According to the standards of the American Psychiatric Association there are five separate levels of care for eating disorder treatment. In terms of increasing intensity, these levels of care include: outpatient, intensive outpatient, full day treatment/partial hospitalization, residential treatment and inpatient hospitalization. An evaluation for appropriate level of care is the most important initial step in eating disorder treatment. Without receiving treatment at an appropriate level of care, the chances of successful treatment are significantly reduced.
It is critically important when beginning treatment or meeting with a provider for the first time that the assessment includes data to decide what the appropriate level of care is. This data should include: medical status, sucidiality, body weight as a percent of healthy body weight, motivation to recover, comorbid disorders, structure needed for treatment, ability to control impulsive behaviors, lethality/dangerousness of behaviors, environmental stressors, and geographic availability.
Outpatient care is generally indicated for a medically stable patient without suicidality, whose percent of ideal body weight is generally greater than 85%, with fair to good motivation. The client must be self-sufficient in their need for structure, able to manage their behaviors, and have an adequate support system.
Intensive outpatient programs are indicated when percent of ideal body weight is higher than 80%, and there is fair motivation. This level of care is appropriate when the client needs some meal support and when mild external structure will produce significant behavioral change.
Day treatment/partial hospitalization is indicated for patients when percent of ideal body weight is higher than 80%, with lower motivation, who may be preoccupied with intrusive thoughts and needs significantly higher external structure. This level of care provides a much greater level of meal support and structure to patients.
Residential care is generally indicated when a patient needs supervision for all meals, whose percent of ideal body weight is less than 85%, and requires a fulltime structured environment to reduce behaviors and increase medical stability.
Inpatient hospitalization is generally indicated for patients requiring medial stabilization, who may be experiencing low motivation and may have an existing psychiatric disorder that requires hospitalization and full time supervision. When medical stability is as risk all other criteria must take a backseat until stability is achieved. Once medically stable, other treatment decisions can be made.
Many people searching for eating disorder treatment are naturally unclear as to what level of care they initially need. This is particularly true when deciding between day treatment and residential programs, as they have similar criteria for admission and are both quite life interrupting. There are a number of excellent residential programs with whom we work and refer to. In general, day treatment should be attempted prior to residential treatment. There are a number of reasons for this including: the preference for a least restrictive environment, the ability to work with partial motivation at both levels of care, presence of increased structure at both levels of care, and the ability to stay at home while in treatment. Additionally, the importance of generalizing skills learned in treatment to ones home life is a critical issue for all patients with eating disorders. When residential is indicated, it often must be followed by a day treatment program to practice using acquired skills in a real life setting.
Next week: What is compulsive exercise?
Contributions by Sarah Emerman