Treatment: What Level of Care, and Do I Actually Want it?

The decision to seek out (and begin) treatment for your eating disorder is inevitably going to produce some anxiety (or a lot of it). This is a normal feeling that you’re expected to be feeling! Let’s face it: treatment requires that you consciously take responsibility for the behaviors you have been engaging in, and consider the possibility of giving them up in hopes for recovery. Along with anxiety, there tends to be a great deal of shame, guilt, and/or disappointment. And yet, these emotions serve no real positive purpose in recovery itself. I get it though: these feelings can stem from the thought of, “why wasn’t I just able to do this on my own?” By choosing treatment, you’re not saying that you are a failure at your own recovery. Rather you’re showing your strength by being honest with yourself that you may need some extra support along the way. Remember: it’s YOU that is doing the work. Your treatment facility just happens to be the environment that the work is taking place in.

Let’s break down treatment options

Treatment can feel overwhelming in general, and this is amplified when we recognize the variety of treatment settings available.

  1. Inpatient: this is the highest level of care. You may have unstable vital signs, are at an acute health risk, and have other complications as a result of coexisting medical problems. You may also have worsening symptoms or be experiencing suicidal ideation or attempt. An individual is monitored 24 hours a day by their treatment team. The stay of inpatient care is typically less than 3 weeks, as the main goal is to stabilize the individual as medically safe (and quickly) as possible.
  2. Residential: imagine a dorm-room like setting providing 24-hour care for individuals. Individuals in this level of care are medically stable and do not require any intensive interventions. You will be monitored daily (and constantly) in structured programming. One central location provides all needs for recovery, including therapy, nutritional support, meals, group therapy, and the opportunity to independently use coping skills in a safe environment. You will be educated on effective coping skills, participate in meal planning and cooking classes, identify perfectionistic thought patterns while working to diminish them, while developing an age-appropriate identity separate from your eating disorder.
  3. Partial Hospitalization: this level of care is for those who are medically stable, but are experiencing eating disorder thoughts and behaviors that impair their daily functioning. Daily assessments are done to keep track of your progress, as well as psychological and mental status. Partial hospitalization typically requires 30-40 hours/week (or about 8 hours a day) where you work with a nutritionist and therapist (in both an individual and group setting) to establish healthy eating behaviors, while delving into the psychological factors that may be contributing to the eating disorder’s maintenance.
  4. Outpatient: this is the least restrictive level of care. You may no longer need daily monitoring, and your symptoms are under enough control to function in your daily life. Continued progress is achieved by attending programming 2-3 times per week. You are in a setting that requires independence, using effective coping skills, and holding yourself accountable for your recovery.

Where do I fit in?!

This is a reasonable question to ask! Fortunately, there is a team at the treatment center whose main role is to help guide you into the best possible setting for your recovery. This is based on coexisting mental health conditions, insurance, and medical risk. This can be extremely scary when we decide to place the decision into another person’s hands. The common belief when it comes to treatment is: I know what I need, my treatment team doesn’t. This becomes especially true when the dietician increases your meal plan, and you wonder WHY is this happening again to me? Trust is so crucial in treatment; I can assure you, your treatment team’s goal is not to intentionally make you more anxious than you already might be. When we surrender some of our control to a treatment team, we’re actually gaining control back. When we give a team our trust, we’re allowing them in, while pushing the eating disordered thoughts further and further out of our minds.

Show up

What does this even mean? Treatment isn’t a miracle solution to an eating disorder if you’re not willing to work. I can recall my first week of treatment very vividly: I was stubborn, unwilling to challenge myself, I engaged in manipulation, secrecy, and lying. It did nothing for me but keep me stuck in my eating disorder. If you’re going to choose treatment, choose it fully. Show up 110% every single day. Showing up means not merely “skating by” in treatment for the sake of getting out quicker. Showing up means not simply saying that “I’m in a healthy mindset” for the sake of appeasing your therapist. Showing up means participating in group, not simply doodling in your notebook waiting for minutes to pass by. Showing up means taking advantage of treatment: the ultimate goal is that it is a one-time occurrence. This is only possible if you allow it to be.



Nicole works as a life and wellness coach through Nicole Leigh Coaching ( Nicole strives to empower women with similar struggles to redefine and re-identify themselves, separate from their eating disorder. Through her work, she empowers women to use balance in every aspect of life to maintain lifelong recovery. When Nicole isn't blogging or counseling, she loves spending her time traveling, eating burgers, and surrounding herself with positive people.