Treatment for an eating disorder is a very individualized process. Therefore, there are different types of treatments depending on how medically stable a person is and how much emotional support they need.
What to expect at each level of treatment:
Outpatient: for someone who is beginning to struggle with an eating disorder, or who is stepping down from residential or intensive outpatient (sometimes called IOP). There are two approaches to outpatient treatment: multi-disciplinary and family-based.
Multi-disciplinary: This type of treatment often involves regular meetings with ALL members of the treatment team. Medical providers usually schedule weight-checks for patients who are recovering from an eating disorder anywhere from 3 times a week to once a month. They may also want to check blood pressure, heart rate, and urine to make sure the patient is drinking enough fluids. Meetings with the therapist and dietitian may be scheduled weekly or bi-weekly.
Family-based treatment (FBT): This type of treatment puts parents and/or family members in charge of the recovery process. Family members control their child’s food and offer support at every meal and snack with guidance from a licensed therapist who specializes in family-based treatment. Family-based treatment is usually done at home, and may involve only the family-based therapist and a medical doctor, but other health professionals may also be involved. The focus of the treatment is on weight restoration and behavioral change. Once weight is restored the therapy will focus on normal adolescent developmental issues. This type of therapy is sometimes referred to as the “Maudsley” approach.
Intensive outpatient program (IOP): This type of treatment is for people either transitioning back into school, work, etc. from residential or partial hospital level of treatment, or for people who are not ready for or do not require a higher level of treatment. Intensive outpatient treatment usually involves evening group meetings 3-5 days per week. The amount of time spent at the program each day varies between programs. Usually 1 meal is supervised which may be provided by the program or brought by the patient.
Partial hospitalization program (PHP): This type of treatment occurs during the day and 2-3 meals are provided and supervised along with group and individual therapy, and nutrition education. Patients in partial programs often attend 5 days per week and go home at night.
Residential: This type of treatment is for medically stable patients who need a very structured level of treatment. Patients live and sleep in a center with other young people. Patients in residential programs have frequent meetings with their team (therapist, dietitian, nurse and/or health care provider, and psychiatrist) and have a lot of group meetings. After residential treatment, patients often meet with an outpatient team, or transfer to an intensive outpatient program.
In-patient: This type of treatment is for people with severe eating disorders who are medically unstable or people who were unsuccessful with treatment at a lower level. Patients receive 24-hour hospital supervision and care and have a very structured schedule. Once medically stable, patients may go home or go to residential treatment.
Treatment of eating disorders varies from person to person. Some people only do outpatient treatment, while others may need to transition through multiple levels of care as part of their eating disorder treatment. Transitioning into outpatient from inpatient or residential treatment may be very challenging in the beginning.
If you are transitioning from inpatient or residential to outpatient treatment, here are some important things to remember:
- Before you leave inpatient or residential treatment, set up an outpatient team that you can meet with regularly. Ask your treatment team to help you find providers that are the right fit for you and who accept your health insurance. Usually an outpatient team consists of a therapist, dietitian, HCP or nurse practitioner, and often psychiatrist and/or a family therapist.
- Some days will be easier than others. It’s OK and normal for you to have some challenging days.
- It will be your responsibility to follow your meal plan when you are in an outpatient setting, not engage in unhealthy behaviors, and maintain a healthy weight.
- Don’t be afraid to seek support from family and friends when necessary, especially around meals. In some cases, your parents might be asked to be in charge of your meal plan.
- Think about one meal at a time, and try not to become discouraged if you have a hard time once in a while.
- Be completely honest with your treatment team and tell them if and when you have any thoughts about disordered eating or if you begin using unhealthy behaviors again.
- Realize that treatment and recovery are a process and that might mean stepping back up to a higher level of care at some point if your behaviors and/or weight are not improving at the outpatient level of care.
Group Support Meetings can also be helpful before treatment or during recovery. People with eating disorders often find it helpful to meet other people who are experiencing similar challenges. Group meetings are both encouraging and valuable because young people can share stories, feelings, accomplishments, and coping methods. Group meetings can usually be found at local health centers, agencies, or schools.
Therapy: Because an eating disorder is both a medical and psychological condition, most people with eating disorders meet with a therapist or counselor as part of treatment. Although some people may feel embarrassed about going to therapy, it’s important to keep an open mind. Many teens, including those with and without eating disorders, find therapy very helpful.
Why should I see a therapist?
There are a lot of benefits to seeing a therapist and the specific benefits can differ from person to person. Although there are many different types of therapy, therapy tends to be individualized, meaning that you and your therapist will work on what’s most helpful to you.
Here’s what an individual therapist can do for you:
- Provide a safe place to (privately) share feelings without judgment and without fear of causing problems or hurting someone else’s feelings
- Give you a place to address other emotional problems that may be related to the eating disorder such as depression, obsessive-compulsive behaviors, and/or substance abuse
- Help you process parts of your life that may affect your mood
- Help you figure out reasons why you may have developed an eating disorder, what function/role it has played in your life, and what triggers you to use certain behaviors
- Help you examine thoughts that might be unhealthy, distorted, or obsessive
- Teach you healthy ways to cope with stress and manage strong feelings
- Help you build self-confidence, self-esteem, and a positive body image
One teen wrote: “It has always been hard for me to open up even to my closest family members and friends. When I finally started opening up in therapy and sharing thoughts and feelings that I had never talked about before, I noticed a huge difference in my mood and how happy I was. Since then, my friends have told me what a huge difference they see in me and how much more open I am. I know this sounds cheesy, but there is no way this would have been possible had I not gone to therapy.”
What are the different types of therapy I might find?
CBT (cognitive behavioral therapy): A type of therapy that teaches you how to be alert to the thoughts you have as you do certain behaviors. CBT targets thoughts and behaviors that are unhealthy or unhelpful. The focus of CBT is to decrease negative thoughts or unhealthy behaviors.
DBT (dialectical behavioral therapy): A type of therapy that encourages you to embrace the thoughts and feelings you have but to think in ways that prevent harmful behaviors. It is primarily a group-based therapy with individual therapy back-up. You keep logs of your thoughts and feelings, and you will learn and discuss coping strategies with your therapist.
Family therapy: A type of therapy that involves you and your family members and or friends meeting with a therapist. Many treatment programs will include family therapy because it can be a very helpful place to discuss family issues and tensions while there is a therapist or counselor there to find a solution. It can also be a good place to talk to your family members and friends about your eating disorder and how they can best support you throughout the process of recovery. Note: this is different from family-based treatment (FBT) which is described above.
Group therapy: Is when you and other peers meet with a counselor as a group and can share experiences, stories, goals, etc. It can be very helpful to talk to other people who are going through the same thing as you and get advice on what has helped them.
- It’s ok to feel uncomfortable at first. It takes everyone different amounts of time before people begin to feel comfortable opening up to their therapist. If this is your first time seeing a therapist, it is totally normal for you to be shy.
- Be honest. Therapy gives you a chance to share how you genuinely feel without being judged or offending anyone. Everything you say to your therapist is confidential, unless you say something that makes them concerned for your, or someone else’s safety. The more honest you are with your therapist, the more helpful therapy will be.
- If you don’t think your therapist is a good match for you, find another therapist. It’s very important for you to feel like you can trust your therapist. If you don’t connect with them, don’t be afraid to ask your parents to find you another one. The more comfortable you feel, the easier it will be for you to open up and be honest.