By Andrew Walen, LCSW-C, LICSW, CEDS
You or a loved one is struggling with an eating disorder. You’re scared about how to get started and what you’ll have to do to get better. Perhaps you’ve even tried to get help, but things aren’t improving. This is how most clients come to us at The Body Image Therapy Center. It’s our job as an eating disorders treatment team to know our stuff, and to be an impartial guide for you on the road to recovery. First step is identifying what kind of care you need, and in what setting that care can best be delivered.
The goal of this blog is to describe why you may be referred to try day treatment as a level of care to help you fight your eating disorder. Day treatment at our program consists of 6 hours a day of care Monday through Friday. It includes 3 meals a day, group therapy, individual therapy, nutrition counseling, and psychiatric services. Let’s look at the various areas of assessment to help understand who is a good fit for day treatment, also known as partial hospital programming (PHP).
- Medical status: this is the most important part of the assessment. You need to be medically stable enough so you are not at risk for sudden medical complications. The Academy for Eating Disorders gives concrete guidelines for physical exams, labs, and other tests. As long as your results do not meet inpatient or acute treatment guidelines, you are a candidate for day treatment depending on the rest of the assessment items.
- Weight as a percentage of pre-eating disorder weight: A standard guideline for assessing severity of an eating disorder is to determine how much weight you lost after the onset of the eating disorder behaviors. Losing 15% or more of your body weight is a sign that the disorder is significant and needs to be addressed in a day treatment setting at minimum. Weight loss or gain are symptoms of an eating disorder but are not the only factors to consider. There may be medical and natural/biological functions at work. To determine if you are suffering from an eating disorder, it requires investigating how weight and shape play into your mood and behaviors.
- Structure needed for weight restoration or stabilization: if you are in outpatient treatment or trying to recover on your own, you may simply need more help. The goal of day treatment is to provide several opportunities a day to practice the act or normal eating and manage the thoughts, emotions, and behaviors that come up at mealtime. Doing this every day, multiple times a day, is how you’ll get past the roadblocks that keep you sick. In day treatment, you can process your thoughts and feelings, and develop the skills to tolerate the distress that comes from following your meal plan and getting better.
- Structure needed to refrain from compulsive exercise: the drive to exercise, burn calories, or work compulsively on muscle definition is powerful in those with eating disorders. If you find you’re unable to stop acting on that compulsion, day treatment can give you the support and structure you need.
- Frequency of binge eating and/or purging: a good gauge for severity of an eating disorder is the average number of times a day or week you engage in the behaviors. If you’re binge eating, bingeing and purging, or some combination four or more times a week you should be in day treatment to make use of the structure and skills development provided to stop engaging the eating disorder.
- Suicidality: if you’re having mild thoughts of suicide but don’t have any intention or ability to act on them, day treatment is still an option for you. One of the biggest risks in any mental health program is when a client has thoughts, intentions, and resources to hurt themselves. That person needs to be stabilized in a residential or hospital program.
- Motivation: this is really important. If you’re motivated to recover, even just a little, then you can make use of that motivation and get started in a day treatment program. We expect there to be hard times, lapses in behavior, and fluctuations in your available energy to use your recovery skills. Learning how to recover while living in your home environment has actually been shows to improve outcomes. But it all starts with actually wanting to get better.
- Co-occurring disorders: if you have symptoms of untreated or under-treated depression, anxiety, or some other mental health or substance abuse concern, day treatment is the place to start. Having the security of daily monitoring of your symptoms is crucial when you’re going through psychotherapy treatment and psycho-pharmacology treatment.
- Environment/social supports: We often see college students and adults who are new to the area as examples of those who greatly benefit from day treatment. If you’re lacking in local supports, or have supports that just aren’t helping, day treatment is also a good fit.
- Previous level of care: if this is not your first step in eating disorders treatment, you’re like many of our clients stepping down from inpatient or residential care or up from outpatient or intensive outpatient program (IOP). But if you’ve never had treatment before, day treatment is still an option based on all the other factors we’ve gone over.
It takes a comprehensive treatment team educated in eating disorders and their physical, emotional, and social elements to determine the right level of care. It also takes a level of trust in that team for a client to put themselves and their recovery first and get the care they need. How can we help?