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Text in the bottom left corner reads "Levels of Care in Eating Disorder Treatment: How to Choose the Right Option", layered over a stock photo of a Black woman on a couch, talking to a healthcare provider.

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

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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.

Are you a clinician? Sign up for my mailing list and get a coupon for 10% off of one of my CE courses!

A graphic that reads "Finding Support as the Parent of a Child with an Eating Disorder" in white text on the bottom left above a stock photo of a father and daughter working together at a table on homework.

Finding Support as the Parent of a Child with an Eating Disorder

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It’s not easy to be a parent or caregiver for someone who is struggling with an eating disorder, at any age.

Parenthood is often described as having your heart walk around outside of your body, so watching your child struggle with such a complicated disorder can be heartbreaking. It’s scary to feel like your child needs help beyond what you can give.

Eating disorders don’t go away without being treated. It is essential for your child to begin treatment for their eating disorder so they can get relief from the distress they are feeling.

As a parent or caregiver, you are an important pillar of support for your child as they go through eating disorder recovery.

Eating disorders are complicated, and we often don’t learn much about them until someone we know is dealing with one. Much of the ‘common knowledge’ out there about eating disorders are actually myths, like that eating disorders only affect teen girls or that they’re not that serious. Eating disorders don’t discriminate by age or gender- anyone can develop an eating disorder. In fact, a common risk factor for developing an eating disorder is a history of dieting.

As the caregiver of someone with an eating disorder, you naturally want to do what you can to help your child through this. Learning more about eating disorders can help you understand what your child is going through, and connecting with other caregivers can give you an opportunity to feel supported yourself. You don’t have to go through this alone.

Here are some resources for caregivers of children with eating disorders:

Eating Disorder Books For Caregivers:

The following books give practical strategies for families supporting their loved one with an eating disorder. They are all using a family-based treatment (FBT) approach to treating an eating disorder.

Family-based treatment empowers the family to help support their child through nutritonal rehabilitation and eating disorder behaviors.

Support Groups + Other Resources for Caregivers

Here are a list of support groups for caregivers. Many families find it helpful to learn that they are not alone in their struggle.

FEAST Resources

Families Empowered and Supporting Treatment for Eating Disorders (Feast) is a non-profit that supports caregivers and loved ones with eating disorders. FEAST provides free support to caregivers around the world:

  • FEAST’s First 30 Days Educational Service
    • Information delivered right to your inbox on how to care for your loved one.
    • “We want to change the course of a family’s caregiving journey in 30 days. These 30 days of lessons are meant to start the family on a new course of empowerment and good information. Over the 30 days you will learn about eating disorders, caregiving, and the resources available for ongoing learning. We will introduce you to the resources and the peer support of our worldwide community.
  • Forums to get support from other caregivers
    • “This is a free service provided for parents of those suffering from eating disorders. It is moderated by kind, experienced, parent caregivers trained to guide you in how to use the forum and how to find resources to help you support your family member. This forum is for parents of patients with all eating disorder diagnoses, all ages, around the world.”
  • Webinar Series that frequently feature leading researchers and experienced clinicians in the field.
  • FEAST’s Parents Do Not Cause Eating Disorders Info Page
      • This statement may seem obvious, but it is the sad history of eating disorder treatment that parents are sometimes still blamed or feel blamed when a loved one develops an eating disorder. For those families suffering from guilt, from feeling blamed, or unsure of who to believe on this topic, here are some things to keep in mind.”

Are you looking for more ways to support your child as they recover from their eating disorder? Working with a treatment team is the gold-standard for eating disorder recovery, as eating disorders impact health in many ways, from physical to mental health.

Part of a treatment team for eating disorders is a psychotherapist. For more information on how I can help, send me a message.

A graphic that reads "Parents: An Essential Part Of Eating Disorder Treatment" in white text in the bottom left corner, over a stock photo of a frustrated looking mother and daughter.

Parents: An Essential Part Of Eating Disorder Treatment

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To all the parents out there: you are an important part of your child’s eating disorder treatment team! This is true even if your child is no longer a child, but a young adult or an adult. Even if you don’t live with your child, you have an important role to play in eating disorder recovery. 

Why are parents + caregivers so important in eating disorder recovery? 

Therapists, doctors, and dietitians are must-haves on any eating disorder treatment team. But parents have an important role to play too! Here are a few reasons why parents are important in the recovery process:

  • You spend much more time with your child than the treatment team does. As a therapist, I may spend one to two hours a week with your kiddo, you spend dozens of hours!
  • You are usually involved in feeding or making sure that your teen is fed.
  • You have a relationship with them. They trust and love you. If you are a parent of a teen, I know it may not always feel like it, but it is true!
  • You know your child better than anyone else!

Where do eating disorders come from?

Eating disorders are thought to function as a way to cope with uncomfortable feelings. Feeling distressing emotions is, well, distressing. Eating disorders often develop as a coping mechanism to avoid feeling those painful feelings. It’s possible to learn new ways to cope to manage those distressing feelings. 

As a parent, you can learn tools to help your child manage their feelings without using the eating disorder to cope.

When you hear this you may feel like a deer caught in the headlights. 

  • You may be thinking, “Yeah right! I can’t even get through a conversation with my teen without it turning into a fight.” 
  • Or maybe you’re thinking, “I can’t get them to say more than a few words to me.” 
  • You may even be throwing your arms up in exasperation because your kiddo is in total denial of their eating disorder.

If your child has an eating disorder, you may be feeling a range of emotions all of which are okay. You might feel anger, worry, sadness, resentment, disbelief, panic, and hopelessness, to name a few. And you may be feeling no way equipped to help your child recover from an eating disorder, but you are wrong.

Historically, parents weren’t always involved, and at times even discouraged to participate, in the treatment of eating disorders. In recent years, we are learning that parents can be a really powerful tool in their kid’s recovery process. This holds true not just for eating disorders, but for all mental health conditions. Parents have an important role to play! 

Parents often blame themselves or feel responsible for their child’s eating disorder.

I haven’t met a parent or loved one who doesn’t want what is best for their loved one – to be happy and live a productive, healthy life.

Let me be clear: you are not to blame for your child’s eating disorder. 

Eating disorders are complex. They develop for a variety of different reasons including social, biological, and psychological factors. For example, did you know that being a girl or a history of dieting are risk factors for developing an eating disorder?

As an eating disorder therapist + dietitian, I encourage parents to focus less on why their child has an eating disorder, and more on eliminating the eating disorder. 

For example, if your child developed cancer you would spend less thought on why she got it, but more on getting her good treatment.

While you are not to blame for your child’s eating disorder, you certainly can be part of the treatment and solution. Often, parents don’t feel equipped to help their children recover. Parenting is hard, and parenting a teen with an eating disorder has a unique set of challenges. 

You are right you may not have the eating disorder knowledge (yet!) to help. But, you do have a special connection and bond with your child that is so powerful in the treatment of eating disorders.

Some parents report that their kids don’t want help for their eating disorder, or even that they are in denial about their eating disorder. Certainly, this feels like it is true, but it is not. 

Remember eating disorders are a way for your child to cope with discomfort. Yep that’s right – just like their lovey or security blanket that they had as a kiddo! The disorder is serving a purpose, even if it’s not a healthy way to cope. Since the disorder is filling a need, it might seem like on the surface, your child doesn’t want to acknowledge or deal with it. However, living with an eating disorder can be a miserable existence. Your child deserves better!

Now that I have (hopefully) convinced you that you are an important part of your teens recovery, you may be asking yourself how do I help my teen? 

Here are a few tips to get you started.

  1. Get educated about eating disorders. Here are specific resources for parents.
  2. Make sure that your teen has a complete treatment team.
  3. Verbalize to your teen that while you don’t have all the answers, eating disorders are serious mental health conditions, treatment is needed, and that you are going to be there every step of the way to support them.

Are you looking for more ways to support your child as they navigate eating disorder recovery? Please feel free to book a free 15 minute phone call with me to learn how to better support your teen as they navigate an eating disorder. 

Must-Ask Questions When Looking For An Eating Disorder Therapist

Must-Ask Questions When Looking For An Eating Disorder Therapist

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Let’s face it, finding the right eating disorder therapist for your eating disorder can be daunting. It can feel downright overwhelming. You may be ambivalent about getting treatment. Maybe you are worried that your eating disorder isn’t “bad enough” to warrant treatment (trust me, it is). Or perhaps you are feeling hopeless about finding another therapist after being treated in the past.

Whether you are an individual with an eating disorder or a loved one of a person with an eating disorder, looking for a qualified therapist can be tough.

This post will give you tips on what to look for in a treatment provider, and questions to ask to help you determine the right eating disorder therapist for you.

Most therapists are willing to talk with you on the phone before you set an initial appointment. They will help assess goodness of fit in regards to scheduling, payment, and issues you may want to address in therapy.

If the therapist doesn’t offer a phone consultation, then these questions can be asked in the initial face-to-face appointment.

You can use the following questions and talking points when interviewing a potential therapist:

How do you help clients with eating disorders?

If a therapist has a lot of experience treating eating disorders, they should have a concise and clear answer. Many well-meaning therapists indicate on their website, referral site, or insurance websites that eating disorders are their specialty, but really don’t have experience treating eating disorders.

Because of the complex nature of eating disorders, try to get a therapist with extensive experience with eating disorders if possible.

Do you have a network of other professionals who have experience treating an eating disorder to whom you can refer me?

The gold standard of care in eating disorder treatment is to have a multidisciplinary team. An eating disorder treatment team usually consists of a therapist, registered dietitian, medical doctor, psychiatrist, family therapist, and possibly other specialists.

If the therapist has experience treating eating disorders, they should have a relationship with other treatment providers in your community. To learn more about eating disorder treatment teams click here.

What hours do you see clients and what are the payment options?

The course of eating disorder treatment can be long. Having a conversation up front with a potential eating disorder therapist about finances and scheduling is important. Be sure that the scheduling and payment options work for you over the longer -term.

Here are a few resources to help you find a qualified eating disorder therapist in your area:

Finding an eating disorder therapist can take time.  Consider breaking down your search into smaller pieces and chip away at it each day.

Additionally, if you feel overwhelmed trying to find an eating disorder therapist, ask a friend or family member to help you in your search.

Please call for a free 15-minute phone consultation to learn how I work with clients with eating disorders.

Don’t live in the Austin Area, but want tips about how to improve your relationship with food and your body? Subscribe to my newsletter here.

Must-Ask Questions When Looking For An Eating Disorder Therapist
Must-Ask Questions When Looking For An Eating Disorder Therapist


5 Signs That It Is Time to Get Treatment for Your Eating Disorder

5 Signs That It Is Time to Get Treatment for Your Eating Disorder

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Anticipating getting treatment for your eating disorder can be daunting for many reasons.

Maybe your friends and family are worried about you and pushing you to get treatment, but you feel like they don’t understand.

Perhaps you have gotten treatment and feel like it hasn’t helped.

Or you may feel like you can beat the eating disorder on your own.

You are not alone.

Most clients I see are often unsure if a) they want to recover, b) they can recover, or c) Their eating disorder is “bad enough” to need treatment.

Furthermore, you may feel ambivalent about getting treatment because your eating disorder may have helped you.  What I mean by this is that your eating disorder may have stuck by your side, given you a sense of control, or provided feelings of safety.  You may even feel like it is who you are.

On the other hand, treatment can offer new ways of coping, improve your self-confidence and self-esteem, and help you achieve goals that you never thought were possible.

Eating disorders don’t go away without professional treatment.

Untreated eating disorders usually get worse and harder to treat as time goes on. They can cause serious medical problems, some of which can result in death.

Here are 5 Signs that it is time to get treatment for your eating disorder:

1.  You think about food a lot. 

If you’re planning out your day around food as soon as your feet hit the ground-what to eat (and what not to eat), when, and how much- you might have an eating disorder.   Thoughts about food take up so much head space and can be exhausting.

For example, you may have thoughts similar to these: “Did I make the right decision about what to eat?”, “She didn’t eat a snack.  Should I be eating a snack?”. Your thoughts about food can be so pervasive at times that they lead to poor concentration, feelings of worry, sadness, and/or guilt.

2. You have problems concentrating on tasks. 

Whether you are at school, work, or at home, it is hard for you to stay focused on the task at hand (or maybe hard for you to even get started).  Your brain needs adequate fuel to function properly, and if you have an eating disorder, chances are you are not properly nourished.  Poor concentration can be the result of inadequate and/or poor quality nutrition and erratic eating.

3. You feel alone.

Eating disorders can be isolating. Eating and food can be a big part of family and social engagements. You may find yourself avoiding social situations because the food associated with these engagements is too anxiety provoking. Or you may attend the social engagement, but feel distracted or not fully present because you feel worried about food or fitting in.

Poor body image may also cause you to avoid social situations.  Feeling worried about how you look and what others are thinking of you may cause you to stay home. Isolation can make the eating disorder worse, increase feelings of depression and anxiety, and erode your self-confidence.

4. You find yourself being dishonest with others. 

Most of us value honesty.  Trustworthy and honest may be words that you use to describe yourself, except when it comes to your eating disorder. Often, eating disorder behaviors such as purging, binge-eating, and restriction are done in secret because you have feelings of guilt and shame around the behaviors.

5. You want to stop your eating disorders behaviors but can’t. 

It is not unusual for people with eating disorders to try to get better on their own.  You may have had success for short periods of time, maybe even months.  But then life happens and the behaviors come back.  Trust me, it is not because of lack of effort, intelligence, or motivation that you can’t stop your eating disorder on your own.  It is the nature of eating disorders.  They are complex, consisting of psychological, biological, and social factors.  Adequate treatment by experienced clinicians is needed to help support you in your recovery.

This is a very short list of signs.  Even if you experience one of them (or none of them but know that you are struggling), please talk to a professional.  I know taking that first step to seek treatment is hard and scary, but if you have any inclination to improve your situation, seek treatment.  The National Eating Disorder Association is a great resource.

Please call for a free 15-minute phone consultation to learn how I work with clients with eating disorders.

5 Signs That It Is Time to Get Treatment for Your Eating Disorder
5 Signs That It Is Time to Get Treatment for Your Eating Disorder