“It’s bad right?” That’s the first question we get asked when people call The Body Image Therapy Center for help with their eating disorder behaviors. And they want to know right then what they need to do to recover. That’s not as subjective a call as many think. There are guidelines for levels of care and we want to share them with you.
Let’s go over these acronyms so there’s no confusion.
- Standard Outpatient Program (SOP)
- Intensive Outpatient Program (IOP)
- Partial Hospitalization Program (PHP)
- Residential Treatment Center (RTC)
- Inpatient Treatment Center (ITC)
When do we know what level of care to place our patient? Only after we see them in person and assess them for the following areas: medical status, suicidality, frequency and severity of eating disorder behaviors and thoughts, ability to modify binge and/or purge behavior, ability to control level of exercise, motivation to recover, sufficient community supports, mental health status, and environmental stress. Now this is not a comprehensive list, but it’s a good place to start.
When is The Body Image Therapy Center the right fit?
Our treatment philosophy is that anyone with active eating disorder behaviors is better served by starting with our IOP program. This includes 4 meals a week in a therapeutic setting, group therapy, individual therapy, and nutrition counseling. It’s a commitment to be sure, taking up 12 hours a week in the evenings. But consider how much time is lost experiencing compulsive eating disorder thoughts and behaviors every day? One hour a week of therapy usually stretches out the course of treatment to many months, if not years. Our program for binge eating disorder (BED) typically lasts about 12-16 weeks and has over a 90% recovery rate. Our IOP track for anorexia and bulimia typically lasts 16 weeks, but can take longer depending on the severity of the disorder. It’s not uncommon to move people to a higher level of care when they find they can’t control their behaviors or feel significantly worse emotionally or physically while trying to recover at this level. Again, it’s often a starting point.
To be in the IOP program, clients have to have fair to good motivation, be medically stable, be able to decrease compulsive binge and/or purge behaviors over time, have adequate emotional and physical supports in the community, and be able to tolerate external stress without increasing eating disorder behaviors.
Our SOP track is for those who have eating disorder behaviors that are infrequent, but have significant thoughts that disrupt their life and need or desire the support of talk therapy and nutrition counseling.
When is it time to consider the PHP track?
We find that clients who are medically stable and have moderate to low motivation to recover, have moderate levels of intrusive thoughts that interfere with their ability to function normally in school or work, and have limited external support, need the extra care, motivation, and accountability of PHP. Our low-level PHP program adds a supervised snack, individual or family therapy four times a week, and additional nutrition counseling once a week for meal planning. This level is often good for students in high school and college who have the flexibility of afternoon and evening hours to devote to their recovery, or those who need to step up their treatment options from IOP care.
Full-day, or high-level PHP, is not part of our program, but is recommended for those who need significant help with meal structure and accountability to restore weight and stop all purging behavior. We work closely with area programs who can provide this level of care.
What about residential?
Residential is indicated for clients with very low weight [typically less than 85% of their pre-eating disorder weight], who can ask for support from others with coaching but generally have fair to poor motivation to recover, need supervision for all meals to avoid restriction, bingeing and purging behaviors or compulsive exercise, and are only cooperative with treatment in highly structured settings. Typically, these are more medically fragile patients who can be stabilized without the need for IVs or feeding tubes. While it is very uncommon, binge eating disorder is sometimes treated at this level when clients cannot stop themselves from bingeing and have become medically compromised due to the behaviors.
Inpatient treatment is recommended for anyone with significant medical issues such as very low heart rate, blood pressure, glucose, potassium, and electrolyte imbalance. Also for those showing compromised hepatic, renal, or cardiovascular functioning. This level is also for those with suicidal thoughts, very low body weight, additional psychiatric disorders that require strict monitoring, very poor motivation to recover, preoccupation with thoughts and behaviors related to the eating disorder, and need intravenous and feeding tube support.
I hope this helps you understand what to expect when looking for help with an eating disorder. It’s a very tough disease to beat, but getting into a recovery program that understands your unique needs and motivation can get you there.
By Andrew Walen, LCSW-C - Founder, Executive Director, Psychotherapist at The Body Image Therapy Center. If you would like to get in touch with Andrew please call 877-674-2843 or email firstname.lastname@example.org.