So you’re contemplating — or actively seeking out — treatment for your life-threatening illness. Congratulations! Admitting to yourself that you need help is the first step in eating disorder recovery. These are 6 terms and related information you need to know before eating disorder treatment, or while you search for eating disorder treatment providers, including terms related to:
- How long you will be in treatment, and where you will receive it
- How other mental health issues might show up in treatment
- The way treatment providers should figure out where your body and mind are most healthy
- The completely normal body signals you will get in recovery
- How meals are structured within treatment
You don’t have to blindly jump into treatment. While it’s good to let go of some level of expectations and control, this information can all help you decide what kind of treatment is right for you.
1. Levels of Care
Formal eating disorder treatment providers have various levels of care. A level of care just describes how often you will go to an eating disorder treatment provider and where that treatment may occur.
THERE ARE FIVE STANDARD LEVELS OF CARE:
At the inpatient level of care, patients stay 24/7 in a treatment facility capable of treating any acute medical issues that come with recovery and keeping patients safe if they are a danger to themselves or others.
Note: Eating disorders are mental illnesses that sometimes have physical side effects. Whether you experience physical side effects or not, your eating disorder is valid and in fact life-threatening.
Next, there’s residential treatment. Medically stable patients stay 24/7 at a treatment facility focused more on restoring regular eating patterns, immediately stopping eating disorder behaviors, and coping with the distress of regularly eating without any form of compensation (such as purging or excessive exercise).
In Partial Hospitalization Programs (known as PHP, “partial”, or day treatment) patients stay at home at night and often during the weekends. They are able to be at home without engaging in dangerous behaviors, but still need a lot of structure to engage in therapy and continue restoring regular eating patterns. They travel to the treatment facility for around 5 days every week. They are in treatment for 6-8 hours a day, usually having two meals and at least one snack with other patients and a supervisor.
In an Intensive Outpatient Program (also called “IOP”) patients have most meals and snacks at home, but come into a treatment facility 3-4 days a week for about 3 hours. For the most part, they are able to continue eating at home without compensation, but need to practice coping skills and engage in slightly more intensive therapy. At this stage, individuals are able to resume daily activities for the most part, including school and work.
Finally, there’s outpatient treatment, where individuals are treated by at least one provider out in the community. They typically see a therapist, and may see a psychiatrist or dietician depending on their individual needs. They may see their providers once a week, or less often.
Related: Here is how to determine which eating disorder treatment center is right for you.
Individuals “step up” or “step down” in levels of care, depending on their needs. The level of care you start treatment at depends on a few factors:
- Medical stability
- Risk of harming yourself or others
- Co-occurring diagnoses
- Insurance coverage
Individuals will “step up” in their level of care if they need more support than their current level of care can offer. For example, if you cannot meet your basic nutritional goals at an IOP, then you may “step up” to PHP for more structure and support. It’s a way to get you the support you need to get back on track in recovery. You “step down” when you no longer need the level of treatment you are at. For example, once your treatment team is confident that you can keep yourself safe and eat at least one meal at home, they recommend you “step down” to PHP.
The “step up” and “step down” structure of treatment ensures that patients do not immediately go out into the community with no support at a high level of treatment. It also ensures that patients are not unnecessarily removed from their home and obligations if they do not need to be.
Related: This is how to pay for eating disorder treatment when insurance won’t cover what you need.
Note: You do not have to wait until you’re “sick enough” to need a higher level of care, because there is no “sick enough” that will satisfy your eating disorder. And you deserve recovery whether you have suffered for a day or several years.
2. Comorbid Diagnosis (or Co-Occurring Diagnosis)
Comorbid diagnoses are second (or more) mental illnesses you are diagnosed with, in addition to an eating disorder.
A lot of people with eating disorders may have comorbid OCD, OCPD, anxiety disorder, PTSD, and/or depression. That’s because eating disorders are not really “about food.” Rather, eating disorder behaviors like restriction or binge eating are a way of coping with the effects of other mental health issues.
For example, when someone has anxiety about an upcoming event or scenario they can’t completely control, they may react by controlling the type or amount of food they intake.
Related: This is how comorbid diagnoses work in eating disorder treatment and recovery.
3. Set Point Weight
A lot of eating disorder treatment providers also focus more on weight/BMI as an indicator of your recovery, rather than your psychological state and needs.
If you are “clinically underweight”, you may be given a meal plan designed to help with weight gain, increasing until you get to a “clinically healthy weight.”
However, everyone who suffers from an eating disorder involving restriction or compensation for food intake needs to gain weight, no matter how much they weigh at the start of treatment. This is true whether you are at a “healthy BMI” of 18.5 or you are “clinically obese.”
That’s because we are all different, and our bodies all function best at different weights. They all have different “set point weights”, or weights that allow you to live a life where you can:
- Eat whatever you want without guilt
- Meet your body’s nutritional needs
- Eat without compensating for your nutritional intake
- Focus on anything and everything beyond your eating disorder
Your healthy weight is at that set point weight, and it will be different from everyone else in eating disorder treatment (and everyone else in general.)
Related: Read more about set point weight and how to find an eating disorder treatment provider that does not engage in weight biased care.
4. Extreme Hunger
Extreme hunger is an intense hunger that results from your body healing in eating disorder recovery. It is not the same as binge eating episodes, which result from emotional distress. Your body starts sending intense hunger signals as a way of communicating to you that it needs more fuel to heal physically and mentally.
The only way to end extreme hunger is to honor your cravings and listen to your body’s needs. You will stop feeling ravenous, as soon as you adopt an “all foods fit” mentality and your body trusts you to consistently meet your nutritional needs.
5 & 6. Food Exchanges and Intuitive Eating
Many eating disorder providers and treatment centers use the food exchange system to create meal plans while others use more of an intuitive eating approach. In general, meal plans in treatment get you into the habit of eating normally and with flexibility. They also show patients how different foods (in different quantities) fulfill different nutritional requirements. Patients follow their meal plan both in treatment and in the early stages of recovery.
THE EXCHANGE SYSTEM
A “food exchange” is any food that could be substituted with another food from the same category. The five categories are:
- Carbohydrates
- Proteins
- Fats
- Fruits
- Dairy/”milk”
- Vegetables
- Dessert (sometimes this is included, this various by treatment center)
- “Other” (this category is sort of a “choose your own adventure” that allows you to try new foods and challenge your food fears while meeting your nutritional needs)
For example, one fruit exchange could be an apple. It could be “exchanged” for an orange, if you preferred, and would still meet the requirements for one fruit. Exchanges are described in quantities, which all add up to a meal plan with the right number of exchanges to meet an individual’s nutritional needs. For example (and everyone’s nutritional needs are different in recovery), a person may need 1-2 protein exchanges, 1 dairy exchange, 1 fruit, 1 fat, and 2 grains to make a complete breakfast.
Within those requirements, you can (usually, sometimes there are “challenge breakfasts” that everyone participates in) choose whatever types of food exchanges you want. You could choose Greek yogurt or a scrambled egg for protein, milk or soy milk for dairy, any fruit, peanut butter or butter, and toast or cereal — add those exchanges up and you have a complete breakfast.
While this system is helpful for some, it can complicate matters for others because it is a system that continues to assign values to food. For those with eating disorders that cling to numbers and rigidity, the exchange system can be somewhat problematic. For these individuals, an intuitive eating approach might be more sustainable.
INTUITIVE EATING APPROACH
We could write a whole article on intuitive eating (look out for that coming up!), but in summary, intuitive eating is “an evidenced-based, mind-body health approach, comprised of 10 Principles and created by two dietitians, Evelyn Tribole and Elyse Resch in 1995. It is a weight-neutral model with a validated assessment scale and over 90 studies to date.” Intuitive eating involves getting back in touch with your innate hunger and fullness cues in order to relearn how to effectively achieve nourishment, satiety, and pleasure from the experience of eating.
In treatment, this looks like:
- Normalizing eating and eating on a structured schedule
- Checking in and out at the table with hunger and fullness scales in order to practice this skill
- Experimenting with a wide variety of foods to challenge our eating disorder and allow our bodies and minds to makes decisions about food based on genuine wants and needs as opposed to the wants and needs of Ed
And there you have it: 6 terms you need to know before eating disorder treatment.
Now you know a little more about what to expect when you start your recovery, but to get a complete sense of the eating disorder treatment process, read this. Knowing what to expect in eating disorder treatment may help ease your anxiety as you start a journey that will literally save your life.
If you or a loved one is suffering from an eating disorder, take the first step today and talk to someone about recovery or simply learn more about the holistic eating disorder recovery programs we offer.
