the impact and severity of their behaviors and support them in moving toward treatment and growth. Do not stage an intervention without also having options for the individual to choose from. Some of these should be treatment options and others should be firm boundaries should the individual choose not to get help. Regardless, remember to lead with love in your approach.

Outpatient

Outpatient treatment involves meeting with a Therapist, Dietitian, and Primary Care Professional at least once per week. This treatment is reserved for individuals in the “Maintenance” stage of change, meaning their eating disorder symptoms are drastic, if not completely, reduced and that they are able to maintain a recovery-focused lifestyle.

Individuals may begin their eating disorder treatment on an outpatient basis whether because of accessibility, finances, and/or willingness. It is important for treatment professionals to acknowledge when the severity of a patient’s disorder is beyond their ability to care for on an outpatient basis and refer the individual to a higher level of care.

While in Outpatient treatment, the individual should continue coordinating with all members of their treatment team. Outpatient appointments can become flexible based on the individual’s level of need at the time. For example, if an individual finds themselves struggling, they might increase therapy appointments to twice per week instead of once or they may implement an additional check-in with their therapist or dietitian. The goal is to provide the individual with the support necessary to live a recovery-focused life.

Intensive Outpatient (IOP)

Individuals recommended for IOP treatment are those that are fairly motivated for recovery and do not require a structured setting to maintain recovery. These individuals are compliant with treatment team recommendations as well.

IOP involves a commitment to, on average, 3 days per week of 3-hour programming. This programming includes individual therapy as well as group therapy and support from a Dietitian and Psychiatrist. IOP can occur either virtually or in person, depending on the treatment center.

The structure of programming helps individuals to receive well-rounded and consistent support while maintaining employment or schooling as necessary. Individuals in IOP live at home while engaging in this programming.

Partial Hospitalization Program (PHP)

A PHP involves individuals living at home while engaging in treatment that is, essentially, a full-time job. Individuals attend programming 5 days per week for 6 to 11 hours each day [1]. This level of care was once provided predominantly in-person, however, COVID has led to many treatment centers providing PHP virtually.

PHP is for those individuals that are beginning to make recovery-focused choices yet still require structure and consistent support to maintain these choices. Individuals enrolled in a PHP will engage in most meals while in programming but will have some meals at home.

Individuals often go to PHP after stepping down from Inpatient or Residential treatment in an effort to increase their independence and accountability while still providing support. Individuals might also begin treatment in a PHP if they do not require 24-hour monitoring and have a supportive home environment.

Criteria that treatment programs look for when recommending an individual to PHP are:

• Greater than 80% of weight as a percentage of healthy body weight
• Partial cooperation with treatment team recommendations
• The individual is preoccupied with intrusive thoughts 3 hours a day or more.
• Can greatly reduce instances of purging in an unstructured setting
• Pt. needs some structure to gain weight [2].

Residential Treatment Center

Residential Treatment involves the struggling individuals living in a treatment center and engaging in programming all day. This treatment involves supervised meals and snacks, sessions with an individual therapist, dietitian, and psychiatrist, group therapy, as well as group activities intended to promote recovery, identity work, and self-care. This treatment also often involves either in-person visitation and/or family sessions with the individual’s support system in-person or virtually.

Individuals appropriate for residential treatment are those that are considered medically stable yet still require 24/7 monitoring by nursing and clinical staff. According to the National Association of Eating Disorders, the following indicates an individual that would meet the criteria to stay in a Residential Treatment Center:

• An individual is less than 85% acute weight decline and engages in food refusal.
• An individual has “very poor” to “poor” motivation.
• Individual struggles with intrusive, repetitive, disorder thoughts at least most of day, every day.
• An individual is uncooperative with treatment or only cooperative in a highly structured setting.
• Individual requires supervision during and after meals.
• An individual has trouble controlling compulsive exercising without structure and accountability.
• An individual is unable to control purging episodes [2].

Inpatient Hospitalization

Inpatient hospitalization is the level of care reserved for individuals with severe eating disorder behaviors that require medical stabilization due to their disorder. Individuals are recommended to this level of care if there are concerns that they would experience severe medical consequences without round-the-clock care and observation from medical professionals.

This level of treatment involves individual and group therapy as well as family therapy sessions and monitored meals yet focus primarily on medical stabilization of the individual, often through intravenous fluids and/or tube feeding.

Counseling

All of the above treatment levels should involve some form of counseling, as it is simply another word for “therapy.” As mentioned above in relation to Outpatient Treatment, counseling is an important part of the treatment team, however, as eating disorders are physical as well as psychological, the most effective approach to treatment involves counseling as well as support from a medical provider as well as a Dietitian.

Support Groups

Support groups are incredibly beneficial for individuals that struggle with accessing treatment centers or financing treatment. Support groups can be in-person or provided virtually and are a more free-form and accessible approach to group therapy. Be advised, there are less limitations on what can be considered a “support group,” therefore, it is important to ask about methodology as well as the education or experience of group leaders. Support groups have been found most beneficial when utilized as an additional component to mental health therapy provided by a licensed professional.

Resources

1. Muhlheim, L. (2019). Which level of eating disorder treatment is right for me. Very Well Mind. Retrieved from https://www.verywellmind.com/levels-of-eating-disorder-treatment-4134267.
2. Unknown (2018). Level of care guidelines for patients. National Eating Disorders Association. Retrieved from https://www.nationaleatingdisorders.org/toolkit/parent-toolkit/level-care-guidelines-patients.