The Differences Between Higher Levels of Care for Eating Disorders: Residential Treatment Programs, Partial Hospitalization Programs (PHP), and Intensive Outpatient Programs (IOP)

Thrive • July 15, 2022
By Thrive Wellness’ National Director of Risk Management Kerstin Trachok, CPC

Eating disorders are complex and manifest differently from person to person. To address the varying severity of eating disorders , there are different levels of treatment for healing from these serious conditions. When one’s illness requires a higher level of care than general outpatient therapy and related services, eating disorder treatment programs from highest to lowest include:

  • Inpatient treatment
  • Residential treatment programs
  • Partial hospitalization programs (PHP)
  • Intensive outpatient programs (IOP)

A comprehensive clinical assessment will determine what level of care a client should begin in. Because healing is not linear and can look different for each individual, one’s treatment team may recommend they move to higher or lower levels of care as they navigate their journey to recovery. Any co-occurring mental health concerns will also influence a person’s recommended level of care.

Included in this article are brief overviews of each level of care with a primary focus on programs that emphasize therapeutic healing, (i.e. residential treatment programs, PHP, and IOP), rather than medical stabilization, (i.e. inpatient treatment).

INPATIENT TREATMENT FOR EATING DISORDERS

At an inpatient level of care, a person is typically severely medically unstable and requires constant medical attention. They may have depressed vital signs and other acute health risks while also being psychiatrically impaired. Inpatient treatment for eating disorders offers a hospital setting to provide tube feedings, perform daily laboratory tests, and ultimately help individuals reach medical stability. 

RESIDENTIAL TREATMENT PROGRAMS FOR EATING DISORDERS 

Residential treatment programs offer a structured environment that removes an individual from environmental stressors that may be contributing to the eating disorder. A person lives in a residential treatment center full time. This level of care prioritizes healthy weight restoration so the client can be prepared to do more intensive therapeutic healing later on in their recovery journey. 

Some criteria for a person to be a part of a residential treatment program for eating disorders include:

  • Body weight: The person has restored less than 85% of their target weight if they are underweight.
  • Intrusive thoughts: Repetitive thoughts about disordered eating take up four to six hours of their day. 
  • Eating and compensatory behaviors: Generally, the client is somewhat responsive to encouragement to eat and is able to sustain themselves without a feeding tube, but usually requires a nutrition supplement. The person is often also unable to control compensatory behaviors, such as exercising and purging and requires constant supervision to keep them safe. They may, however, begin attempting to implement skills to keep themselves from disordered eating behaviors
  • Medical state: The individual may not be entirely medically stable, but they don’t require hospitalization or multiple laboratory tests every day.
  • Motivation: The client’s motivation is generally relatively poor. They’re likely attending treatment to satisfy their loved ones, rather than their own desire to recover. 
  • Suicidality: The person may struggle with suicidal ideation which their clinicians are monitoring, but they aren’t actively engaging in suicidal behaviors.
  • Support system: Due to the severity of the individual’s eating disorder, the client’s family doesn’t have the resources or knowledge to keep their loved one safe. Other times, a person may lack healthy relationships with their family and may not have a support system at all. 

Residential treatment commonly includes: 

  • Medical support: Typically, a residential client has access to 24-hour nursing care to monitor their medical status. 
  • Nutrition support: When a person is in a state of starvation , their brain doesn’t function properly. At this level of care, dietitians are oftentimes most focused on refeeding the client’s body so that the person can be ready to integrate intuitive eating principles with less interference from thoughts related to the eating disorder. 
  • Therapeutic support: In residential treatment, individual and group therapy sessions generally focus on developing healthy coping skills to replace destructive behaviors.  

PARTIAL HOSPITALIZATION PROGRAMS (PHP) FOR EATING DISORDERS

Similar to a residential treatment program, a PHP is generally very structured, focusing on continuing to restore weight, reduce eating disorder behaviors, and build skills. It is at this level, once a client is more medically stable, that deeper therapeutic work can be done. A PHP typically includes six to eight hours of treatment five to seven days a week. Thrive Wellness’ PHP offers 12 hours of treatment daily to accommodate clients who may be in between residential treatment program and PHP levels of care.

Some criteria for a person to be a part of a PHP for eating disorders include:

  • Body weight: The person is typically above 80% of their target weight if they are underweight.
  • Intrusive thoughts: The individual is preoccupied with intrusive thoughts about disordered eating for close to three hours per day. 
  • Eating behaviors and compensatory behaviors: The client is reducing their restriction and compensatory behaviors but still requires supervision around mealtimes . Often, PHP clients receive a supplement to help boost their nourishment. 
  • Medical state: The person is becoming more medically stable and doesn’t require extensive medical monitoring. 
  • Motivation: The individual client’s motivation is relatively fair while continuing to improve.
  • Suicidality: Any suicidality is declining, but the client remains under clinical supervision.
  • Support system: The person’s family and friends can provide at least some sense of support and structure to encourage recovery.

Partial hospitalization care commonly includes:

  • Medical support: Even though the individual is becoming more medically stable, they still receive regular medical monitoring. 
  • Nutrition support: At this level of care, dietitians begin teaching the person about listening to their body’s hunger and fullness cues so that they may learn to trust their body and eat intuitively.
  • Therapeutic support: Mental health professionals often begin helping the client manage intrusive thoughts related to their eating disorder while continuing to guide them in implementing healthy coping skills. Intensive family therapy is also usually integrated at this stage. 

INTENSIVE OUTPATIENT PROGRAMS (IOP) FOR EATING DISORDERS 

An IOP typically offers four hours of treatment three to five days a week. IOP clients are generally more self-sufficient and don’t require as much structure. Instead, they have more space to explore what their recovery looks like for them. 

Some criteria for a person to be a part of an IOP include:

  • Body weight: The person is within 90% of their target weight range.
  • Intrusive thoughts: The thoughts driving the individual’s disordered eating behaviors are quieting down. They have developed more skills that help them refrain from engaging in disordered eating behaviors .
  • Eating behaviors and compensatory behaviors: The client still participates in guided meals , but they are increasingly incorporating intuitive eating practices into their daily life. Any compensatory behaviors are still being monitored, however, the frequency of these behaviors is likely trending downwards. 
  • Medical state: The person is increasingly medically stable at this level of care, though still routinely monitored by specialists. 
  • Motivation: They are more internally motivated, rather than externally motivated. 
  • Suicidality: Ideally, any suicidal ideation has decreased. 
  • Support system: The client’s loved ones are engaged in their recovery by attending any family therapy sessions, helping them with meals they’re not having during treatment programming, and supporting their healing overall. 

Intensive outpatient care commonly includes:

  • Medical support: The person continues to receive medical monitoring as they work on restoring their weight. 
  • Nutrition support: Guided by their nutritionists, the individual begins implementing intuitive eating principles and other gentle nutrition skills into their daily life. 
  • Therapeutic support: A client’s therapeutic team will dive deeper into the psychological factors that may be contributing to their eating disorder and any other co-occurring mental health concerns, such as anxiety or depression . They’ll continue to help the client implement healthy coping skills. 

EATING DISORDER TREATMENT AT THRIVE WELLNESS 

At Thrive Wellness, we currently offer PHP and IOP treatment for eating disorders, which varies by location. Our treatment programs involve psychiatry, individual and family therapy, primary care, occupational therapy nutrition counseling, and mindful movement. Our treatment teams collaborate on each client’s treatment to provide integrated, comprehensive care, Thrive Wellness’ interdisciplinary clinicians tend to mental, physical, and emotional health while helping individuals implement an intuitive nutrition philosophy that emphasizes adequacy, balance, and choice in eating . Reach out to learn more about our eating disorder treatment services

About the Author
Thrive Wellness’ National Director of Risk Management Kerstin Trachok, CPC

Kerstin received her master’s degrees in clinical mental health counseling and school counseling from the University of Nevada, Reno. She has several years of experience in the counseling field working in different settings and treating a wide array of mental health issues. Her experience includes working in schools with children of all ages, clients with psychosis in a hospital setting, and adults and teens in private practice as well as working at an agency providing counseling to children and families and two years of experience working with eating disorders at the partial hospitalization program (PHP) and intensive outpatient program (IOP) levels of care. 

Kerstin is a fully licensed clinical professional counselor in the state of Nevada and received her certification in Complex Trauma Levels I and II. She has experience working with children, teens, adults, and families with trauma, anxiety, grief, depression, attention-deficit/hyperactivity disorder (ADHD), autism spectrum, suicidal ideation, eating disorders, obsessive-compulsive disorder (OCD), and behavioral issues. Kerstin is passionate about fostering clients’ growth and autonomy while providing a safe and secure space to process emotions. She uses creative interventions and other tools to allow clients to voice their internal experiences beyond traditional talk therapy and her modality of choice is acceptance and commitment therapy (ACT). She uses mindfulness tools and techniques to help clients be present-moment oriented and reduce stress so they may move towards psychological flexibility. Kerstin believes all individuals have the right to live a full and vital life.

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By Brianna Villalpando, LMSW, LCSW March 19, 2025
Teen eating disorders are serious. As a parent or caregiver, one of the most difficult situations you can face is noticing that your teen may be struggling with a basic human need like eating. Adolescence is already a rough period for many teens filled with fluctuating emotions, changing bodies, and social pressures. However, sometimes coping with these challenges can manifest in unhealthy ways, like developing complicated relationships with food, body image, control, or exercise. Many teens face body image issues as their bodies mature, excessive pressure to meet unrealistic expectations fueled by social media and peers, and emotional instability and anxiety during their adolescent years, all of which can combine to create the perfect storm for an eating disorder. These challenges can often make your teen more vulnerable to unhealthy coping mechanisms , such as restricting food intake, excessive exercise, or engaging in disordered eating behaviors . If you’ve started noticing signs that something may not be right, it’s essential to take action to help your teen get the support they need. Recognizing the Signs of an Eating Disorder Eating disorders can vary in appearance, but there are some common signs and symptoms to watch for. If you notice any of the following behaviors or changes in your teen, it may indicate a problem that requires further attention: Preoccupation with body image : Teens with eating disorders often show increased focus on their weight or appearance, frequently expressing dissatisfaction with their body. Excessive discussions about dieting : If your teen frequently talks about dieting, food restriction, “getting skinny,” or often makes weight-related comments, this could be a red flag. Obsession with calorie counts : Teens who are obsessed with tracking every calorie, comparing the caloric content of foods, or controlling their calorie-intake may be struggling with an eating disorder. Skipping meals : Frequently skipping meals or not eating regularly is a common sign that something is wrong. Eating in isolation : Eating alone or avoiding family meals may signal discomfort with eating or shame around food. Excessive exercising : Over-exercising or using exercise as a way to purge calories can also point to an eating disorder. Spending long amounts of time in the bathroom : This could be a sign of emerging or purging behaviors, such as vomiting after meals. Hoarding foods : Hiding food or being secretive about eating may indicate issues with food control and secrecy around eating habits. Irregular periods or thinning hair : In females, a disruption in menstrual cycles or thinning hair can be physical signs of the effects of an eating disorder on the body. How Can I Talk to My Teen About Eating Disorders in a Supportive Way? Approaching a conversation about eating disorders with your child requires sensitivity and care. It's important to emphasize empathy and understanding, conveying that your primary concern is your teen's health and well-being. Initiating this conversation compassionately can create an environment of trust and openness to explore the problem. Selecting a calm, comfortable, and private setting is vital so your teen feels safe discussing a sensitive topic that may cause them to feel anxiety or shame. Effective communication hinges on using open-ended questions and active listening. Encourage your teen to share their thoughts and feelings without fear of judgment. By actively listening, you validate their experience, making them feel heard and understood. Before diving into the conversation, educating yourself about eating disorders can provide a solid foundation for discussing the issue knowledgeably. Some quick preparation with research allows you to dispel myths and provide accurate information when you talk to your teen. Why It's Crucial to Seek Medical Help When you notice warning signs, it’s important not to wait to get help. Eating disorders can be life-threatening, both physically and emotionally. They take a serious toll on a teen’s health, affecting their metabolism, hormonal function, and overall well-being. Beyond the physical impact, eating disorders can often involve deeply ingrained psychological and emotional challenges, such as low self-esteem, anxiety, depression, and trauma. After an initial conversation, the first step is to schedule an appointment with a medical provider. Your teen’s primary care doctor or a pediatrician can help evaluate their physical health and provide guidance for next steps. Be prepared to discuss the specific behaviors or signs you’ve observed, as this will help your provider better understand the situation. The doctor may conduct a physical examination, lab tests, and discuss your teen's emotional and psychological state. Building a Support Team Once you’ve taken the first step to ensure your teen’s immediate medical needs are addressed, it’s time to build a multidisciplinary treatment team . This may include: Therapists : A licensed, specially trained therapist who specializes in eating disorders or adolescent mental health can help your teen address the emotional and psychological root causes of their disorder. Medical doctors : Your teen’s doctor can monitor their physical health during the recovery process, ensuring they are safe while navigating the challenges of nourishing their body. Nutritionists or dietitians : A professional who specializes in eating disorders can create a nutrition plan tailored to your teen’s specific needs and help them rebuild a healthy relationship with food. Psychiatrists : In some cases, medication may be prescribed to address underlying mental health issues contributing to their behavior. Act Quickly and Seek Professional Guidance It’s crucial to act as soon as you recognize signs of an eating disorder in your teen. The longer eating disorders go untreated, the harder they can be to overcome. Recovery from an eating disorder is a complex journey, involving both physical and mental obstacles to tackle. It can be incredibly difficult for both the teen and the family to manage this process at home without professional support. A well coordinated team of medical providers, therapists, and eating disorder specialists is essential in guiding your teen through their recovery. This team can help monitor your teen’s progress, provide emotional support, and ensure that your teen is getting the care they need for both short and long-term recovery. Supporting Your Teen on Their Recovery Journey Eating disorders are serious, but with the right care and support, recovery is possible. If you suspect that your teen may have an eating disorder, don’t hesitate to reach out for help. Seek medical advice first, and build a support team of professionals who can work together to provide comprehensive care. Eating disorders are complex, and it’s not something you or your teen should have to face alone. Taking swift action and offering compassionate support will help your teen regain control of their health and their life so that they can thrive through their adolescence and beyond. At Thrive, we offer specialized treatment for anorexia, bulimia, binge-eating disorder, and avoidant/restrictive food intake disorder (ARFID). Our adolescent intensive outpatient and partial hospitalization programs have not only changed lives, but saved them. If you believe your teen is struggling, don't hesitate to reach out for help, we are ready to conduct a complimentary intake assessment today. To learn more about eating disorders, download our free guide "Recovery is Real" filled with practical insights and strategies to help a loved one navigate the journey toward recovery.
By Brianna Villalpando March 12, 2025
It can be difficult to know when it's time to reach out for help. We often try to manage stress, anxiety, sadness, or relationship issues on our own, thinking it’s just a phase or something we can work through to “get over.” But sometimes, these feelings or behaviors persist and can start affecting our overall mental and emotional well-being. The truth is, seeking therapy shouldn't be a last resort. Therapy is a valuable tool for anyone looking to better understand themselves, improve their emotional health, and work through life’s challenges. If you’ve been wondering whether it’s time to seek therapy, there are a few key factors to consider when performing a self-evaluation. Here are five signs that it might be time to reach out for additional support: 1. Is My Mood Affecting My Life or Relationships? One of the most telling signs that you may need support is noticing that your mood is negatively impacting your daily life or interpersonal relationships. Have you noticed an increase in conflict with friends, family, or colleagues? Are you feeling stuck in patterns of negativity that seem hard to shake? If your mood is affecting how you function at work, school, or in your personal life, it may be time to talk to a therapist. Pay attention to your behaviors; are you withdrawing from activities you usually enjoy? Are you reacting more intensely to situations than usual? If your emotional state is beginning to impact your relationships, interactions, or your ability to move through everyday life, a therapist can help you explore underlying causes and develop tools to improve your social wellness. 2. Am I Isolating Myself to Avoid Conflict? There’s a big difference between being introverted and isolating yourself as a way to avoid conflict. If you find yourself consistently pulling away from social situations, not because you need time to recharge, but because you’re avoiding uncomfortable conversations or emotional confrontations, this could be a sign of a deeper issue. It’s natural to want to avoid tension or discomfort, but consistent isolation can worsen feelings of loneliness and make it even harder to work through conflicts. Therapy can help you learn healthy coping mechanisms, problem-solving and communication skills, so you can feel more comfortable facing conflict in a productive way rather than shutting down or avoiding it at the cost of self-isolation. 3. Are My Emotions Out of Control? Do you ever feel like your emotions are so overwhelming that you can't regain control? If you're finding it difficult to calm yourself down, quiet your thoughts, or manage your feelings, this might be a sign that therapy could be helpful. Emotions like anger, disgust, fear, anxiety, or sadness are natural, but if they start taking over your thoughts and actions, it can be exhausting and difficult to complete daily tasks. A therapist can help you understand why your emotions are so intense and teach you strategies to regulate them and regain a sense of balance. 4. Have I Experienced Trauma That’s Affecting My Daily Life? Trauma comes in many forms, it could be from a single incident or from ongoing experiences that have affected your sense of safety, connection, or well-being. Sometimes, trauma is tied to experiences in childhood, but it can also be linked to recent events, like accidents, loss, or abuse. If you've experienced trauma and are struggling to perform basic daily tasks or meet your needs, therapy can be incredibly beneficial. Unresolved trauma can lead to feelings of anxiety, depression, or being stuck in past experiences. A trauma-informed therapist can help you process these experiences, understand their impact on your life, and work toward healing and recovery. 5. Am I Hurting Myself or Others? If your mood or behaviors are causing you to hurt yourself or others, it’s crucial to seek help immediately. Whether it’s through emotional or physical self-harm , or unintentionally inflicting harm on the people around you, this is a serious sign to find support from mental health professionals. A therapist can provide a safe, nonjudgmental space to talk about what you’re going through and help you work toward healthier ways of coping. If you’re in immediate danger or experiencing thoughts of self harm, it’s essential to reach out for help as soon as possible. There’s no shame in seeking support when you're struggling with harmful thoughts or actions. Why is Professional Mental Health Support Necessary? Although there may be barriers to seeking therapy, reaching out for professional mental health support is worth it to address the emotional and psychological issues that you shouldn’t have to deal with alone. Therapists have the knowledge and tools needed to guide you through your struggles, offering insights and solutions that aren’t available outside of the therapeutic setting. Their expertise promises not only a deeper understanding of your challenges, but the application of practical methods and skills to resolve them in your everyday life. Additionally, trained mental health professionals offer personalized strategies and coping mechanisms tailored to your unique situation and needs. These strategies are informed by evidence-based practices and a therapist’s experience working with and healing emotional and mental struggles. Personalized therapy helps clients receive the most relevant and effective guidance for their personal challenges. Embracing the Journey Toward Mental Wellness Recognizing that you might need support is the first step toward feeling better and getting the most out of life. Therapy isn’t just for when things are at their worst; it’s a proactive way to improve your emotional health, work through challenges, and build skills for resilience. If you relate to any of these situations, it might be time to reach out and explore therapy as an option. It’s okay to need help, and you don’t have to navigate this journey alone. If you’re unsure whether therapy is right for you, consider talking to a mental health professional to discuss your concerns and explore specialized support options available to you. You deserve to feel your best, and therapy can be a stepping stone to help you reach your goals. Are you in need of support? At Thrive Wellness, we offer personalized therapy and treatment to support you in whatever you're going through, don't be afraid to reach out for help . We also offer a FREE comprehensive guide to wellness in our “How to Thrive” guide . This guide offers practical, easy-to-follow habits that promote physical, mental, and emotional well-being. Start your journey towards a balanced and fulfilling life today with these simple yet transformative steps.
By Sage Tippie February 14, 2025
This Eating Disorders Awareness Month, we’re focusing on fighting the misinformation and stereotypes surrounding eating disorders that so often create barriers to diagnosis and treatment. Myths about eating disorders can perpetuate harmful stereotypes and keep people from receiving effective and timely treatment when they need it. It’s no secret that the field of eating disorders is riddled with misinformation, leading to confusion, stigma, and shame for those struggling. In this blog post, we'll explore the common myths about eating disorders and fight them with concrete facts in the hopes of building a more informed and educated community when it comes to these serious mental health conditions. Eating Disorder Myths Versus Facts Myth: Only those who are medically underweight have an eating disorder. Fact: Someone can have an eating disorder at any weight. In fact, less than 6% of those diagnosed with an eating disorder are medically underweight. There is even a specific diagnosis for those who are not underweight showing the symptoms of anorexia called atypical anorexia. People of all sizes are at risk for serious complications from an eating disorder, not just those that are underweight. Myth: Only women have eating disorders Fact: Although often associated with teen girls, eating disorders can affect those of any gender and age. While stereotypes and stigma surrounding eating disorders may tell us that men are not commonly affected by them, research has found that nearly 25% of those who present for eating disorder treatment are male. Keeping an open mind around who can be affected by eating disorders allows for more accurate and timely diagnosis and treatment for those who need it. Myth: Eating disorders are just about food. Facts: While eating disorders always involve an unhealthy relationship with food or body image, they also are rooted in biological, psychological and sociocultural aspects. Eating disorders cannot be treated just by changing eating behaviors, but by addressing the mental aspect of the illness as well. This is why integrated treatment involving a team of social workers, primary care specialists, therapists, and in some cases occupational therapists or psychiatrists is so crucial: a holistic approach is needed to treat all aspects of an eating disorder. Myth: Eating disorders aren’t that serious. Fact: Eating disorders are extremely serious and life-threatening mental disorders that require dedicated treatment. In fact, anorexia nervosa has the second highest mortality rate of any psychiatric disorder. By taking eating disorders and their diagnosis and treatment seriously, we can save lives. Myth: Eating disorders are a choice. Fact: Just like any other illness, eating disorders are not a choice or a phase, nor is recovery from an eating disorder just a simple decision to start eating more or less. Recovery is not dependent on willpower, but on ongoing professional treatment and long-term support. The recovery process can be lengthy and challenging, requiring patience and a supportive environment and team on your side. It is a gradual, step-by-step journey, rather than an instantaneous decision made on one person’s part. Myth: Eating disorders always involve negative body image. Fact: Avoidant/restrictive food intake disorder (ARFID) does not have to do with body image. Those with ARFID may avoid many foods because of texture, taste, color, or smell, or feared outcomes of eating like choking or vomiting. Like any other eating disorder, ARFID is serious and requires specialized treatment like exposure-response prevention therapy. Myth: Eating disorders only affect White people. Fact: Although Black, Latina/o/x/e, Indigenous/Native, and Asian people are historically underrepresented in studies of eating disorders, large-scale studies have found that rates of eating disorders are the same or higher in all racial and ethnic groups as compared to white individuals (NEDA). Removing racial stereotypes around eating disorders can help to remove barriers that BIPOC individuals commonly face when seeking treatment. Dispelling the Myths: A Path Towards Understanding By addressing and dispelling these myths, we can create a safe space that promotes understanding and empathy. Eating disorders are not choices or phases, but debilitating mental health issues that can affect anyone. Recognizing the seriousness of these disorders is so important in reducing stigma and ensuring that those who are struggling receive the care and support they require. This month and every month, we encourage you to fight misinformation and stick up for those experiencing eating disorders, because knowledge and education can be one of the greatest assets to recovery for those who need it. If you or someone you know is in need of eating disorder support, don’t be afraid to reach out , our team of healthcare professionals are here for you. To learn more about eating disorders and the journey to recovery, download our free eating disorders guide .
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