Description of available higher levels
Higher levels of care for EDs include various types of programs, with different levels of intensity.
The treatment goals for EDs are similar and include:7
• Restoring weight;
• Interrupting binge, purge, and restrictive behaviors;
• Managing physical complications;
• Enhancing motivation for recovery;
• Providing psychoeducation regarding regular eating;
• Challenging ED-related cognitions;
• Treating comorbid conditions;
• Supplementing family support; and
• Preventing relapse.
Psychotherapy approaches among higher levels of care are typically informed by cognitive behavioral and dialectical behavioral therapies. Family-based treatment is often incorporated for children and adolescents. Patients might transition between levels of care due to variables such as symptom severity, medical status, motivational status, treatment history, and financial limitations.7,8
There are several different levels of care from which to choose:
1) Inpatient hospitalization is the highest level of care available. This setting can be in a medical hospital and is intended for patients with acute medical instability. Alternatively, this may be in a psychiatric hospital if there are severe behavioral symptoms. In either event, subspecialty medical and behavioral consultation are readily available, meals are supervised, and one-to-one monitoring is available.
2) Residential programs offer full-time treatment in a non-hospital setting. Patients receive multidisciplinary care that includes nutritional support, medication management, and individual and group therapy.
3) Partial hospitalization programs (PHP), or daytreatment, offer treatment in an outpatient setting approximately six to 10 hours a day, between three and seven days per week. Patients typically spend nights and sometimes weekends on their own, allowing them to practice the skills they are learning in social, occupational, and leisure settings outside of treatment.
4) Intensive outpatient programs (IOPs) offer treatment approximately three hours a day, from three to five days per week. At both the PHP and IOP levels, patients receive meal support, group therapy, individual therapy, dietary sessions, and medication management.
Dr Anderson is Associate Clinical Professor Director of Training, Ms Simpson is Milieu Therapist, and
Dr Kaye is Professor and Founder and Executive Director, Eating Disorders Program, Department of Psychiatry, University of California, San Diego, CA. The authors report no conflicts of interest concerning the subject matter of this article.
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