Types of Treatment Programs

There are basically four kinds of treatment programs:

1. Outpatient Treatment Programs - The least restrictive type of program in which a patient may see a nutritionist, therapist and/or other recovery professional 2-3 times per week.
2. Day Treatment Programs - The patient spends 8 hours per day, Monday through Friday, in a therapeutic setting, returning home in the evenings and on weekends.
3. Residential Treatment Programs - The patient stays 24 hours a day, 7 days a week in a residential setting where the focus is on psychotherapy and skill building.
4. In-Patient Treatment Programs - The patient stays 24 hours a day, 7 days a week in a hospital setting or residential and therapeutic facility for the duration of intensive treatment.

Two important points must be kept in mind:

1. Recovery from an eating disorder is a long-term process, lasting from 1-6 years, and frequently requiring different levels of care during the patient's recovery.
2. If a person has not been successful in a specific treatment program, this does not mean that the person has failed treatment -- it means that the kind of treatment she received failed her!

A Typical Outpatient Treatment Program

The least restrictive treatment is outpatient therapy. As a person continues to recover, it may be appropriate for her to see a therapist and a nutritionist 2-3 times weekly, gradually reducing the number of sessions as he or she progresses.

A Typical Day Treatment Program

Partial hospitalization or a day treatment program provides intensive treatment and nutritional rehabilitation during daytime hours. A day treatment program typically runs for 8 hours a day, Monday through Friday. The average length of stay is 6-14 weeks. The program is staffed by a multidisciplinary treatment team consisting of nutritionists, therapists, psychiatrist, physician, and psychologist.

The goals of a day treatment program are as follows:

• establishing normal eating behavior and the complete cessation of bingeing-purging and other unhealthy behaviors aimed at weight control
• ensuring adequate caloric intake and, when necessary, weight gain to achieve nutritional balance
• identifying psychological and familial factors that contribute to the eating disorder (Kaplan and Olmsted, 1997, p. 354)

A day program is not suitable for patients with acute medical risk, acute suicide risk or severe substance abuse or dependence. A day treatment program may also be unsuitable for patients who need the psychological feeling of safety provided by a structured, inpatient setting.

A Typical Residential Treatment Program

Residential treatment consists of a variety of therapies with a treatment team that may include physicians, psychiatrists, psychologists, nutritionists and any other specialists helpful to a patient's recovery. This team focuses on helping the patient learn:

• coping skills for stress management
• to determine appropriate amounts of exercise
• the constructive use leisure time
• nutrition and cooking skills
• assertiveness
• diminish perfectionism

Patients typically participate in various groups including body awareness, coping skills, cognitive-behavioral therapy, psychoeducation, leisure-time skills building, meal planning, nutrition and shopping. Aftercare planning and relapse prevention begin with admission and continue throughout the patient's treatment stay.

Some of the newer residential programs (such as Mirasol) are beginning to treat eating disorders using a model that incorporates the best of medical treatment with the most effective interventions from alternative treatment methods. The success rates for traditional, medical model treatment programs have been marginal, with only 32% of all people who have had treatment being eating disorder free after one year.

The following is a list of significant and achievable goals for residential care of anorexia nervosa (and by extension, other eating disorders):

• a healthy, stable body weight and a healthy body composition
• normal eating behavior
• social comfort, personal confidence, knowledge of balanced nutrition and practice eating meals in a wide variety of situations
• treatment of comorbid psychiatric disorders
• moderate, appropriate exercise
• appropriate thinking regarding body weight and image, fear of fatness, pursuit of thinness, etc.
• improved family/interpersonal interaction
• understanding and resolving the primary conflict
• developing an age-appropriate identity
• establishing aftercare plans, relapse prevention plans and readmission criteria

A Typical In-Patient Treatment Program

Residential and hospital treatment settings are both considered in-patient treatment. In-patient treatment for an eating disorder is intended to provide safe, prompt, and effective short-term treatment to prepare patients for transition to a lesser level of care such as residential care, partial hospitalization, or intensive outpatient treatment.

Suicidal or homicidal ideation and severe medical consequences need to be treated in a hospital setting but the other items can be treated in a residential setting. Once a patient has become medically stable, residential treatment may be a treatment choice that can serve as an alternative to hospitalization. Most residential settings are much more comfortable and feel "safer" for a patient than a hospital environment.

The following is a list of significant and achievable goals for the inpatient care of anorexia nervosa (and by extension, other eating disorders):

• a healthy, stable body weight and a healthy body composition
• normal eating behavior
• social comfort, personal confidence, knowledge of balanced nutrition and practice eating meals in a wide variety of situations
• treatment of comorbid psychiatric disorders and medical complications
• moderate, appropriate exercise
• appropriate thinking regarding body weight and image, fear of fatness, pursuit of thinness, etc.
• improved family/interpersonal interaction
• understanding and resolving the primary conflict
• developing an age-appropriate identity
• establishing aftercare plans, relapse prevention plans and readmission criteria

It's important to remember that weight stabilization is vital, but it's not the only goal of treatment for an eating disorder.

How to Choose a Treatment Program »