Eating Disorder Treatment
Since an eating disorder is both a medical disorder and a psychiatric disorder, treatment usually involves both medical professionals and psychotherapists as well as nutritionists. Treatment for an eating disorder can be provided on an outpatient or an inpatient basis depending on the level-of-care required for effective treatment.
On Long Island, the majority of treatment offered is on an outpatient basis through private physicians, therapists and nutritionist, some who work independently and others that collaborate with other team members. When searching for a qualified treatment provider is it recommended that you research credentials to see if they have specialized training with eating disorders and are members of professional organizations such as the Academy of Eating Disorders (AED) and the International Association of Eating Disorder Professionals (IAEDP). Do they also belong to organizations such as The National Eating Disorder Association (NEDA) and The National Association of Anorexia Nervosa & Associated Disorders (ANAD). While being a member does not guarantee the quality of the provider, it does provide an indication that the provider has a special interest in eating disorders.
Level-of-care refers to the intensity and scope of services offered for the treatment of an eating disorder. Ethically, patients should be treated a level-of-care that offers the least restrictive environment that is effective for treatment. With eating disorders, most patients are treated on an outpatient basis, seeing their therapist one or two times a week, a nutritionist once a week and their medical doctors/psychiatrist as necessary. However, severe cases of eating disorders often require a more intensive level of care where patients are seen daily and have meals provided. Very severe case can require hospitalization or residential care when patients are supervised and monitored on a 24- hour basis.
The following levels-of-care for treatment are as follows:
Level 1: Outpatient – Patients work on an individual basis with their private clinicians as opposed to being a part of an organized treatment program. Outpatient care usually involves a combination of a psychotherapist, a dietician or nutritionist, and a medical doctor who monitors medical stability and provides treatment through regularly scheduled office visits. Level 1 care usually is best suited for patients who are medically stable with no suicidality and are at least eighty-five percent of expected body weight. Patients should also be fairly motivated for treatment and able to eat and maintain a weight restoration plan on their own, manage compulsive exercise urges, are capable of reducing purging behaviors without supervision, and have a good outside support system.
Level 2: Intensive Outpatient – Intensive Outpatient Programs (IOP) are usually at least 3 days per week, for 3 to 4 hours per day. IOPs can be private, clinical or hospital-based, and are group oriented in their treatment approach with supervised meals provided. Intensive outpatient programs are usually offered as a step-up level of care when regular outpatient treatment is not being effective or as step-down programs from a higher level-of-care to transition patients back into level 1 care. On Long Island, ED-180 Treatment Programs and Mather Hospital offer level 2 treatment on a regular basis.
Level 3: Partial Hospitalization or Full Day Program – A partial hospitalization program or a full-day program is usually at least 5 days a week for about 8 hours each day. These programs can also be private or hospital-based and usually consist of 3 supervised meals and snacks with group therapy remaining as the main modality of treatment. Partial hospitalization/full-day programs are more likely to be more intensive in that they often include individual therapy, nutritional therapy and medical supervision.
A level 3 program is a “full-time” commitment requiring daily treatment and is best suited for patients who are medically stable without the need for extensive medical monitoring, and are at least eighty percent of expected body weight. On Long Island, NSUH-LIJ Hospital in New Hyde Park offers level 3 treatment for adolescences.
Level 4: Residential Treatment Facility – A level 4 residential treatment facility can be a private treatment center or an adjunctive center to a hospital where patients receive extensive treatment on a 24-hour/7-day basis, while maintaining residence at the facility. Residential facilities provide on-duty staff 24-hours a day for continuous supervision and treatment. Some level 4 residential centers have a full-time medical staff and can accept patients who are medically compromised, while others may require incoming patients to be medically stable. Types and styles of residential treatment facilities vary greatly from clinic style management to more “luxurious” programs. Most residential centers for children and adolescence also provide educational services to avoid any interruption in academics. Patients who would be appropriate for this level-of-care should be medically stable to the extent that I.V. fluids, nasogastric tube feedings and/or daily laboratory tests are not required. Anorexic patients are usually below eighty-five percent of expected body weight and constant supervision is required for patients with uncontrollable binge-eating and purging behaviors or compulsive exercise. Also, patient who have poor or low motivation for treatment and have failed lower levels-of-care are prime candidates. There are no residential centers currently on Long Island.
Level 5: Hospitalization – Hospitalization is required for patients who are medically compromised, suicidal or completely uncooperative for treatment and pose an imminent risk to their health. Most hospitalizations for eating disorder patients are for the short-term management of medical and psychiatric risk factors and/or for nasogastric re-feeding with weight restoration to a minimally acceptable level and safety until a lower level-of-care is appropriate and available. A few hospitals may provide medical stabilization in specialized eating disorder units, and even fewer offer residential treatment or other step-down programs. Most hospitals on Long Island can provide medical stability, however NSUH-LIJ Hospital in New Hyde Park, Mather Hospital in Port Jefferson, and Stony Brook Hospital have additional staff with eating disorder experience.