Levels of Care in Eating Disorder Treatment: How to Choose the Right Option

Posted on October 1, 2024September 30, 2024 by Alison Pelz, LD, RD, CDE, LCSW

Treatment for eating disorder recovery isn’t a one-size-fits-all approach.

Every person is unique, and not everyone recovers in the exact same way. This is why eating disorder treatment is categorized into different levels of care, depending on what the person in recovery needs.

This post will provide a brief overview of the different levels of care available during eating disorder treatment.

What are levels of care?

Levels of care refer to how much support is needed to reduce eating disorder behaviors during treatment. Several levels of care may be utilized throughout treatment for an eating disorder, based on what is necessary for the person in recovery.

Treatment choices can be overwhelming if you or your teen are newly diagnosed with an eating disorder. Residential, day treatment, or outpatient care – what does this all mean?

Levels of care in eating disorder treatment are selected based on many factors including:

Medical: This often is the driving factor in selecting the level of care. If you or your teen are medically compromised more care may be needed.
Severity of malnutrition: Different levels of care offer varied amounts of support for nutrition rehabilitation.
Co-occurring conditions: Often those with eating disorders have other medical or psychological conditions that also need to be treated.
Social support: Social support improves mental and physical health. The different levels of care offer varying levels of social support.
“Motivation”: Most of us want to feel better and be healthy. However, change can feel scary, overwhelming and downright impossible at times. Those who feel more stuck in their eating disorder may need more support to feel like change is possible.
Access to care: Proximity to treatment, insurance, and specialty care are all considerations. Virtual treatment by clinicians and treatment programs are being utilized to increase access to care.

What are the different levels of care in eating disorder treatment?

In-patient hospital care

In-patient hospital care is used when a person with an eating disorder needs round-the-clock medical care. Since eating disorders have significant medical consequences due to malnutrition and/or purging, medical stabilization may be needed during treatment.

Residential care

In this level of care, round-the-clock care is provided in a therapeutic environment. This allows for intensive psychological treatment and nutrition rehabilitation, while also monitoring medical status. The residential care environment is highly structured and allows for the reduction of eating disorder behaviors.

Partial hospitalization

In a partial hospitalization program, the person attends several hours per day most of the week. Partial hospitalization provides psychological treatment (individual therapy, group therapy, and family therapy) and nutritional therapy, including therapeutic meal support. This level of care is very similar to residential care, just without spending the night. In this level of care, you or your teen may go in several days a week, and each day have a meal or snack at home.

Intensive out-patient (IOP)

This level of care is when you or your teen spend the majority of time at home and engaged in usual activities such as work or school. The person in eating disorder treatment usually has a therapist, dietitian, and doctor and attends several groups per week.

Outpatient

Outpatient care is considered the lowest level of care in eating disorder treatment. In this level of care, you or your teen are spending 2-3 hours a week in treatment with an outpatient treatment team. Oftentimes, outpatient services are utilized first because it allows the person in treatment to stay active in daily activities such as work or school. Outpatient care can be easiest to access because most areas, particularly with telehealth options available, have qualified eating disorder outpatient providers.

Family-based treatment (FBT) is an outpatient treatment for teens. It is particularly effective for teens with anorexia nervosa. FBT can be an option in place of residential care or partial hospitalization, if the person in treatment is medically stable.

How do I know which level of care is right for me?

First, consider your medical needs with your doctor. The more medically compromised the person with the eating disorder is, the higher level care they may need.

If residential treatment is recommended, that doesn’t mean the eating disorder is worse than others. It just means that you need this level of support to get back to health.

If you or your teen are utilizing outpatient care, your treatment team will work with you to help determine the level of support needed.

Many treatment centers provide multiple levels of care residential, partial-hospitalization, and IOP. The treatment center will help determine the level of care needed via an assessment, which is usually free and done over the phone.

It is not unusual to utilize multiple levels of care during the course of recovery.

For example, someone in treatment may start out as an outpatient. If the person in treatment and their treatment team determine that their eating disorder symptoms are not getting better, they may benefit from a more supportive level of care (which is also referred to as a “higher level of care”).

Eating disorders usually don’t go away on their own. They can progressively get worse over time. My hope is that if you, or someone you care about, is suffering with an eating disorder that you make the initial call to get help.

Hi! I’m Alison Pelz, a psychotherapist and registered dietitian in Austin, TX with over 16 years of experience in eating disorder treatment. If you or someone you care about is struggling with an eating disorder, don’t hesitate to reach out for help. To learn more about eating disorder treatment and levels of care, schedule a consultation with me today.

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Book Review: When Your Teen Has an Eating Disorder is a Must-Read

Posted on September 10, 2024September 11, 2024 by Alison Pelz, LD, RD, CDE, LCSW

In the book When Your Teen Has an Eating Disorder: Practical Strategies to Help Your Teen Recover from Anorexia, Bulimia, and Binge Eating, author Dr. Lauren Muhlheim discusses eating disorders and their treatment in great depth.

If you think your child or teen has an eating disorder this is a must read.

Eating disorders can perplex many parents and clinicians alike. Your teen may not be acting like their usual self, and it’s hard to know if this is just normal teenage angst or something more serious. If your teen has an eating disorder, they may have changed greatly right before your eyes: refusing food, feeling anxious around eating, or experiencing changes in mood and energy.

You may have tried several times to talk with them about the importance of eating and try to reassure them that they are not gaining weight. (In fact, they are likely losing weight.) But, your child’s struggles seem to be getting worse not better.

If your teen has not seen a doctor yet about their eating disorder this is the first step to make sure they are medically stable.

This book can help guide you and your family in treatment while establishing an eating disorder treatment team consisting, at minimum, of a doctor and therapist.

About the Book

When Your Teen Has an Eating Disorder discusses the complicated concepts surrounding eating disorders in teens in a non-clinical manner, so it can be more easily understood. The book provides helpful information about eating disorders, an overview of various treatment options, and goes into depth about a unique and well-studied treatment called Family-Based Treatment (FBT).

The author of the book, Dr. Lauren Mulheim, owns a counseling and training center in southern California called Eating Disorder Therapy LA. She uses Family-Based Treatment in her clinic and has been instrumental in training many of the eating disorder therapists in the Los Angeles area and beyond. She is currently serving on the advisory panel of FEAST (an organization providing support to families of those impacted by eating disorders) and is a regular speaker at national eating disorder conferences.

If you are a parent worried about your child and unsure how to help them overcome their eating disorder, or a clinician wanting to learn more about FBT, this book is a must-read. As an eating disorder therapist myself, I recommend this book to all of the families that I work with and to other clinicians. It will be a great resource and provide a glimmer of hope to you on your journey.

What is discussed in When Your Teen Has an Eating Disorder?

When Your Teen Has an Eating Disorder outlines the complexities of eating disorders and the impact that they can have on your teen (and your family’s) life.

A thorough list of the early warning signs of an eating disorder are discussed. These warning signs include:

Changes in eating and/or exercise habits
Frequent trips to the bathroom
Changes in body weight
Loss of menstrual cycle
Complaining of of feeling cold all of the time
Lack of growth
Obsessive thoughts about food, body image
Changes in overall mood
Poorer concentration

Muhlheim highlights the importance of early detection and intervention with trained clinicians, so that the eating disorder can be addressed before it escalates or becomes chronic.

Dr. Muhlheim provides the reader with an excellent explanation of how malnourishment impacts your teen’s ability to understand how the eating disorder is impacting their mind and body. Parents often feel perplexed when their bright, loving child begins to act irrationally around food. Parents will also learn how to separate their child from their illness, one of the basic assumptions of family-based treatment.

The majority of the book really gets to the heart of the matter: What parents really want to know when their child has an eating disorder. You might be asking yourself questions like “What do we do?” or, “How do we improve our child or teens’ health and get them feeling better again?”

This book can help you answer those questions. In it, Mulheim:

Outlines the path to help your child or teen heal from their eating disorder using family based treatment (FBT). Parents will then learn what the path to recovery from an eating disorder looks like using Family-Based Treatment.
Discusses the three stages of recovery-nutrition rehabilitation, eating independence and relapse prevention-in depth.
Provides parents rationale behind each step so parents can feel empowered to help their child.

Discover Practical and Helpful Tools to Help Your Teen in Eating Disorder Recovery

This book is a practical guide that provides effective, concrete strategies for eating disorder treatment, and examples of how to use them.

Muhlheim helps parents become empowered agents of change amid their child’s eating disorder. The book provides general guidelines about what to feed your child and how to structure meal times. It also highlights how to effectively interact with your child at each stage of treatment, and how to be empathetic with them when they are struggling.

Not only does this book share concrete strategies and practical steps, it also covers the challenges that parents might face during treatment. The book details what to do when your child refuses to eat. It also explains how the parents can get support throughout the difficult journey of helping their child get better. This helps parents know about the hard aspects of treatment they should expect beforehand, so that they are prepared.

Muhlheim provides all of this information while also sharing real-life examples throughout the book. The stories within this book help parents feel less alone about what is going on with their child. It also provides them with a realistic picture of what they are facing. These examples make parents feel more confident about applying the practical tools needed for recovery.

It is normal for parents to worry about how treatment will affect their relationship with their teen. When Your Teen Has an Eating Disorder emphasizes the importance of your relationship with your teen in the treatment of their eating disorder. It talks about how to further develop a family culture of unconditional acceptance and respect and focuses on the importance of trust, empathy, and understanding to support your child in their recovery. Furthermore, it provides the reader with strategies of how to talk to their teen about food and body image during the recovery process.

When Your Teen Has an Eating Disorder is a Great Resource For Parents

Whether your teen is struggling with anorexia, bulimia, or binge eating disorder, this book is helpful for parents. This book will help you if your child is newly diagnosed with an eating disorder, in early stages of treatment, or if your teen has been through several rounds of treatment already.

This book will empower you to support your child’s recovery. If you are seeking treatment for your child, it will give you enough information to decide whether or not Family Based Treatment is right for your family. If you decide that FBT is the best treatment option, this book walks you through how to create a treatment team that will be the best fit for your child and family.

As a therapist and parent, I appreciate how this book (and FBT in general), takes a very non-blaming stance on eating disorders. Parents aren’t faulted for the disorder and the child isn’t isolated from their family. This book recognizes the family-based treatment approach and belief that parents are the experts on their child. It emphasizes how treatment for eating disorders needs to include the family for best results and also the importance of meal support and nutritional rehabilitation for recovery. I highly recommend reading this book!

If you think your teen has an eating disorder please consult their doctor for assessment and medical care as eating disorders can be life threatening. If you are a parent and are interested in family-based treatment for your child in Texas, you can schedule a consultation with me here.

If you are a clinician looking for a book that can help you understand eating disorders and family-based treatment, you can get CEU’s for reading this book by clicking here.

*Please note this book is not a substitute for professional help from a doctor and eating disorder treatment professionals.

Can Family-Based Treatment Help My Child Recover from an Eating Disorder?

Posted on June 3, 2024June 3, 2024 by Alison Pelz, LD, RD, CDE, LCSW

If you are a parent or caregiver, desperate to help your child who is struggling with an eating disorder, family-based treatment may be the solution you are searching for.

Often, families come into my office worried sick about their child.

Their child might have lost a lot of weight or been acting “sneaky” around food. Maybe their child has been over-exercising, using laxatives, or throwing up after eating.

Or, they might be worried because their child only eats a small number of foods, or eats a lot of food at once.

Or maybe your child has become an extremely “picky eater”.

On top of that, parents are often terrified because they have heard doctors mention hospitalization and many therapists have turned them away. When they do research online, things look bleak.

No matter their child’s symptoms, when families first come in they are often frantic, frustrated, and feeling powerless. They don’t know what to do.

If you find yourself in a similar boat today, you’re not alone. I have worked with countless families who walk into my office feeling this way. Sadly, there’s a lot of blame put on the parents. All they want for their child is to get better and live a happy life without the constant obsession with food.

Many parents have been seeking help for a while. Unfortunately, they have found no real results. They often receive criticism, but no real guidance on how to help their child get better, or well-meaning doctors say they will grow out of it and that it’s just a phase.

I’m here to give you hope.

After years as a therapist and registered dietitian, I’ve seen the positive results that come from family-based treatment where parents are properly equipped and supported to be part of the solution their child needs.

Why Choose Family-Based Treatment?

Family-based treatment (FBT) for eating disorders is an evidence-based treatment for disorders like anorexia, bulimia, binge eating disorder, and even ARFID (i.e. extreme selective eating).

Unlike many other treatments that put the responsibility on the identified patient or the person with the eating disorder, FBT includes the parents. Instead of seeing the parents as part of the cause of the eating disorder, they are seen as part of the solution.

We use your expert knowledge of your child to help your child get better.

This method of treatment makes sense to parents. If your child had cancer or some other serious medical condition, you, as the parents, would be highly involved in treatments including appointments, physical therapy, and all the steps to recovery.

It shouldn’t be any different for treating eating disorders.

Eating disorders are an epidemic in our country. According to the NIH, for teens between the ages of 13 and 18, the lifetime occurrence of anorexia, bulimia, and binge eating disorder is 2.7%. These disorders are twice as common among girls than boys. They also tend to be more common the older the teen gets.

When it comes to ARFID or avoidant/restrictive food intake disorder, the prevalence is between 5 and 22%, with about 2% reaching the need for help. ARFID also tends to happen with anxiety disorders and neurodivergence. Effective, evidence-based treatment for eating disorders is important and necessary.

How Effective is Family-Based Treatment?

Family-based treatment has been used in the United Kingdom for many years. It has proven to be more effective than other forms of eating disorder treatment.

With a 75% success rate, teens receiving FBT also recover faster than with other treatments. The research also shows that teens are doing better after engaging in FBT than in other treatments.

How Does Family-Based Treatment Work?

In family-based treatment, a clinician guides the parents in empathizing with the child while also holding boundaries around eating, food, and other eating disorder behaviors like binge eating and laxative use.

The therapist coaches the parent on how to teach their child to eat again. The goal is for the child to eventually have age-appropriate responsibility with food intake and eating habits, once the child has reduced their eating disorder symptoms and is stabilized. They also want to encourage an appropriate relationship with food and their body image.

Family-based treatment usually lasts around 20 sessions and happens in three stages.

During the first stage, the parents are responsible for preparing and serving food as well as insisting that it gets eaten. They are pretty much doing what a nurse during inpatient treatment would do. There is no room for negotiation around food or other eating disorder behaviors like purging, misusing exercise, or laxatives.

The second and third phases include slowly giving responsibility for food and exercise back to the child.

During the second phase, the child may return to more normal activities while being supervised by their parents for any signs of relapse.

During the third stage, the child begins to transition back on track with their developmental stage of eating.

What Makes FBT Different?

Family-based treatment is quite different from the standard eating disorder treatment.

First of all, at its core, FBT does not blame the child’s parents (or the child) for the eating disorder. One of the core beliefs of family-based treatment is that no one in the family is to blame. Really, the focus is on getting the child well instead of placing blame.

In other treatments, the person with the eating disorder is treated on their own outside of the family system, but with FBT, the parents, child, and sometimes even the siblings, are involved in treatment.

The parents’ care and motivation to help their child are used to make some major changes in the family’s life, especially around food. Their unique expertise on their child is used to help them get better, and parents are taught how to interact with their child around food, and other eating disorder behaviors.

This allows the family to overcome the eating disorder, together.

Another difference with FBT is the focus on food, nutrition, and eating disorder behavior rehabilitation. FBT believes that a lot of the symptoms of the eating disorder will disappear when the child is better nourished and no longer using other eating disorder behaviors. So they first focus on nutrition, feeding, and decreasing the other eating disorder behaviors.

Often, parents think that their child has to be “motivated” for treatment to be effective. One of the differences with FBT is that the child does not need to be motivated to change to get better. The motivation to make change happen starts with the parents.

What are the Benefits of Family-Based Treatment?

Family-based treatment has benefits for both the family as a whole and the child, including:

The child or teen usually gets better faster than any other treatment, making it one of the quickest ways to help your child and family heal.
Parents are involved in the child’s treatment, allowing them to be the child’s primary support instead of feeling powerless and at fault.
This is a good replacement for inpatient treatment or partial hospitalization, allowing your child to stay home.
FBT is an evidence-based approach, so you know you are doing the best you can for your child.

Now that you know how FBT can help, let’s look at who it can help.

Who is FBT for?

FBT has been shown to be effective for kids, teens, and young adults. showing signs of eating disorders.

It has been used to help kids and teens who are struggling with anorexia, bulimia, binge eating disorder, as well as avoidant restrictive food intake disorder (ARFID).

In the cases of binge eating disorder and bulimia, the family is taught to help feed their child adequately and supportively interrupt binge eating, purging, laxative use, and misuse of exercise.

FBT works both for teens who have been to inpatient multiple times and still struggle to let go of the symptoms, and for teens who have just started to engage in eating disorder behaviors, and any child in between.

FBT is not just for teens, however. It can also be used with children and young adults still living at home. FBT can be used in all different types of families or caregiving situations (like grandparent caregivers and single-parent households).

Who Should Not Do FBT?

FBT is often used instead of hospitalization. If the child is underweight and does not have any other reason to be medically supervised, FBT can be a great option rather than hospitalization.

However, if your child or teen needs to be medically supervised for another reason, then hospitalization is recommended.

In the same way, if the child needs to be supervised for other psychiatric illnesses, then this is also a situation where FBT is not going to help until the child is stable psychologically. Family-based treatment may also not be a good option if the child has experienced certain types of trauma.

What Happens During Family-Based Treatment?

Family-based treatment may last around 20 sessions. At each session, you can expect your child or teen to check in with the therapist for mental health support.

After this, the therapist will meet with the parents and child for coaching around nutrition and other eating disorder behaviors. The coaching isn’t just about what to eat but also about how to talk to your child about eating and other eating disorder behaviors, including how to express empathy without giving in.

Unlike other eating disorder treatments where the therapist just meets with the child, most of the time, the FBT therapist meets with the caregivers and child.

Family-Based Treatment is Worth the Hard Work

Family-based treatment can be very intense for the whole family. In the beginning, you will be very involved in your child’s day-to-day life, as well as your child’s nutritional rehab, but the hard work will be worth it when your child learns to eat and regains their health again.

Not only does family-based treatment help your child stay home, as hospitalizations can last weeks or months, but it also helps to heal your whole family from the disruption that the eating disorder has caused.

While it can be hard to find family-based treatment, don’t give up! Finding someone who is trained to do family-based treatment can make the difference for your child.

At the minimum, when you are seeking FBT you will need to at least start with a medical doctor and a therapist. If your team includes a dietitian, initially they will only meet with the parents and not the child.

As a therapist who is also a dietitian, I can help you understand what is going on from both angles. If you are in Texas and interested in working with me, click here to fill out a contact form. I would love to support you and your child on your journey to health.

Free Resources for Eating Disorder Recovery

Posted on April 12, 2023September 16, 2024 by Alison Pelz, LD, RD, CDE, LCSW

Eating disorder recovery is tough. Learning about eating disorders can help. I have a great list of free resources.

Are you just getting started with eating disorder recovery? Or do you have a treatment team in place, but are looking for some extra support? Does your teen have an eating disorder and you’re looking for ways to support them (and yourself)?

Many of these free eating disorder recovery resources are in the form of support groups and mentorship programs.

Besides being free, the emphasis on connection is another reason why I love these resources. Eating disorder recovery doesn’t occur in a vacuum. We are social creatures, and connection can be especially healing in hard times.

Eating disorders are really hard to understand. Support groups can help you learn more about eating disorders while feel seen and understood. Eating disorder groups are filled with folks who are going through what you are experiencing and who can relate to your ups and downs.

Additionally, support groups reduce feelings of shame, guilt, anxiety, depression, and isolation. Attending an eating disorder support group can help you find new ways to cope during recovery.

If you or your teen is in eating disorder recovery, check out these 5 free eating disorder recovery resources:

1. National Alliance for Eating Disorders

The National Alliance for Eating Disorders is a great resource with lots of information about the treatment of eating disorders.

According to their website, “The National Alliance for Eating Disorders (formerly The Alliance for Eating Disorders Awareness) is the leading national nonprofit organization providing referrals, education, and support for all individuals experiencing eating disorders and their loved ones.”

The Alliance offers free support groups for people with eating disorders and those who love them. Support groups meet in-person and others meet virtually.

Click here to learn more about the free support groups offered by the National Alliance for Eating Disorders. For any readers in Austin, TX, there is an in-person group held weekly.

2. F.E.A.S.T. (Families Empowered And Supporting Treatment for Eating Disorders)

F.E.A.S.T. is an international network to help support caregivers and parents who have a teen with eating disorder.

The organization was started by parents to help other parents: “We are here because we have been there! F.E.A.S.T. is an international non-profit organization of and for parents and caregivers of loved ones affected by eating disorders. Our free programs and services offer families much needed support, information, skills, and tools to help them on their journey. F.E.A.S.T. is about parents helping parents, about paying it forward, and about being there for families at a time when they need us the most.”

Be sure to visit the services tabs on their website which links you to forums, guides, videos, and much more. The videos from F.E.A.S.T. are one of my favorite resources. There are videos of family members, who are going through the exact same thing as you. There are also videos from highly regarded eating disorder treatment professionals talking about various treatment topics so you can learn more.

Be sure to sign up for F.E.A.S.T. 30 Days. It’s a free program that sends you one email a day for 30 days, each including a brief lesson on how to support your teen during recovery.

3. ANAD (National Association of Anorexia Nervosa and Associated Disorders)

ANAD, or the National Association of Anorexia Nervosa and Associated Disorders, is a non-profit whose mission is to provide free peer support services to anyone struggling with an eating disorder.

Their website states, “Recovery is possible. ANAD is here to help. ANAD is the leading nonprofit in the U.S. that provides free, peer support services to anyone struggling with an eating disorder, regardless of age, race, gender identity, sexual orientation, or background. Our nationwide network of volunteers understand first-hand the ups and downs of the recovery journey—because they, too, have lived the experience of an eating disorder. ANAD empowers volunteers to help others through their own recovery.”

ANAD has a helpline where you can get referrals to treatment and get emotional support. In addition to the helpline, ANAD offers a free mentor support program. You can get matched with a peer mentor who has recovered from an eating disorder to help support you through the recovery process. Having a mentor who has already been through it can be extremely helpful in bolstering support, motivation to change, and instilling hope that recovery is possible.

ANAD also offers free virtual support groups for folks with eating disorders. They offer general support groups as well as groups for specific identities including LGBTQ+, BIPOC, Older Adults, Teens & Young Adults, and People in larger bodies.

4. Project HEAL

Project HEAL helps to find eating disorder treatment. Access to quality healthcare is not always easy, and there are lots of reasons why most people who deal with eating disorders do not get treatment. The goal of Project HEAL is to help those who the system fails find treatment for eating disorders.

According to their website, “Project HEAL’s vision is to create a world where everyone with an eating disorder has the opportunities & resources they need to heal. Our programs break down systemic, healthcare, and financial barriers that millions of people in the U.S. face when trying to heal from their eating disorder.”

They provide free services to help you find treatment including:

Clinical Assessment Program which helps determine a diagnosis, treatment recommendations, and referrals.
The Treatment Placement Program offers free or very discounted treatment via vetted treatment providers.
Cash Assistance Program Offers recipients a one-time cash assistance grant to help cover the costs of treatment.
Insurance Navigation Program. This program helps people navigate the complexities of insurance.

5. FEDUP (Fighting Eating Disorders in Underrepresented Populations: A Trans+ & Intersex Collective)

FEDUP is a collective that is made up of trans, nonbinary, intersex, and gender expansive people who view eating disorders through a social justice lens. Their work is focused on eating disorders in marginalized communities – understanding them, treating them, and preventing them.

Their mission is “to make visible, interrupt, and undermine the disproportionately high incidence of eating disorders in trans and gender diverse individuals through radical community healing, recovery institution reform, research, empowerment, and education”.

They have a wealth of information on their website. A list of free virtual support groups. FEDUP has an approved list of providers who provide affirming care, and a Treatment Scorecard which scores some of the largest treatment centers in the US on various accessibility criteria. In addition, they provide training and workshops for treatment facilities to become gender-literate. They also have a guide to gender-affirming surgeons with consideration of BMI limits for each surgeon.

This is just a short list of free and reliable resources to help support you in your eating disorder recovery. I encourage you to explore these resources to see if one is right for you!

Part of eating disorder recovery is working with a treatment team, which includes a psychotherapist. For more information on how I can help with eating disorder recovery, send me a message.