Eating Disorders And Treatment Centers: Inpatient, Outpatient, And Residential Treatment

Eating disorder treatment is often multifaceted and highly specialized, involving a combination of psychotherapy, education, nutrition counseling, and medical oversight. While these services can all be delivered separately in a community setting, some people prefer to get help from treatment centers that offer a unified, integrated approach. What kinds of facilities and programs are available for eating disorders?

The availability of eating disorder treatment centers can vary depending on your location, but it’s often possible to access several different levels of care. These can range from intensive outpatient programs to round-the-clock hospitalization. The most appropriate form of care may depend on the affected individual’s symptoms, preferences, and treatment history. We’ll explore the different types of treatment programs and discuss what to expect from an eating disorder facility. 

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Different types of eating disorder treatment

An eating disorder can be defined as a form of mental illness involving a combination of biological, psychological, and behavioral challenges and characterized by unhealthy, often compulsive habits related to eating. Symptoms can include behaviors like fasting, binge eating, purging, and excessive exercise, as well as negative emotions like shame and self-loathing.

Eating disorder behaviors are often motivated in part by dysfunctional beliefs and attitudes related to self-worth, attractiveness, body shape, and self-control. However, the severe medical complications that often arise alongside or as a result of eating disorders can further reinforce the psychological and behavioral difficulties, making recovery challenging. 

Interpersonal and societal risk factors, such as unrealistic beauty standards, may also feed into the pathology of these conditions.

Due to this complex web of cause and effect, clinical guidelines generally recommend that people with eating disorders receive help from a multidisciplinary care team. An effective treatment plan may involve the following:

• Psychotherapy to address behavioral health issues and address problematic beliefs and attitudes
• Medical oversight to monitor body weight and other vital signs
• Nutritional counseling to help individuals understand and maintain healthy eating behaviors
• Support and assistance from family (when appropriate)
• Psychiatric care if pharmacological treatments are indicated

The need for coordination in eating disorder treatment

Better coordination between the various care providers involved in eating disorder treatment can significantly improve patient outcomes. When someone is receiving help from several different sources that don’t communicate effectively, important information may be overlooked, treatment can be delayed, and the client can receive confusing or contradictory instructions. 

While many different approaches may be used to improve coordination, one common option is to bring the different forms of care together under one roof. An eating disorder treatment center can provide a unified location where an individual can interface with the various specialists assisting their recovery.

Levels of care in eating disorder treatment

Care for eating disorders can fall along a wide spectrum of intensity. According to the National Eating Disorders Association (NEDA), these differing approaches are typically grouped into five categories.

Outpatient eating disorder treatment 

In outpatient treatment, an individual generally continues to reside at home while attending treatment sessions at a care provider’s office (usually weekly). Specific treatment methods can include various combinations of the methods described above. For people with mild to moderate eating disorder symptoms, outpatient care may be roughly as effective as more intensive options. 

Intensive outpatient eating disorder treatment

This level of care is sometimes referred to as an intensive outpatient program (IOP). As in standard outpatient or community care, the client typically lives at home, but they attend focused sessions at a treatment center multiple times a week. These sessions typically last two to three hours and can involve multiple forms of assistance, including nutritional counseling, meals in supportive settings, and individual, group, and family therapy. 

Partial hospitalization programs (PHPs) for eating disorders

Often called day programs or day-hospital programs, PHPs can be seen as a hybrid between inpatient and outpatient programs. The client usually spends each day at a treatment center, receiving care throughout typical “business hours,” but returns home at night. This approach may balance the desire for independence with the need for consistent support in maintaining healthy eating behaviors, and research indicates it can be an effective aid to recovery. 

Residential eating disorder treatment

In residential treatment, individuals normally live full-time in a care facility. They usually receive close supervision to prevent harmful eating disorder behaviors, such as binge eating and purging, as well as a full spectrum of care practices like therapy and meal coaching. Current evidence suggests that residential care can be an effective treatment method for most eating disorder patients. 

Inpatient eating disorder treatment

Individuals undergoing inpatient treatment generally reside in a hospital setting where they can receive 24-hour monitoring from physicians. This level of care is typically reserved for people who are experiencing severe or life-threatening eating disorder symptoms that may require medical stabilization. Studies frequently support the effectiveness of inpatient care for eating disorders, although this approach may work better for some types of clients than others. 

What type of eating disorder treatment center is best for you?

How should you select the appropriate treatment setting for an eating disorder? More intensive programs may provide a higher level of assistance and help you avoid some of the more serious health complications of an eating disorder. On the other hand, treatment centers allowing greater independence could help you better integrate the recovery process into your day-to-day life. 

You may need to consider some of the following factors when choosing your level of care.

Your treatment history

For example, if you have moderate eating disorder symptoms, you might begin with an intensive outpatient treatment program. If you successfully reduce your dysfunctional eating behaviors within a few weeks or months, you could be ready to step down to a less intensive community care approach. In contrast, a lack of progress could indicate that you need to step up to a partial hospitalization or residential program where you can receive a higher level of support. 

The severity of your disorder and symptoms

The specific kinds of symptoms you’re experiencing may be another significant consideration when choosing a treatment type. Some eating disorders, like anorexia nervosa, could place you at a higher risk for severe or life-threatening medical complications due to the likelihood of malnourishment. Recovering safely may also require a doctor’s supervision to avoid dangers like refeeding syndrome. 

As such, people with restrictive eating disorders like anorexia may benefit from starting at a higher level of care intensity than those with conditions like bulimia nervosa or binge eating disorder. However, the determination of symptom severity may need to be made by a medical professional who can assess whether you need medical stabilization. 

You may also want to give some thought to how much support you think you’ll need. Can you go several days without binge eating? Do you need someone with you at every meal to ensure that you eat? Are you highly motivated to change, or are you still ambivalent about letting go of your disordered eating behaviors? A more intensive program may be appropriate if you think you’d benefit from more consistent oversight. 

Comorbid mental illnesses

Many people with eating disorders also experience other forms of mental illness, such as post-traumatic stress disorder (PTSD), substance use disorders, and obsessive-compulsive disorder (OCD). These conditions can complicate treatment and may require higher levels of care to address.

If you are struggling with substance use, contact the SAMHSA National Helpline at (800) 662-4357 to receive support and resources. Support is available 24/7.

For example, some research indicates that inpatient treatment may produce greater reductions in symptoms of depression compared to lower levels of care. If you’ve been diagnosed with multiple disorders, choosing a more intensive treatment center might be a good idea. 

Evaluating treatment centers for eating disorders

Here are a few potentially useful criteria to keep in mind when you’re considering possible facilities for eating disorder treatment:

• Accreditation: A seal of approval from an independent agency, such as the Commission on Accreditation of Rehabilitation Facilities (CARF) or the Joint Commission, can indicate that a treatment center meets certain standards of quality.
• Treatment methods: Certain forms of psychological treatment for eating disorders are backed by more evidence than others. You may want to find out whether a facility offers research-supported methods like cognitive behavioral therapy, interpersonal therapy, dialectical behavior therapy, and family-based therapy. 
• Other supportive services: The range of supportive programs that treatment centers offer can vary considerably. You may want to think about what kinds of assistance you most value, from nutritional counseling to music therapy. 
• Available staff: How comprehensive is the care team at the facility you’re considering? Is mental health care provided by therapists alone, or do they have a psychiatrist who can prescribe medications if necessary? Will there be a registered dietitian there to help you develop healthy eating habits? 
• Personal comfort and preferences: Trust and connection with a treatment provider can impact the odds of recovery, especially for younger individuals and those living with anorexia. Paying attention to how comfortable and supported you are when you first visit a treatment center could help you assess whether it’s a good fit. 
• Affordability: Cost-effectiveness can be an important concern — it may not matter how much you like a particular treatment center if you’re not sure you can afford to complete treatment there. You may benefit from beginning your search with facilities that accept your insurance or offer financial aid programs.

How to find treatment centers near you

Several reputable organizations offer online databases and guides to help you locate a high-quality treatment center in your area. You may still need to assess any given facility based on the factors described above, but these resources can help you narrow down your search:

• National Alliance for Eating Disorders —  Treatment Center & Practitioner Directory
• National Association of Anorexia Nervosa and Associated Disorders (ANAD) —  Treatment Directory
• EDReferral —  Eating Disorder Referral and Information Center
• Eating Disorder Hope —  Eating Disorder Treatment Near Me

Receiving treatment for eating disorders online

For those who don’t need intensive eating disorder treatment, online therapy can be a convenient and affordable alternative to a treatment center. Getting help over the internet often means greater flexibility in scheduling, which can mean you’ll have an easier time integrating evidence-based psychotherapy into your recovery routine. 

Telemedicine for eating disorders is a newer approach, but it’s gaining increasing support from research. A 2023 review of over a dozen controlled trials reported that the existing evidence suggests online cognitive behavioral therapy can be an effective method for preventing and treating eating disorders. In combination with nutrition counseling and supervision from a physician, web-based counseling may be a beneficial tool for overcoming disordered eating.