Eating Disorders: How to Determine an Appropriate Level of Care

You need eating disorder treatment, but where should you get it? What level of care do you need?

Well firstly, though getting educated on your treatment options helps enormously, as long as you get involved with a reputable treatment program/team, these aren’t decisions you’ll have to – or even should – make on your own.

You’ll make a treatment plan with your care-team after a full assessment of your medical, social and psychological needs. Variables that influence level of care recommendations include:¹

• The seriousness and duration of your eating disorder.
• Your physical health and the co-presence of any physical disease.
• Your current mental health and the co-presence of any mental illness.
• Your insurance coverage and or your ability to pay for care.

Treatment recommendations are individualized to your unique situation, based on a complex array of medical, social, psychological and financial variables and should change over time as your situation changes.

However, it’s also useful to understand, in general terms, when you’d be most likely to need hospital care, general residential care and outpatient care.

Which Treatment Setting Do You Need?

The three primary goals of eating disorder treatment are to:

1. Get medically stabilized.
2. Stop engaging in harmful behaviors.
3. Deal with co-occurring mental health problems that interact with your ED.

And the primary treatment settings for eating disorder treatment are:

1. Medical inpatient.
2. General non-medical residential.
3. Outpatient (this includes day treatment or partial hospitalization, intensive outpatient and general outpatient).

You may need medical inpatient if:

• You are dangerously underweight.         
  
• You have unstable vital signs.
• You have severe complications from your eating disorder – such as electrolyte imbalances, irregular hearth rhythms or severe dehydration.
• You have complications from another disorder.
• You have seriously worsening psychological symptoms.
• You are suicidal.

You may need residential care if:

• You have just been released from a medical inpatient environment.
• You are medically stable and do not need intensive medical care.
• You have serious mental health challenges that impair your ability to thrive in an outpatient environment.
• You need the structure of a residential environment to make progress.

You may need day treatment/partial hospitalization if:

• You are not in immediate risk of serious consequences but your ED situation is serious enough that you need daily assessment.
• Your mental health is generally stable but you are unable to function well in normal social or school/work environments.
• You are engaging in destructive behaviors, such as food limiting, binging, purging, etc.   

You may need intensive outpatient or outpatient treatment if:

• You are medically stable and your ED symptoms aren’t severe enough to require daily assessment.
• You can make recovery progress at this level of care.
• You can function socially and at school/work.

The Importance of a Continuum of Care

When evaluating treatment providers, one variable to consider is your relative access to a complete continuum of care.

Eating disorder recovery requires patience and determination - and often treatment at different intensities as your needs change over time. Ideally, you want treatment that offers easy access and fluid movement along a complete continuum of care, for example:²

• Community prevention - > A range of outpatient programs <-> More intensive outpatient programs, designed to help people who need more intensive support remain at home and in the community <-> Day programs or partial hospitalization programs that offer even more support <-> 24 hour a day residential programs that serve as a step down from hospitalization or a step up from day treatment (especially for people who lack supportive home environments <-> Medical inpatient, for mental and physical stabilization.

Treatment along a complete continuum of care:

• Allows you access to an appropriate level of care as soon as you need it (for example, quick access a higher intensity level of care after a relapse).
• Provides you with exit and transition support (so you’re not left on your own as you move from one treatment program to the next).