Levels of Treatment for Eating Disorders

There are several levels of treatment for eating disorders. Some types of treatment are done in an outpatient setting. More severe cases may need inpatient treatment. The first step toward diagnosis and treatment is the initial assessment. The initial assessment includes:

• A review of the patient's history.
• A review of current symptoms.
• Assessment of physical status. This includes weight, heart health, metabolic status, vital signs, and lab values.
• Assessment of other psychiatric issues or disorders. These could include depression, anxiety, substance use, or personality issues.

After this assessment, you'll get a treatment recommendation. The recommended treatment will happen on either an inpatient or outpatient basis. This is called level of care (LOC).

Outpatient Care

Outpatient care can include 12-step programs, therapy, support groups, and partial hospitalization. Learn more:

12-step programs

• Are usually community-based and free.
• Include programs such as Overeaters Anonymous, the National Association of Anorexia Nervosa (NADA), and Eating Disorders Anonymous.
• Can help as you work on building healthy eating habits.
• Allow you to connect with other people in recovery.
• Offer support and strategies for successful recovery.

Routine outpatient care (ROC)

• May include counseling with a therapist with training in eating disorders.
• May also include visits with a psychiatrist. They can help decide whether medication would be useful.
• Might involve weekly meetings with an eating disorder support group.
• May include the services of a nutritionist or dietician.
• Isn't right for treating complicated eating disorders.

Eating disorder intensive outpatient program (IOP)*

• Can include group, individual, and family therapy.
• Involves frequent visits (usually three to five days per week). Takes about three to four hours of treatment per day.
• Teaches patients about eating disorders and recovery.
• Is structured so patients can continue to work and live their usual routine.

Eating disorder partial hospitalization*

• Is an intense, structured program.
• Involves treatment five to seven days per week for six hours each day.
• Can include group, individual, and family therapy.
• Often includes an evaluation by a psychiatrist. They may prescribe or adjust medications.
• May involve a nutritionist. They will work on healthy meal planning as part of treatment.
• Is often recommended for patients who are still struggling after completing lower levels of care.
• Is helpful for patients who are at risk of hospitalization. Can also work as a step-down for patients who have been hospitalized.

Inpatient Care

Inpatient eating disorder acute care*

• Takes place in a hospital setting.
• Is meant for people with severe eating disorder symptoms or behaviors. These people need 24-hour medical monitoring.
• Is needed for patients with medical complications. These can include problems with the heart, metabolism, vital signs, and lab values. Acute inpatient care treats and stabilizes these symptoms.
• Includes nursing care and daily doctor visits.
• Can last for a few days, or up to 10 to 14 days in complex cases.
• May require a family session to discuss aftercare plans.

Inpatient residential*

• Is meant for people who need constant behavioral care without medical care.
• Is usually tried after other levels of care have failed.
• Takes place in a supportive living environment.
• Includes group, individual, and family therapy.
• Is used to stabilize the patient and transition them to a lower level of care. The goal is to return to community and family life.
• Includes weekly family therapy if appropriate.
• Cigna Healthcare^SM does not authorize “programs.” Appropriate clinical care based on medical necessity criteria is authorized.

Treatment Expectations

Effective treatments for an eating disorder include:

• Psychotherapy or psychological counseling
• Medical support
• Nutritional support and guidance

Treatment is tailored to the patient's needs. It is usually provided by a licensed health professional. This can be a psychologist, psychiatrist, nutritionist, or physician.

Counseling addresses both the symptoms and roots of the eating disorder. There are psychological, interpersonal, and cultural factors that must be dealt with.

Family Dynamics

The family dynamics surrounding eating disorders can be tricky. When people aren’t getting the right nutrition, they tend to think about food constantly. They might even dream about it. They may also become depressed, isolated, and exhausted. And they might avoid loved ones because of the pressure to eat.

Having a loved one with an eating disorder can be tough on family members. They may have to take on a caretaking role and advocate for their loved one. They may not fully understand the eating disorder. It’s common for loved ones to feel depressed or hopeless. They may also try to cope with their feelings in unhealthy ways.

Treatment programs and individual therapy often includes the family. Treatment often works to uncover family roles and communication styles. Therapists will try to pinpoint areas of control or neglect.

When to consider a higher level of care

A higher level of care should be considered when the patient:

• Has been sticking to the treatment but is still struggling with eating behaviors.
• Is dealing with medical complications.
• Shows a decreased level of functioning.

If you have questions or concerns about eating disorder treatment, talk to your doctor or therapist.