It is well-established that eating disorder treatment should be provided in the least restrictive setting possible.
To clarify what “least restrictive setting” means, it’s important to understand that there are five levels of care for the treatment of eating disorders. As you see in the pyramid below, the majority of people with eating disorders can be successfully treated in the outpatient setting. Outpatient eating disorder treatment is delivered while the patient remains in their home setting. Therapy services, like individual, family and/or group therapy, are generally limited to one to three sessions each week.
The level of support, intervention, and frequency of visits increases when patients move up through intensive outpatient programming, partial hospitalization, and upwards through the five tiers of care. Both residential treatment and inpatient hospitalization involve overnight stays. Inpatient, a highly controlled setting that incorporates medical care, is necessary if there are immediate medical complications or serious co-occurring issues like suicidality.
If a favorable treatment outcome can be achieved in the outpatient setting, it’s in the interest of the patient to be treated outpatient. Outpatients can remain fully engaged in their lives, attending work, school, family obligations, and other important pursuits. There is flexibility in the “dose” of treatment in outpatient with the intensity shaped by symptom severity, time frame for the treatment, and the presence of other conditions that often occur alongside the eating disorder (e.g. anxiety and depression).
There are several other reasons why outpatient eating disorder treatment is the most desirable course.
1. The most well-studied and effective eating disorder treatments, like Enhanced CBT (CBT-E) and Family-Based Treatment for Adolescents, were created specifically for the outpatient setting. These treatments may be adapted somewhat in more intensive settings, but they are rarely delivered with adherence in these environments.
2. Remaining engaged in important pursuits like professional life, school, and recreational activities supports the treatment process. These environments become the “lab” where people can practice new behaviors and patterns.
3. Increasing connection with family, friends and community is an important part of the recovery process for many individuals. Treatment from home (as opposed to moving temporarily to a facility) means that important contacts can get involved to bolster support and progress.
4. While stepping away from life to engage in residential or inpatient treatment may be necessary in some cases, for most people, it’s ideal to do the important work of eating disorder therapy while facing the day-to-day triggers and challenges of life. This way, you can learn how to manage these triggers effectively without resorting to eating disorder behaviors to cope.
5. For many, taking time away from work, school, or family responsibilities is not at all possible. Outpatient treatment significantly reduces disruption and is the most accessible of the levels of care.
6. Outpatient treatment tends to be the most affordable course. Outpatient treatment is roughly 10 percent of the cost of inpatient (Hay et al 2014). Insurance companies closely control the utilization of higher levels of care and often push to keep treatments in higher levels of care as short as possible.
So how do you determine what level of care is needed?
A thorough assessment is essential to properly establish the necessary level of care for treatment. By obtaining a history and clear understanding of the individual’s current struggles, providers can make thoughtful recommendations for care – both in terms of the kinds of therapy and the intensity.
If you or someone you care about needs guidance around how to confront their eating disorder and where, please contact us here at Columbus Park. We can support you through the process of securing the right care.
Katzman DK, Golden NH, Neumark-Sztainer D, et al. (2000) From prevention to prognosis: Clinical research update on adolescent eating disorders. Pediatric Research 47: 709–712.
Hay P, Chinn D, Forbes D, Madden S, Newton R, Sugenor L, Touyz S, Ward W. Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of eating disorders. Australian & New Zealand Journal of Psychiatry 2014, Vol. 48 (11) 977–1008