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Is Residential or Day Treatment the Better Option for You?

One of the keys to a successful stint at an eating disorder treatment center is learning about your options before committing to one center or plan. Learning more about what to expect at residential or outpatient may provide a sense of motivation to get better. Most eating disorder treatment centers are ready to support that motivation with programs that match their clients’ needs and desires. This variety of treatment options allows for a great degree of individualization.

The Basic Types of Program – Residential and Day Treatment

No matter which type of eating disorder you or a loved one is seeking treatment for, the available programs normally fall into two categories – inpatient and outpatient. Those terms are often interchangeable with, respectively, with the terms residential and day treatment, although terminology surrounding certain medical and psychiatric programs are more specific. Understanding the main characteristics of each of these categories may make it easier to choose a program.

Residential Eating Disorder Treatment

Useful in treating severe or long-term cases, residential treatment is a type of program wrehere the client lives at the eating disorder recovery center during their treatment, enjoying 24/7 support and unbroken focus on recovery. These treatment programs may last anywhere from 30 days to six months or more. Residential programs are intensive; while they might not be the most accessible programs for people with responsibilities such as child care or school, they afford the most complete spectrum of care for treatment. Some things to know about residential eating disorder treatment include.

  1. Residential treatment focuses everything in a person’s life around recovery.

Residential programs for anorexia nervosa, binge eating disorder, bulimia nervosa, and other eating disorders focus 24/7 on working toward recovery.Clients live at the center and their lives are structured around healing. Normally, the client’s day will follow a predetermined routine, from wake-up time to various therapy sessions, food preparation, and mealtimes. As treatment continues, more privileges and free time may be allowed as rewards for meeting certain milestones.

  1. Residential treatment removes environmental triggers for disordered eating behaviors.

Many disordered eating behaviors act as coping mechanisms to stressors in the individual’s environment. For example, negative feelings after a fight with one’s partner might lead to a binge eating session followed by purging in the case of bulimia nervosa. These factors can be quite powerful, often repeating in a disordered cycle. Residential treatment programs remove these outside factors to a great extent (although be aware it can’t remove all possible triggers). Many residential programs also include family training sessions that give the client’s loved ones a chance to prepare themselves for the client’s return and provide support.

  1. Residential programs are the best way to counteract the danger of self-harm.

People that are at risk of self-harm or suicide benefit from psychiatric supervision and 24-hour available support, which can only be provided by residential programs.Most evidence suggests that people with eating disorders have a much higher incidence of suicide than the rest of the population. In addition to the medical and nutritional coverage provided by residential treatment, the mental health professionals on-site can provide preventive support for clients at risk of self-harm.

  1. Medical concerns can be treated in-house at a residential center.

Eating disorders can result in health complications. Depending on the nature of the individual’s disorder, these medical concerns can correspond to both obesity and malnutrition.Because of these complications, residential treatment centers normally provide medical support in-house, without the need for outside hospitals or clinics. For example, clients with diabetes, heart troubles or malnutrition need extensive medical care in addition to the therapy and counseling. Unlike outpatient treatment, full medical care can be ensured.

  1. Ongoing monitoring means severe eating disorder behaviors can be addressed.

When an individual engages in outpatient or day treatments, their actions at home or away from the treatment center can’t be monitored. Residential programs can put certain restrictions and monitoring solutions in place that can curtail disordered eating behaviors. For example, clients may not be allowed to flush their own toilets, to prevent hiding the evidence of purging related to bulimia nervosa.

  1. Residential treatment is a great option for people who don’t live close to an outpatient option.

Outpatient is a great option for many people, but for those who live far away from a large city or suburb, making a several-hours drive to a center just isn’t possible. For people in this situation, a day treatment puts too much of a time commitment. With a residential eating disorder program, though, there is no need to travel beyond the initial admission. The center provides all meals and other living arrangements and since the client doesn’t leave the center except on supervised excursions, it might be the better option for someone who doesn’t live very close to an outpatient center.

What Are the Cons of Residential Treatment?

  1. Residential treatment requires a big commitment.

The idea of devoting a month or more to eating disorder treatment can be a frightening prospect, especially for people struggling with emotional distress or stringent responsibilities. A month is a long time to be away from friends, family, work, school, etc. Some people with eating disorders simply may not be ready to make that level of commitment

  1. Residential treatment might be too intensive for some cases.

Inpatient 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. Outpatient eating disorder treatment is also effective. Whether inpatient 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

The main difference between day treatment and residential treatment is that during day treatment, the client doesn’t live at the center. Instead, they regularly attend therapy and other training sessions on a regular basis at the center and return home at night. It’s often used as a step-down for people who’ve completed a residential program, but it can also be effective as a primary option.

Some of the factors to consider about outpatient treatment include:

  1. The individual can maintain their responsibilities without much disruption.

Residential treatment is a big commitment, and nr everyone can take a leave of absence from their job or school to enter a residential facility.If the medical team determines that the client doesn’t require 24/7 coverage, day treatment might be the better option. Often the talk therapy and group therapy sessions will be identical to those received in residential treatment and without the need for the time commitment required by residential.

  1. Day treatment can be sufficient for less-severe eating disorders.

As with any psychiatric or mental health condition, an eating disorder can have levels of severity. As an example, a person with anorexia nervosa may have a need for intense medical care related to malnutrition, or they may have only recently begun to restrict food intake. With less severe disorders, there may not be as pressing a need for intensive care. In situations like this, 24/7 coverage may not be necessary. However, no eating disorder should be ignored – outpatient or day treatment should be fully discussed with the medical and therapeutic professionals before deciding.

  1. Day treatment programs are generally not as costly as residential programs.

While health insurance benefits normally help with the cost of recovery they are still more costly than an outpatient program. Insurance may cover an entire day treatment program where it can’t do the same for residential. For people with less means to afford a treatment program, day treatment might be the only option. Day treatment facilities can provide valuable treatment without higher costs, meaning more affordable programs for many clients.

  1. Day treatment programs are perfect for step-downs following the completion of a residential eating disorder program.

Even though residential programs are effective in retraining people’s distorted thought patterns and behaviors, treatment often continues for years after ward. Aftercare is an essential part of continuing recovery since relapse is common and daily life brings with it many triggers. These stresses can be enough to challenge a recovered individual’s thought patterns and behaviors, which is why many recovered people choose to continue with regular day treatment sessions.

The Cons of Day Treatment

  1. Day treatment may not be accessible to some people.

If a person has to drive several hours three times a week or more to reach their eating disorder treatment sessions, it may put an impossible time and money strain on them. Although tele health sessions are becoming more common in the age of Zoom meetings and social distancing, this can still be a preventive factor for many people.

  1. Outpatient treatment may not be enough for some individuals.

Although it’s the more convenient and less expensive option, day treatment may not be enough on its own for some situations. The more severe the eating disorder, the more likely it is that residential care will be more appropriate. Outpatient or day treatment programs can’t provide the round-the-clock psychiatric, medical, and nutritional support that residential provides. You or your loved one should consult with your doctor and/or therapist to determine if your needs go beyond what day treatment can provide.


Melissa Orshan Spann, PhD, LMHC, RTY 200, is Chief Clinical Officer at Monte Nido, 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.