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Find the Best Treatment Option for Your Patient

As a medical provider, you ensure your patient receives the care and treatment they need to feel like themselves again. In terms of eating disorder treatment, you have several different options to choose from.

  • Intensive Outpatient Program (IOP)
  • Partial Hospitalization Program (PHP)
  • Residential
  • Inpatient

It’s crucial to observe and record any eating disorder signs and symptoms to determine your patient’s best treatment option. Because eating disorders are a disease of disconnection, adolescents, teens, and adults tend to isolate themselves, hide their symptoms, and make excuses for their behavioral changes.

Patients often deny having an eating disorder. They usually don’t want to receive help. They want to maintain the control they have over their eating. But disordered eating is a mental illness that must be addressed.

Eating disorders have the highest mortality rate of all mental illnesses. Identifying one in your patient and getting them the proper treatment could save their life.

How to Determine the Most Beneficial Eating Disorder Treatment for Your Patient

Eating disorders are highly complex. Their causes and symptoms differ from one patient to the next, so it can be challenging to determine which treatment will be the most beneficial. To help you figure out which eating disorder treatment meets your patient’s needs, we’ve listed what you should look for under each type of treatment.

IOP

Our Intensive Outpatient Program is highly successful for most patients with an eating disorder. Use the following guidelines when considering the appropriateness of an IOP for your patient:

  • Despite best efforts, the patient is unable to (or would be unable to) recover in an outpatient setting. (i.e., therapy once a week)
  • The patient’s eating disorder symptoms or behaviors impact their daily life.
  • Your patient would benefit from having support and structure to help them learn how to manage and cope with their illness.
  • They have co-occurring medical or mental health conditions (i.e., depression, anxiety, substance use) that can be safely managed at this level of care.
  • They are not at imminent risk of self-harm or harm to others.
  • Your patient and their family can comply with the program and treatment recommendations.

IOP and/or PHP

Patients with the following profile may benefit from IOP and PHP levels of care:

  • Your patient’s medical status is stable and does not require a higher structure level to maintain stability.
  • They can control their binge/purge behaviors and maintain caloric intake for defined periods.
  • They can control maladaptive coping with the program’s support.
  • Their mental status is stable, with no suicidal or homicidal ideation.
  • Your patient is not dependent on alcohol or drugs.

Residential

Patients with the following concerns usually require a residential level of care:

  • They are medically stable.
  • They have psychiatric symptoms requiring inpatient structure to ensure safety compliance.
  • Their home environment does not provide adequate or stable support to help your patient work toward recovery in an outpatient setting.

Inpatient

In extreme cases, patients are considered for medical admission to hospital when they have:

  • Lost more than 30% of their body weight in three months or their body weight is less than 75% of the ideal body weight
  • Severe psychological risk (suicidal, psychosis)
  • Severe metabolic changes
  • Pulse < 45 or > 110 with symptoms
  • Systolic BP less than 75
  • Orthostatic change in HR > 20 bpm
  • Orthostatic change in BP > 20 mm Hg
  • Potassium less than 2.5
  • Hypophosphatemia
  • BUN greater than 30 or other
  • Signs of dehydration

Eating Disorder Symptoms, Physical Findings, and DSM-5 Diagnostic Criteria

Identifying the signs and symptoms of an eating disorder will help your patient’s treatment team determine their individualized treatment plan to aid in their recovery. Here’s what to look for in your patients that may have anorexia nervosa, bulimia nervosa, or binge eating disorder.

Anorexia Nervosa

Symptoms

  • Weight loss
  • Distorted body image
  • Weakness/fatigue
  • Dizziness/fainting
  • Cold intolerance
  • Constipation
  • Loss of muscle mass
  • Depression/anxiety
  • Loss/delay of menses
  • Cognitive impairment

Physical Findings

  • Emaciated
  • Hypotension
  • Bradycardia
  • Hypothermia
  • Hypoglycemia
  • Amenorrhea
  • Lanugo hair
  • Dry skin
  • Hypercarotenernia
  • Edema
  • Anemia
  • Cyanotic extremities

DSM-5 Diagnostic Criteria

  • Restriction of energy intake relative to the requirements leading to a significantly lower body weight
  • Intense fear of gaining weight
  • Body image disturbances or denial of the seriousness of low weight
  • Two types: restricting and binge eating/purging

Bulimia Nervosa

Symptoms

  • Bingeing and purging
  • Abdominal pain
  • Bloating/heartburn
  • Depression/anxiety
  • Feelings of shame and guilt
  • Abuse of laxatives, diet pills and/or diuretics
  • Heartburn/reflux
  • Sore throat
  • Self-injury

Physical Findings

  • Normal or overweight
  • Hypertensive
  • Edema
  • Electrolyte imbalance
  • Dehydration
  • Pancreatitis
  • Extremity weakness
  • Russell’s sign
  • Dental erosions
  • Esophagitis
  • Mallory-Weiss tears
  • Boerhaave Syndrome

DSM-5 Diagnostic Criteria

  • Recurrent binge episodes (large amount with a loss of control)
  • Recurrent use of inappropriate behaviors to prevent weight gain (vomiting, laxatives, exercise, diet pills, fasting, water overloading)
  • Both bingeing and purging occur, on average once a week for three months or more
  • Does not meet criteria for anorexia

Binge Eating Disorder

Symptoms

  • No purging behaviors
  • Weight fluctuations
  • Loss of control over food intake
  • Eating large amounts of food when not feeling physically hungry
  • Eating much more rapidly than normal
  • Self-medicates with food
  • Secretive eating

Physical Findings

  • Overweight
  • Gallbladder disease
  • Increased blood pressure
  • Increased cholesterol
  • Heart disease
  • Type II diabetes
  • Lipid abnormalities
  • Osteoarthritis
  • Sleep apnea
  • PCSO
  • Kidney problems
  • Certain cancers

DSM-5 Diagnostic Criteria

  • Recurrent binge episodes; at least once a week for three months
  • Lack of control over eating during binge episodes
  • Marked physical and emotional distress regarding binge eating
  • Binge eating is not associated with the use of inappropriate compensatory behavior
  • Binge eating may alternate with dietary restriction

OSFED: Other Specified Feeding or Eating Disorders

  • A significant eating disorder that does not meet the above criteria

Key Eating Disorder Treatment Definitions

To determine the best treatment option for your patient, you must first understand the terminology associated with eating disorders.

  • Intensive Outpatient Program (IOP): Outpatient treatment taking place 3-4 days each week, 3-4 hours each day
  • Partial Hospitalization Program (PHP): Outpatient treatment occurring daily, 6-8 hours each day
    • PLEASE NOTE: The IOP and PHP are similar in that they treat the same patient profile. However, IOP may allow the patient to receive treatment with less disruption to everyday life (i.e., school, raise a family, etc.)
  • Residential Treatment: The patient lives at a residential facility, so they have 24-hour supervision with treatment interventions throughout the day.
  • Ideal Body Weight = Healthy weight ranges (100 pounds @ 5ft + every 1in adds 5-pounds (female)/6-pounds (male)
  • Weight Range = 10% on either side of ideal body weight
  • Medical Stability: The patient has no abnormal metabolic changes and weighs greater than 75% of their ideal body weight.
  • Psychiatric Stability: The patient has no suicidal or homicidal ideation and experiences no hallucinations or delusions.
  • Medical Necessity: The term used by insurers indicating the patient’s illness warrants the level of care requested.
  • Treatment Team: Anyone engaged in the patient’s care makes up their treatment team. This includes their Dietitian, Therapist, Medical
  • Provider, coaches, parents, teachers, and anyone who can support the patient’s outcome.
  • Insurance Authorization: This is when a patient’s insurance company allows them to use their insurance benefits for treatment. Insurance companies apply the information provided by the patient’s treatment team to their own eligibility criteria to determine a patient’s medical necessity for treatment.

Find the Right Treatment, Get Them the Help They Need

Our clinical teams include an array of exceptional individuals with expertise in all areas of eating disorder treatment. If you’re unsure where your patient can benefit the most to help them with eating disorder recovery, contact us. We’ll be happy to help.

For more tips on how you can help someone with an eating disorder and the do’s and don’ts of what you should say and do to ensure they seek help, visit our “How to Help Someone With an Eating Disorder” page.

Together, we can help your patient get the eating disorder treatment they need and get them on their way to recovery.