[Listen to an audio version of this blog HERE.]
A lot of people read my blog and send me questions about eating disorders: how can someone tell if their child has one? What are the signs? Is it a genetic issue or caused by environmental pressures? What does social media have to do with everything? Can eating disorders be resolved on their own or do they require specific treatment? This last question gets me. It could be possible to recover without help, but I've never heard of it, and I certainly didn't experience it. I had the support of an outpatient program as well as years of therapy and intimate work with a dietitian. Today, I'm going to do my best to disseminate the different types of treatments and help you understand what to expect.
The first step in recovering from an eating disorder is getting a diagnosis. Treating an eating disorder generally involves a combination of psychological and nutritional counseling, along with medical and psychiatric monitoring. Treatment should address the physical aspects of an eating disorder and the subsequent medical consequences, as well as the psychological, biological, interpersonal, and cultural forces that contribute to or maintain the disorder. Essentially, the more comprehensive the treatment plan to more likely it will be to succeed.
My nutritional counseling was also a bit therapeutic. We worked to break down the erroneous beliefs I held about food and slowly introduced foods into my diet that had previously scared the living shit out of me, like brownies, crackers, potatoes, butter, etc etc etc. Generally, treatment is more successful the "earlier" it is caught. This is tricky because usually insurance does not cover inpatient or outpatient programs until a disorder is severe enough. It's a catch-22 that sadly speaks volumes about the nature of healthcare itself. While a preventative measure nearly always works better, our healthcare system is constructed in such a way to nearly never embrace them. So, if you do reach the point of entering a program, you might be limited to 30, 60, or 90 days. You might also need to petition for an extension or an early release, depending on where you are and what the program is. With that being said, there are a few different types of treatment:
Inpatient Treatment: Inpatient treatment is for clients who need support and supervision of 24-hour care. Inpatient treatment consists of both psychological and nutritional monitoring, 24/7 nursing care, and regular individual or group therapy. Patients reside at the treatment location and treatment can last for as little as 1 week to several weeks, depending on the situation. Inpatient treatment is typically for those who require weight stabilization, who are in an acute health risk, or who present suicidal tendencies. Sometimes, insurance providers deny inpatient treatment (because it's quite costly), for the following reasons:
- weight that is not deemed "low enough"
- patient has not tried a lower level of care
- no physical complications
Often, if someone is not treated early, symptoms worsen until they are deemed "bad enough" for treatment, which is one of the single most frustrating aspects of our medical system. Early care has been shown to reduce harmful behaviors and is pivotal to full recovery.
Day Treatment: Day treatment (or partial hospitalization) is a middle ground between inpatient and outpatient treatment. Patients spend the bulk of their day (usually 12 hours) at a treatment center and spend their evenings/nights at home. Day treatment programs provide a supportive and caring community, and are typically reserved for clients who are ready to meet their goals without overnight supervision. Patients have a level of autonomy that inpatient residents don't; they are trusted to keep their progress on track but still benefit from significant intervention. Patients are considered medically stable but their eating disorder impairs their ability to function in normal social, educational, or vocational situations. The average length of stay in a day treatment program is 4-6 weeks.
Outpatient Treatment: Outpatient care provides intensive nutrition and clinical therapy, while allowing for more autonomy and self-sufficiency. Intensive outpatient treatment provides clients with a safe space where they can live independently, make their own choices, and still have the community to support and guide them through their journey of recovery. Usually, patients are able to function in normal social/educational/vocational environments and do not necessarily need daily medical monitoring. Some outpatient programs meet daily for a few hours, while others meet three times a week for longer (three hours at a time). There are usually a lot of group-based activities, one-on-one therapy sessions, nutritional counseling, and a supervised meal. The average length of stay is 4-6 weeks and patients are usually able to exit treatment and live independently with a much lower degree of support.
So, the big question is: what level of care do you need, and who exactly decides? Odd as it may seem, it isn't up to the patient. Healthcare facilities (treatment centers/hospitals), eating disorder specialists (psychiatrists, mostly), and health insurance plans all have a say. Sometimes, a psychiatrist's recommendation for inpatient treatment will be "unsubstantiated" and health insurance providers can challenge the recommendation. While the levels of treatment seem neat and tidy on paper, patients often do not fit into neat and tidy boxes, leaving room for disagreement, treatment plans that fall short, or families needing to pay out of pocket for higher levels of care.
You will likely have a team of people to manage your treatment. You could work with any combination of the following: physician, psychotherapist, dietitian, psychiatrist, yoga/art therapists, and a case manager. Your primary care physician may refer you to therapists or dietitians who have experience in treating eating disorders. Not all clinicians are familiar with eating disorder treatment, so it's important to advocate on your own or your loved one's behalf.
For those who are dangerously underweight, the first step is to restore normal eating patterns and weight. When someone is malnourished, it is hard to engage in psychotherapy or address their mental health. After weight is restored, eating disorder behaviors can be interrupted and unlearned. Then, patients are encouraged to normalize eating and exercise behaviors, challenge eating disordered thoughts, address ongoing or underlying mental health issues (such as anxiety or obsessive compulsive disorder), and establish plans and habits to prevent a relapse.
P.S. Keep in mind that you're a unique individual and treatment should be individualized to suit your needs. Your experience will not and should not mirror anyone else's. To read more about eating disorder treatment, visit the National Eating Disorders Association (NEDA) or watch this video from UC San Diego.