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.
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 .
Did you know that February is Eating Disorder Awareness month? Here at Thrive, we're passionate about educating our community and providing tools for eating disorder recognition while offering the specialized support and treatment that those with eating disorders deserve. Join us this month in the conversation around eating disorders and putting an end to harmful stereotypes and misinformation. Let's cover six reasons why building awareness around eating disorders is so crucial. 6 reasons why eating disorder awareness is important 1. Eating disorders are serious. Despite often being termed as a "choice" or a "phase," eating disorders are an incredibly serious psychological condition that require specialized treatment and support. Anorexia Nervosa has the second highest mortality rate of any psychiatric diagnosis in the United States, and every 52 minutes, 1 person dies as a direct consequence of an eating disorder (NEDA) . By spreading awareness and providing early intervention in eating disorder treatment, we can not only change lives, but save them. 2. Eating disorders are more common than you think. 9% of the US population will have an eating disorder at some point in their lives and 22% of children and adolescents worldwide show symptoms of disordered eating (NEDA). Since eating disorders can be challenging to detect, many go undiagnosed. Raising awareness for eating disorders and educating our community partners about their symptoms can allow us to catch eating disorders as early as possible and bring these statistics down. 3. Fight harmful eating disorder stereotypes. A common stereotype in association with eating disorders is that of the "thin, white, affluent female," however, anyone is at risk of an eating disorder despite their appearance or background. Stereotypes associated with eating disorders around weight, gender, age and race can create serious barriers to seeking care and major disparities in treatment. People experiencing an eating disorder can face challenges in seeking and receiving treatment or may feel unworthy of recovery when they don’t fit a stereotype, preventing them from gaining needed support and treatment. Promoting diversity and representation through awareness and education can help to break down the harmful stereotypes that have historically surrounded eating disorders. 4. Eating disorder recovery is not a one person job. Family and loved ones’ involvement in eating disorder treatment is crucial for recovery. Family-based therapy (FBT) has proven to be effective in 50% of patients being treated for anorexia nervosa, and is effective in the treatment of other eating disorders as well. A strong support system and steadfast relationships through the struggles associated with eating disorders can lead to more effective and long-lasting recovery. With more awareness and education, people will be better equipped to provide assistance to their loved ones in recovery. 5. You’re not alone. Eating disorders can be an isolating and painful disorder, making those experiencing it feel like they’re the only ones, or that no one understands what they’re going through. Building an informed community through awareness and education can be the first step towards diagnosis and treatment for those who need it. 6. Recovery is Real. Those with eating disorders are capable of long-term recovery through appropriate treatment. Research has found that the earlier intervention takes place in the treatment of eating disorders, the better the odds of long-term recovery are. Awareness and education around eating disorders helps the people that need support find it sooner, resulting in a repaired relationship with food and the body and a fuller life. How can I get involved in eating disorder awareness efforts? To get involved in eating disorder awareness efforts, start by educating yourself about the complexities and different types of eating disorders. By gaining a deeper understanding, you can become a more effective advocate. You can also consider participating in local or national events such as walks, trainings, or online webinars that aim to raise awareness, provide support to those affected, and offer education around eating disorders and their diagnosis. Another simple step for building awareness can be using your social media platform to share factual information, personal stories, or relevant resources that can help demystify eating disorders and reduce stigma. Additionally, supporting legislative efforts that promote mental health education and funding for eating disorder research can help in creating systemic change. By taking these steps, you can contribute to this important movement and work alongside us to foster acceptance, encourage early intervention, and ultimately save lives. Eating Disorder Treatment and Support Thrive offers a free eating disorder guide with more information about eating disorder symptoms and recovery. If you or someone you know is struggling with eating or body image, don’t be afraid to reach out to professionals for support. At Thrive Wellness, we offer a number of treatment options for all ages and genders, including a partial hospitalization program, an intensive outpatient program, outpatient therapy, occupational therapy, nutrition services, and more. Don’t wait to get started on treatment, contact us for a free eating disorder assessment today.
You’ve probably heard of “Dry January” or are even participating yourself. More and more people seem to be experimenting with or embracing sobriety from alcohol, but what benefits are there from abstaining? In this article, we’ll explore alcohol’s effects on mental health, the symptoms of alcohol use disorder (AUD), and the benefits of cutting back on drinking. Alcohol's Effects on Mental Health Commonly consumed as a way to relax after a long day or to lighten up in social interactions, alcohol is a widely used and culturally accepted drug despite warnings of its dangers by health experts . When a person regularly drinks, it can result in a slew of complications for their physical and mental health. Although often consumed in an attempt to escape stress, sadness, or other unpleasant emotions, alcohol itself is a depressant that can contribute to negative feelings and exacerbate existing mental health conditions, especially with prolonged use. Alcohol influences thoughts, mood, and behaviors by impacting the central nervous system in a way that slows the communication between the brain and the body. Without the ability to process information effectively, the brain isn't able to regulate emotions and consider consequences effectively which may promote unhealthy behaviors, including drinking to excess. Ways that alcohol can affect cognitive functioning include: Lowering inhibitions Contributing to poor judgment Causing confusion Causing lapses in memory Disrupting sleep Contributing to shifts in mood Alcohol and Mental Disorders According to the Journal of the American Medical Association, 37% of people with alcohol use disorders also have at least one serious mental illness. Furthermore, alcohol abuse commonly occurs alongside depression and anxiety . Research has shown that those with major depressive disorder and those with generalized anxiety disorder were more likely to report life‐time moderate to severe alcohol use disorder than those without these conditions. Frequently, individuals struggling with depression or anxiety self-medicate by drinking alcohol. Although alcohol may provide temporary relief, it expends the chemicals in the brain which help ward off anxiety and depression. When the initial effects of the drug fade, individuals are typically left feeling more depressed or anxious than they did before they began drinking. Related: Eating Disorders, Substance Abuse, and Substance Abuse Disorders Alcohol Use and Depression The slowed functioning of the brain caused by alcohol can allow individuals to numb to their suffering. As such, those experiencing depression may be inclined to drink to avoid the sadness, pain, and hopelessness associated with depression. This maladaptive coping behavior is so prevalent that research shows a clear relationship between alcohol use disorder (AUD) and major depression. Using alcohol while depressed can be extremely dangerous. Not only can alcohol negatively interact with antidepressants, but it can also place individuals experiencing depression at an increased risk for suicidal thoughts and behavior . If you're experiencing suicidal thoughts or behaviors , you can reach the National Suicide Prevention Hotline at 1-800-273-TALK (8255). Alcohol Use and Anxiety According to a study on anxiety and AUD , a person with an anxiety disorder is two to three times more likely to develop an alcohol abuse disorder. When individuals with anxiety drink alcohol, they may feel an initial alleviation of their symptoms as well as a sense of euphoria. However, the symptoms of hangovers and alcohol withdrawal following heavy drinking can heighten feelings of anxiousness and interfere with ones daily obligations, contributing to even more agitation. This feeling of dread and anxiety associated with a hangover is commonly referred to as " hangxiety ," but for those with existing anxiety conditions, this side effect of drinking can feel unbearable. Individuals with anxiety may be driven to drink more to tamper their stress and re-establish the sense of euphoria, resulting in a dangerous cycle of alcohol abuse. Unhealthy Drinking Behaviors and Alcohol Use Disorder (AUD) Most who regularly drink alcohol don't have AUD, which develops when addiction is present. However, alcohol-related side-effects on mental health are still common, and they may still benefit from mental health support . Signs of unhealthy alcohol use include: Feeling a need to consume alcohol to make it through the day Feeling unable to stop consuming alcohol Progressively feeling a need to increase consumption of alcohol Drinking to prevent or alleviate symptoms of hangover or withdrawal Feeling ashamed of ones alcohol consumption Having loved ones express concern over drinking habits AUD is a condition that is often driven by genetics, abuse, trauma, or unhealthy family dynamics. Healing from AUD is possible and it can be treated with the help of mental health professionals and a dedicated treatment plan. Signs of AUD include: Alcohol use that interferes with the ability to carry out daily activities Drinking despite the behaviors adverse effects on their life Often drinking more or for a longer period of time than intended Persistent desire and unsuccessful attempts to curb alcohol use Revolving their schedule around drinking Experiencing strong cravings for alcohol Continuing to drink despite experiencing recurring illness or social issues as a result of alcohol use Giving up activities one used to enjoy in favor of drinking Using alcohol during situations where its physically hazardous to be impaired Continuing to use alcohol despite knowing that it exacerbates a known existing health condition Developing a tolerance for alcohol, or needing more alcohol to feel the same effects Experiencing alcohol withdrawal or drinking more to avoid withdrawal What are the Mental Health Benefits of Going Sober or Drinking Less Alcohol? Reducing or eliminating your alcohol consumption can lead to a variety of mental health benefits, improving your overall quality of life. When going sober or cutting back on your alcohol consumption, some of the benefits you can look forward to are: Improved mood stability, including reduced feelings of depression and anxiety Improved sleep quality Enhanced cognitive function Increased energy levels Improved concentration and productivity Increased self-esteem More authentic social interactions Improved relationships Limiting your alcohol consumption has the capability to change your life for the better, as it can help you establish a healthier mental environment, build better connections, and improve your physical health. Support for Alcohol Abuse and its Mental Health Impacts As humans, it can be uncomfortable for us to process difficult experiences and feel intense emotions. Therapy can help heal the source of your struggles driving alcohol abuse, while also guiding you in implementing healthy strategies for processing painful emotions. Through professional mental health support, you can be empowered to embrace life without having to rely on alcohol. Thrive offers outpatient therapy for substance abuse struggles in addition to other mental and behavioral health conditions. Reach out to learn more. Additional Resources SAMHSAs National Helpline : A free, confidential, and 24/7 service for individuals and families facing mental health conditions and/or substance use disorders, reachable by calling 1-800-662-HELP (4357) or texting 435748 (HELP4U). National Institute on Alcohol Abuse and Alcoholisms (NIAAA) Treatment for Alcohol Problems : A guide for individuals and their loved ones who are looking for options to address struggles with alcohol use.
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