Residential treatment, sometimes called inpatient treatment for eating disorders, is the most effective way to secure a full recovery, but it’s a major step. A potential client has to have a strong motivation to get better to make the most of it. Most residential eating disorder treatment centers are ready to support that motivation with several different options for the types of treatment their clients receive. This variety of treatment options allows for a great degree of individualization in the types of programs and specific treatments with which each client can engage.
Many of these options are also available in day treatment programs, on a more limited basis. Day treatment, sometimes called outpatient (although outpatient can mean several different kinds of programs like PHP or IOP) treatment, provides a less intensive but more flexible set of options for many individuals. Here, we’ll explore the different options for treating eating disorders like anorexia nervosa, binge eating disorder, bulimia nervosa, ARFID, OSFED, and others.
Residential Eating Disorder Treatment
The most intensive and comprehensive form of eating disorder treatment, residential treatment is a type of program where the individual requiring help leaves home and stays at a specialized treatment facility. These treatment programs may last anywhere from 30 days to six months or more, depending on the medical, psychiatric, and emotional needs of the client. While there are many advantages to residential treatment, it’s not necessarily the best choice for every person. Some of the key points to understand about residential eating disorder treatment include:
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Residential treatment is the complete package.
Residential programs for all kinds of eating disorders put the client’s entire focus on recovery.Clients live at the center for at least 30 days, and during that time everything they do is part of the recovery program. The daily routine will often revolve around group therapy, individual therapy, with 24/7 medical and psychiatric support. Experiential therapies and life-enhancing experiences like cooperative cooking classes and art therapy are usually offered as well.
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Roadblocks to recovery in the client’s environment can be avoided in residential treatment.
Family relationships other triggering factors in a person’s environment in everyday life often have an impact on the development of eating disorders. Anything from work stress to difficulties in personal relationships can make things worse. One of the great advantages of a residential eating disorder program is that it allows individuals to step away from these things and focus fully on recovery. Even more importantly, many residential programs include a family therapy segment that can train the client’s loved ones to support the client’s transition to a recovered life after residential treatment is over.
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Dual diagnosis treatment programs are usually available in residential treatment.
Psychologists, therapists, and other mental health professionals have long toned that eating disorders and other mental health conditions like anxiety are often co-occurring, i.e. happening at the same time as the eating disorder. Trying to recover from an eating disorder without simultaneous treatment for anxiety and/or depression is truly an uphill battle; it is not always an easy path. Programs that address both the eating disorder and a co-occurring disorder like PTSD, anxiety, or major depression are almost always included at a quality treatment program.
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Residential programs provide protection from the often-present danger of self-harm.
People that are at risk of self-harm or suicide, who are experiencing what’s known as suicidal ideation, or persistent thoughts of suicide, need special attention and support.Unfortunately, people with eating disorders have a much higher rate of suicide and suicidal ideation than the rest of the population. Fortunately, residential eating disorder recovery centers are usually equipped for suicide prevention by offering support and monitoring around the clock. Because they have mental health professionals on-site, they are often the best choice for individuals at risk of self-harm.
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Medical care is available 24/7.
Eating disorders can result in health complications corresponding to improper nutrition – so any treatment center that requires residence must have a certain level of medical capabilities. This medical care might include support for diabetes, malnutrition, heart, or renal disease. At a residential facility, it can be ensured their healing includes the medical treatments they need.
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Severe cases require all-day support to break through to a full recovery.
The support offered by the staff at a residential center is useful for more than just keeping clients comfortable – it means self-destructive patterns can be corrected more quickly through consistent application. The residential care team is there at all hours of the day, so every time someone is returning to disordered thoughts and actions, there are psychologically gentle, judgment-free reminders of why they are there. A kind, compassionate professional is available to step in and intervene when necessary.
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Sometimes day treatment programs are not close to where the client lives; residential may be more convenient than driving hours several times a week.
For people in small towns or rural areas, there may not be a day treatment center close enough to make the journey workable. Although residential treatment is usually more expensive, for people living far from a major city, it may be the only viable option. With a residential eating disorder program, there is no need to travel. Instead, they can live at the center until the program has concluded.
Drawbacks of Residential Treatment
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The time commitment and expense may be too much for some people.
The idea of devoting a month or more to a residential eating disorder treatment is often intimidating, especially for individuals obligations that can’t be avoided. A month is a long time to be away from children, work responsibilities, friends, family, work, school, and so on. While residential treatment has many significant advantages, it is important to acknowledge it may be a more intensive treatment than some people are ready for. Likewise, some people may not be able to afford out-of-pocket expenses related to residential treatment, although insurance might mitigate this.
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Residential treatment isn’t always needed for less severe cases.
Residential programs can be very effective for treating all types of eating disorders, but that does not mean residential treatment is required for every individual seeking treatment. Eating disorder day treatment is also effective. Whether residential or outpatient is the right treatment option must be determined by the individual’s doctor, therapist, and the treatment center.
Day Treatment for Eating Disorders
While day treatment programs almost always use many similar types of treatment offered in residential programs, like evidence-based methods such as CBT and DBT, there are some significant differences. During day treatment, the client doesn’t live at the center. Instead, regular appointments at the facility give them a chance to get treatment several times a week, meeting with the therapy team according to their own schedule.
Some of the positive factors to consider about day treatment include:
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It’s less disruptive to the life of the client
As stated before, residential treatment is a big commitment. It’s never easy to put aside all your responsibilities and social life, no matter how necessary getting help is. As long as the client’s doctors think day treatment is sufficient for the severity of the case, it can prove a solution when one needs treatment. Perfect for when someone needs eating disorder treatment but cannot leave life behind for the extended period demanded by residential care.
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Some cases of eating disorders aren’t severe enough to warrant residential treatment.
Although any eating disorder should not be ignored, the spectrum of eating disorders can range from less severe to much more dangerous. With severe eating disorders, 24/7 medical and psychiatric care is often required. With less severe disorders, there may not be as pressing a need for intensive care. The less severe the disorder, the less necessary residential supervision can be.
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Day treatment programs are generally less expensive than residential programs.
While health insurance benefits normally help with the cost of recovery, not every type of insurance can completely cover the cost of intensive inpatient or residential treatment. Unfortunately, eating disorders affect people of all socioeconomic statuses. This means that for some people, the more expensive residential option simply isn’t viable. Day treatment facilities can provide valuable treatment without higher costs, meaning more affordable programs for many clients, especially those without insurance.
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A day treatment program is an ideal step-down option for people who have finished residential treatment but still need therapy to avoid relapses and continue their recovery.
Residential programs can completely transform a person’s life, freeing them from the suffering caused to an ongoing eating disorder. And yet, eating disorders don’t simply go away after 30 days. No matter how effective the residential treatment was, the stresses of day-to-day may cause stress which can trigger relapses. To assuage the stresses of these triggers, many graduates and recent alumni of residential programs choose to continue sessions on a day treatment basis. An outpatient program allows them to reconnect with the support of recovery specialists, and serve as a great refresher on the tools required to live a recovered life.
The Main Drawback of Day Treatment
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Outpatient treatment may not be enough for some people.
It is worth noting that outpatient treatment may not be ideal for every individual. The more severe the eating disorder, the more likely it is that residential care will be more appropriate. There are also issues of safety to consider. If the client’s health is severely compromised, or if there is a significant risk of self-harm or suicide, constant monitoring may be required to ensure their safety.
Choosing Between Residential and Day Treatment Options
When an individual has received an eating disorder diagnosis and begun to seek help from an eating disorder treatment facility, they should face the challenge of deciding whether to try a residential or day treatment together with their family and their medical team. In every case, the individual’s unique needs must be the foremost consideration.
No matter how tempting it can be for people with an eating disorder and their families to decide on their own, the doctor and/or therapist should always be consulted and listened to. Another viable option is to seek out the experts at an eating disorder treatment program near you. They are trained to help with the decision-making process and can advise individuals and their families on which treatment options are most likely to produce the desired outcome.
Melissa Orshan Spann, PhD, LMHC, RTY 200, is Chief Clinical Officer at Monte Nido & Affiliates, overseeing the clinical operations and programming for over 50 programs across the U.S. Dr. Spann is a Certified Eating Disorder Specialist and clinical supervisor as well as an accomplished presenter and passionate clinician who has spent her career working in the eating disorder field in higher levels of care. She is a member of the Academy for Eating Disorders and the International Association of Eating Disorder Professionals where she serves on the national certification committee, supervision faculty, and is on the board of her local chapter. She received her doctoral degree from Drexel University, master’s degree from the University of Miami, and bachelor’s degree from the University of Florida.