Inpatient Eating Disorder Treatment

Inpatient eating disorder treatment involves the hospitalization of individuals with severe eating disorders, such as anorexia nervosa or bulimia nervosa, due to the urgency of their medical condition. This level of care provides 24-hour supervision and comprehensive medical, nutritional, and psychological support to address immediate health risks.

People who may need inpatient eating disorder treatment include:

• Those with life-threatening physical complications, such as severe malnutrition, electrolyte imbalances, cardiac arrhythmias, and organ failure
• Those with extreme weight loss, refusal to eat, or failure to respond to outpatient treatment
• Those experiencing dangerous psychiatric symptoms, such as suicidality, severe depression, or acute psychosis
• Those with medical instability, such as unstable vital signs or hypothermia

The primary goal of inpatient eating disorder treatment is to achieve medical stabilization and initiate the early phases of the recovery process. This involves addressing immediate health risks, restoring nutritional balance, and laying the foundation for ongoing therapeutic interventions to support sustained recovery. Before leaving an inpatient eating disorder treatment program, clients will work with their team to determine the next steps in recovery, which could include ongoing therapy, step-down programs, and often the introduction of new team members like dieticians, therapists, or support groups.

Inpatient and Partial Hospitalization

If you (the patient) are in grave physical danger and cannot be treated or maintained safely without immediate medical interventions, the mental health professional who is examining you may arrange for intensive treatment. Treatment in a more intense structured setting may also be required if your symptoms are out of control and danger appears imminent. Inpatient treatment involves twenty-four-hour care in a medical or psychiatric facility (e.g., an inpatient hospital setting) designed to treat medical complications and restore and/or maintain healthier weight, as well as provide limited therapy.

If you are uncooperative with treatment recommendations and doctors feel that your life is in jeopardy unless you receive intensive intervention immediately, you may be admitted to the hospital against your will in a process known as "involuntary commitment." If you continue to refuse food and nutritional supplements while in the hospital, you may need tube intravenous (IV) feedings to save your life. Though hospitalization may be involuntary, it does not typically last for long periods. The goal of hospitalization is to physically stabilize you and prevent serious medical complications and death. Insurance companies cover the cost of brief admissions to the hospital only when medically indicated and justified by qualified physicians.

Sometimes, when you need more support than can be offered through outpatient therapy but less supervision than an inpatient program, you may be advised to attend a partial hospitalization or day treatment program. Although there are few partial and day treatment programs designed specifically for those with eating disorders, these programs are becoming more popular as an alternative to the higher cost of inpatient programs. When attending one of these programs, you will also attend treatment at a hospital or clinic several days per week for a few hours each day. You will not sleep at the hospital, and you'll return to your home in the evening. 

Erin L. George, MA-MFT, says that "while PHP programs are becoming more and more popular, they have their pros and cons. A person in a PHP program will have access to multiple types of therapy, including group therapy during the day, but they will be on their own at night. This can be a great opportunity to experiment with recovery but puts a client at higher risk for relapses—something that can be explored in PHP if a patient is honest about their struggles."

Recognizing the Need for Inpatient Care

If you or someone you know has an eating disorder, you may be wondering if inpatient treatment is necessary. Here are some of the signs indicating that someone may need inpatient care:

• Comorbid mental health conditions, like depression, panic disorder, bipolar disorder, borderline personality disorder, or PTSD
• Suicidal ideation (fantasizing about suicide) or behaviors
• Plans to harm oneself or others
• Severe malnutrition, emaciation, weight loss, or electrolyte imbalances
• Unstable vital signs like blood pressure, pulse, and respiratory rate
• Kidney, liver, or heart dysfunction
• Severe psychiatric symptoms like psychosis
• Frequent, dangerous binge eating and purging episodes 
• Lack of progress in an outpatient program
• Unwillingness to engage in or comply with outpatient treatment 

Residential Treatment

Residential facilities offer 24-hour care to patients who may not be in acute medical danger but who continue to engage in eating-disordered behaviors and need intensive support to continue functioning daily. 

For example, people who use bingeing, self-induced vomiting, laxative use, compulsive exercise, and restricted eating and who cannot stop these behaviors without intensive supervision may be recommended for residential treatment. 

These programs generally offer specialized treatment, including supervision of behaviors and daily living activities while still providing patients with opportunities for increasing responsibility for their own recovery. 

Such programs often exist in medical hospitals or on campus-like grounds, estates, or renovated houses. Insurance companies rarely offer residential benefits to their customers. Often, you and your family must pay out of pocket for residential care.

In some circumstances, you may live in a halfway or recovery house, which provides support and relapse prevention within a less structured setting than a typical residential program. These programs offer transitional situations (e.g., between hospital and regular environments) where residents can live with others who are also in recovery. Residents attend group therapy and recovery meetings and participate in individual therapy either as part of the house program or with an outside therapist. Residents of recovery houses are typically free of the worst behavioral, physical, and medical eating disorder symptoms and are working toward living in the community again. Erin L. George, MA-MFT, says, "From my experience of working in residential settings, they offer patients struggling with eating disorders the opportunity to practice new skills, such as cooking and preparing meals for themselves. These residential homes also offer a good opportunity for a support network and accountability because of the generally smaller number of patients in each home."

Typically, care progresses along a pattern from immediate, life-saving interventions in a hospital setting to partial or residential programs and intensive therapy to less frequent outpatient therapy sessions. Some people, however, may start their treatment in a lower-level facility because their eating disorder isn't as severe or was caught early, or their healthcare team doesn't deem it necessary for them to have 24-hour supervision.

As you gain physical and emotional health (or if your treatment started at a less severe stage), you will transition to a recovery program or outpatient services while living at home again. As needed, you may return to more intensive levels of care if your symptoms resurface or you feel out of control once again.

Inpatient Eating Disorder Treatment vs. Other Levels of Care

Inpatient eating disorder treatment is the most intensive option there is for treating conditions like anorexia, bulimia, and binge eating disorder. Below is a comparison table for various treatment settings:

Inpatient vs. Residential

Inpatient eating disorder treatment is the most intensive and structured treatment setting available. While inpatient occurs in a hospital or treatment facility that offers around-the-clock medical care, residential treatment typically occurs in a more home-like setting or treatment center without 24/7 medical oversight. 

Residential programs may offer some medical services during set hours but aren’t available all the time in case of emergency. People typically stay in residential programs for several months, living there and benefiting from social support as well as therapeutic interventions like therapy and counseling. This setting is ideal for someone who doesn’t need immediate medical attention but still wants a higher level of care than a PHP, an IOP, or an outpatient program.

Inpatient vs. PHPs and IOPs

Inpatient eating disorder care offers 24-hour care within a hospital or specialized facility, with patients living there for the duration of the program.

Partial hospitalization programs (PHPs), also called day treatment, involve living at home and attending up to 30 hours of treatment per week. PHPs are suitable for those who require intensive support but can maintain stability outside of treatment hours.

Intensive outpatient programs (IOPs) are a step down from PHPs, offering a less intensive level of care with fewer treatment hours—usually between 9 and 20 per week. IOPs are designed for patients who may have made progress in higher levels of care but still require structured support and therapy. Both PHPs and IOPs focus on medical, nutritional, and psychological interventions but provide more flexibility for people to maintain some aspects of their daily lives.

The choice between these levels of care depends on the severity of the eating disorder, medical stability, and the patient’s ability to function outside of the treatment setting. 

Inpatient vs. Outpatient Treatment

Inpatient eating disorder treatment and standard outpatient treatment represent two ends of the spectrum in the continuum of care for people with eating disorders. Inpatient is the most structured type of care for people with severe malnutrition, medical instability, and acute psychiatric distress. In contrast, standard outpatient treatment occurs in an office or clinic setting and typically involves scheduled appointments with healthcare professionals, including therapists, dietitians, and medical providers. 

Standard outpatient care is suitable for a type of step-down care for those who have previously attended inpatient treatment or a PHP. Otherwise, it may be helpful for someone with milder eating disorder symptoms who can maintain their daily activities and doesn't require constant monitoring.

Pros and Cons of Inpatient Eating Disorder Treatment

There are many advantages to inpatient treatment as well as some disadvantages. It’s important to remember that treatment is highly individualized, and what works for one person may not be the best choice for you. 

Pros of inpatient treatment:

• 24-hour medical monitoring
• Highly structured and controlled environment, minimizing triggers and providing routine
• A multidisciplinary team approach involving a collaborative team of healthcare professionals
• Intensive therapeutic support like individual, group, couples, and/or family therapy
• Nutritional rehabilitation in which specialized dietitians create and monitor meal plans
• Crisis intervention, which is especially crucial for those at risk of self-harm, suicide, or severe medical complications
• Isolation from triggers
• Peer support in a supportive community
• Transition to lower levels of care once someone completes inpatient treatment

Cons of inpatient treatment:

• Disruption of daily life, including work, school, and family responsibilities
• More expensive than outpatient options and insurance coverage can vary
• May be stigma associated with going to inpatient treatment
• Loss of independence due to the highly structured environment
• Limited exposure to real-world triggers, which can make the transition home more challenging

Inpatient Treatment and Co-Occurring Disorders

Inpatient eating disorder treatment programs adopt a comprehensive approach to address co-occurring disorders by integrating mental health care within the overall treatment plan. Recognizing that eating disorders often coexist with conditions such as anxiety, depression, and substance use disorders, these programs typically use an integrated approach with a multidisciplinary team of professionals, including psychiatrists, psychologists, doctors, nurses, and addiction specialists. 

The treatment team focuses on concurrent management of both eating disorder symptoms and co-occurring mental health issues. Therapeutic modalities, such as individual and group therapy, may target the interconnected nature of these disorders so that they stop fueling each other. 

Additionally, specialized interventions, such as dual-diagnosis treatment, provide tailored strategies to address the unique challenges presented by comorbid conditions. The goal is to offer patients a supportive and inclusive environment that addresses the complexity of their mental health, fostering sustainable recovery across all facets of their well-being.