Treatment Frequently Asked qUestions
Every person’s experience with an eating disorder is different, and so is each treatment path. Use the answers to these FAQs as a general guide, but remember that they are not universal.
What should I do if I think I have an eating disorder?
First, remember that you are not alone. There are resources available for people of all genders, ethnicities, and ages. Treatment and recovery are possible no matter what level of care you need. One of the most important first steps is to talk to someone you know and trust about your concerns and what you’re going through. As you begin to seek treatment, having support and care from a trusted friend or family member can make it much easier to take those steps. Although having these initial conversation isn’t always easy, building support is necessary. A secure support system will make your recovery possible and help avoid relapse. The National Eating Disorders Association (NEDA) has a helpful guide for initiating this conversation that is a great resource if you’re not sure where to start.
Once you’ve shared your concerns with a loved one, hopefully you will feel more comfortable beginning to seek treatment. At this point, it is important to reach out to a professional who has experience with eating disorders. The earlier you can take this step, the better.
How will I know that I am seeing a professional who can help me?
If you are already seeing a counselor or therapist that you know and trust, they can help you find a specialist. EDIN has a list of specialists here that you can consult. Finding a therapist and dietitian who meet your needs and whom you trust is very important. Here’s a list of helpful questions you can ask as you seek a therapist to make sure you find the right person. You can also look for their credentials online. Common licenses for eating disorder professionals include:
- LPC, Licensed Professional Counselor
- LMFT, Licensed Marriage and Family Therapist
- LMSW, Licensed Master Social Worker
- PhD, Doctor of Philosophy
- PsyD, Doctor of Psychology
- RD, Registered Dietitian
- LD, Licensed Dietitian
- CEDS, Certified Eating Disorder Specialist
- CEDRD, Certified Eating Disorder Registered Dietitian
What should I do if I think a loved one has an eating disorder?
If you are worried that your child or friend might be developing an eating disorder, it is very important that you talk to him/her about your concerns. Eating disorders are extremely serious, and the earlier your loved one enters treatment, the greater their chances of recovery. Trust your instincts!
Beginning this conversation with your child or friend can be tough. Here are some tips for how to talk to them about it: Educate yourself about eating disorders, ask them how you can be supportive, and avoid making accusations or becoming frustrated. It is tempting to want to offer solutions or try and convince your loved one simply to eat, but your patience, compassion, and dedication to their well-being will go a long way. Remaining open will encourage them to continuing sharing what they’re going through with you. If you begin to feel helpless or impatient, remember that it is important for you to take care of yourself as well. Seek help from a professional if you need it.
Once you have spoken with your loved one, it is important for them to begin receiving help from a professional who is an expert on eating disorders. Make sure your friend or loved one does this, or if they are your child, you can begin this process for them. The earlier you can take this step, the better. If your friend or child is already seeing a counselor or therapist that they know and trust, this person can help you find a specialist. EDIN has a list of specialists here that you can consult . Finding a therapist and dietitian who meet your child or loved one’s needs and whom they can trust is very important. Here’s a list of helpful questions you can ask as you seek a therapist for your loved one to make sure you find the right person.
NEDA has an excellent “toolkit” for parents that provides much more in-depth information about how to understand and combat your child’s eating disorder.
What does treatment for an eating disorder look like?
Your therapist will help you begin to understand your eating disorder and come up with an appropriate treatment plan. Eating disorder treatment can vary based on the duration of the eating disorder, the severity of the eating disorder, as well as underlying causes of the disordered eating behaviors.
All levels of care aim to help individuals understand and emotionally process their illness and its causes, address body image or self-esteem problems, cope with difficult emotions, learn to recognize triggers, and gain knowledge and skills regarding healthy nutrition and the processes surrounding eating and mealtimes. There are many different theoretical frameworks for eating disorder treatment, so treatment and specific skillsets will vary accordingly. Common ED therapies include: Cognitive Behavioral Therapy (CBT), Dialectical Behavioral Therapy (DBT), Medical Nutrition Therapy, Acceptance and Commitment Therapy (ACT), Exposure and Response Prevention Therapy, and Somatic Experiencing.
At every level of care, patients will have a multi-disciplinary team that typically includes a doctor, psychiatrist, therapist, and dietitian, but the team can be larger or smaller depending on the level of care and the individual.
What are the different levels of care associated with eating disorder treatment?
Outpatient: For most individuals, outpatient treatment with their therapist and/or dietitian will provide them with the resources needed to treat the eating disorder and its causes and work toward recovery. This level of care is common for people who are medically and psychiatrically stable and can continue with their daily routine without jeopardizing their health. It typically involves seeing a therapist and/or nutritionist at least once a week. This is the most common level of treatment, and the length of treatment needed can last anywhere from months to years.
Intensive Outpatient (IOP): This level of treatment is appropriate for people who need more support and structure than outpatient treatment, but are still able to attend work or school every day without putting their physical or psychiatric health at risk. Meetings typically take place during the evenings anywhere from 2-5 nights per week, and often include individual and group therapy, support groups, nutrition and culinary groups, and general skill building. Unless there are no facilities available in your area, or you are transitioning into intensive outpatient treatment from a higher level of care, this level of care is typically sought locally at an eating disorder treatment center.
Partial Hospitalization (PHP): This level of care bridges the gap between inpatient and outpatient care; people in partial hospitalization spend all day in highly structured treatment, often every day of the week, but they have a home environment that is supportive of their recovery, and sleep in their own homes or in transitory housing (if not local) every night. People seeking this level of care are medically and psychiatrically stable, but are still in need of a high level of structure and support in treatment. They can benefit from daily physiological and psychiatric assessment, but are not facing an immediate health risk. The structure provided by partial hospitalization is important for these individuals, because otherwise they would likely be continuing to engage in various pathogenic weight control behaviors to the extent that it impairs normal functioning. Patients will have both individual and group therapy sessions, and, as with other levels of care, there is a focus on emotional processing and skill building.
Residential: This level of care is necessary for people in need of 24-hour support and behavioral supervision. Health is monitored closely, but patients do not see their physician quite as frequently as those at the inpatient hospitalization level, because the patient is medically stable and doesn’t require as intensive of treatment. At this level, individuals are in a very structured environment 24/7 where they can focus completely on healing and have constant access to medical care as needed.
Inpatient: If someone is in immediate medical or psychiatric danger, they will be admitted to an inpatient program. This is necessary if patients have depressed vital signs, and/or are severely psychiatrically unstable, perhaps with depression and/or suicidal intentions. This is the highest level of care available. Patients are monitored very closely, and see a doctor daily. The goal of inpatient care is to return individuals to medical or psychiatric stability so they can return to a lower level of care and continue treatment.
How will you know which level of care you or your loved one needs?
Many people begin treatment at the outpatient level. If at any point your therapist believes you will benefit from a higher level of care, they will refer you to a treatment center that they think will suit your specific needs best. About 35% of patients receiving treatment will go to a treatment center for care. The level of care that is appropriate for the individual will depend on their medical and psychiatric stability, the presence of co-occurring disorders (substance use, depression, anxiety), their ability and motivation to control disordered eating behaviors, and other factors like available support structures and geographic proximity to treatment. It is common for patients to be resistant to a recommendation for a higher level of care, but it is important to remember that your therapist is an expert in the field and their only goal is to help you take back control over your health and get better.
Therapists, nutritionists, physicians, or counselors are not the only ones who can provide referrals; some patients (or parents of patients) refer themselves directly to treatment centers if the eating disorder is very severe upon first seeking treatment. Because people may hide and conceal eating disorders for a long time, it is not uncommon for treatment to begin at one of these higher levels. There are many treatment centers available, and it is important for you to find one that is a good fit for you, and for which you are a good fit. Here is a list of treatment centers on EDIN’s website.
What role do families and loved ones play in treatment?
The participation of family members and other loved ones is another critical part of treatment. Especially when it comes to adolescents, parents can be one of the greatest assets in recovery. It is common to feel anxious, worried, or helpless when your child enters treatment, but participating in your child’s treatment is the best way to support his or her recovery and will help you process their illness as well. As such, many therapists will recommend family sessions, where family members can learn more about their loved one’s eating disorder, and develop skills and attitudes that are supportive and not triggering to the individual. They will also learn many of the same nutrition and culinary skills, since these will be important in their loved one’s recovery. Many treatment centers have entire weekend or week-long programs for families designed to teach them and prepare them to support their loved one as they return to their home environment.
Won’t my child fall behind in school if they go to a treatment center?
Many people seeking treatment for their children often wonder how their child will be able to go to a treatment center during the school year. Because concerns about your child’s education should not be a barrier to receiving treatment, most treatment centers will create a plan for your child to keep up with their home school while they are away. Some centers will include hospital teachers in the treatment team so that they are able to provide the individual with just the right amount of support and encouragement in continuing their studies, while being sensitive and accommodating to their treatment. Typically, someone at the treatment center will work directly with your child’s school so that neither you nor your child will have that added responsibility and you can focus more fully on healing.
What does a “typical” day in a treatment center look like?
The typical day in a treatment center is very structured from around 7 or 8 in the morning until 10 or 11 at night. The day-to-day schedule will vary, but most days include some or all the following types of activities: nurse and therapist check-ins, team meal prep and emotional processing during meals and snacks, various individual and group therapy sessions, educational workshops and skill building classes, experiential outings and field trips (to a grocery store or restaurant, for example), yoga, art therapy, outdoor recreation (as able), and, if the patient is in school, time for schoolwork. Usually, there is a small amount of free time built in to each day for individuals to rest, use their phones, or work on homework.
What is involved in the application/intake process?
Once you, your therapist, or another outpatient provider you have been seeing has initiated your referral to a treatment center, you will begin an application process with that center. These applications typically include general information about you, a medical history, your history of disordered eating behaviors, specific medical lab tests you have had performed, and any other information they need (e.g., insurance information). Some centers will set up a phone assessment to have a conversation where they will learn more about you and your eating disorder. They may recommend a level of care before your arrival, but it is possible that this recommendation may change after further assessments take place once you’ve arrived.
When will patients be discharged from a treatment center?
The average stay in a treatment center can vary greatly, and depends on the level of entry. An individual who starts in inpatient care will often be at a treatment center for 90-120 days, as medical/psychiatric stabilization alone can take several weeks. Most patients at the residential level will be in a center for at least a month and a half, but their stay could be shorter or longer depending on their goals and needs. Treatment plans are usually highly individualized, so the decision on when to discharge a patient will be made based on a number of factors that relate the individual’s readiness and optimal recovery.
When patients are discharged from a treatment center, it is very important that they are returning to an environment and routine that will be supportive of their recovery, and that they continue to see a multi-disciplinary team of care providers. Most treatment centers will ensure that this team of individuals is set in place in your home town before discharging you so that you will not experience any setbacks or relapse. Many centers recommend at least five years of outpatient work following treatment to make sure that recovery is sustained.