Outpatient Eating Disorder Treatment: The Least Restrictive Setting

In a 2016 exhaustive review of the research on eating disorders there was a consistent finding across all diagnoses (anorexia, bulimia and binge eating):

“Treatment should be offered in the setting that is least restrictive and best suited to the individual’s needs and preferences.”[1]

The outpatient setting (treatment in your real life environment) is the least restrictive treatment setting and the best course for the majority of patients. More intensive, highly controlled settings are necessary primarily if there are immediate medical complications or co-occurring issues like suicidality that require a high level of oversight and intervention.

If you think about it, treating in a “real life” setting makes sense. A few factors to consider:

1. The Leading Treatments Are Designed for Outpatient

The gold standard treatments for eating disorders are designed for outpatient application. They can be adapted somewhat for Day Programs or Residential settings, but they were designed for and tested in the outpatient practice setting.

2. Work, School, Family Obligations

For most people, participation in work, school or family/social life is an important factor and “taking a break” from these responsibilities for treatment may be impossible. Outpatient treatment reduces disruption dramatically; in outpatient, you’re encouraged to engage, particularly in activities and pursuits that enrich your life, breed a sense of efficacy and boost self-esteem.

3. Opportunity to Address Stressors Head On

While it’s not easy, working through treatment in the context of daily life challenges allows you to fully address them – with support – and gives you the opportunity to practice new, more effective ways of coping.

4. Cost

Outpatient treatment is the most affordable level of care. It is said to be approximately 10% of the cost of inpatient.[2] Since most of us rely on insurance for major medical expenses, the “higher levels of care” like Residential, Partial Hospital and Day Treatment, may be out of the question; insurance companies are becoming increasingly reticent to cover these higher levels care and if they do, the treatment stays are shorter than ever. Unless there is immediate medical risk, most managed care companies require that patients receive an outpatient trial of treatment first.

The Importance of the Least Restrictive Setting

At Columbus Park, we use short-term, time-limited outpatient treatments that are effective even for the more severe eating disorders. For example, using CBT-E, patients with severe bulimia can see full results in 20 sessions. And MOST of the change actually happens in the first 8 weeks. In fact, early change is the single most potent predictor of a good outcome, so we’re motivated to help people change – fast.It’s important to be an educated consumer and to know your options.The first step is a thorough assessment with a provider who is committed to using the research to guide practice. Click here for information on finding an evidence-based treatment provider.  [1] Hay P, Chinn D, Forbes D, Madden S, Newton R, Sugenor L, Touyz S, Ward W. Australian & New Zealand Journal of Psychiatry 2014, Vol. 48(11) 977–1008[2] 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.