What is Residential Eating Disorder Treatment? (October 2021)

– By Margot Rittenhouse, MS, LPC, NCC –

Residential eating disorder treatment is a level of care that few know about.

Many are familiar with the intensity of inpatient hospitalization or the processes of outpatient and support groups.

However, in between there exists an entire spectrum of treatment, with residential treatment centers being the next step down from inpatient hospitalization.

I have worked in the eating disorder field as an advocate, mentor, and therapist for almost 10 years and just recently began working in a residential eating disorder treatment center in Los Angeles.

Even with my years of experience, there was a great deal I did not understand about this level of care that I am happy to inform you all of.

Level of Care

As mentioned above, residential treatment is often the step-down after an individual has been on an inpatient hospitalization unit.

These individuals often still have severe eating disorder behaviors but are deemed medically stable, meaning that medical services such as IV fluids, nasogastric tube feeding, or multiple lab tests throughout the day are not required.

Even so, they still require 24-hour supervision to help them in challenging eating disorder urges.

Individuals at this level are also generally less than 85% of what a physician and/or dietitian decides is their “healthy body weight.”

Motivation levels vary in these individuals, with many having low motivation to recover and experiencing intrusive and repetitive thoughts for at least 4 hours each day.

Environment

The treatment environment varies based on facility, however, some aspects of residential treatment are consistent across the board.

Some facilities are a home within a community that appears on the outside like any other home. Within, there may be 5 – 10 patients engaging in treatment.

Others are an extension of a treatment center, separate from the hospital itself but still nearby and a bit more clinical in its environment.

Regardless, they are made to feel more like a home and provide feelings of independent living for those working towards recovery.

The goal is to begin challenging these individuals in taking ownership of their own recovery and treatment.

Treatment

Again, this varies from center to center, but residential treatment centers often involve an entire day of structured programming.

Within this programming, individuals engage in individual therapy multiple times per week, numerous process and didactic groups per day, family therapy sessions, all meals, and other activity-based groups that help individuals to build identity, engage in self-care, and connect with others.

The treatment modality depends on the residential treatment center so it is important to ask for information about this in any treatment center you or a loved one are considering.

Treatment in residential facilities also often have shortened schedules on weekends, with many doing a half-day of programming on a weekend day and possibly one entire day off. Individuals will have assignments on these days but are free to organize their time as they would like other than scheduled meal times.

Residential treatment is also unique in that therapists can take their patients out to eat for meal exposures or somewhere to go shopping for clothing exposures as their bodies change and they improve in their treatment.

Restrictions

One thing commonly restricted in residential eating disorder treatment is access to and use of technology, although, the degree to which this is restricted is dependent on the treatment center.

Some locations may have complete technology “black-out,” while others have restricted times where technology cannot be accessed or used such as during program hours.

Additionally, there are often restrictions on individual’s meal preferences, as many of these preferences are centered in disorder.

Many sites will allow a certain number of “preferences” such as 3 or 5 things the individual is absolutely certain they do not like or is allergic or intolerant to( with medical documentation to prove this). These “preferences” are explored with the dietitian to ensure they are not disordered preferences.

Due to COVID-19, other restrictions within residential treatment likely involve wearing a mask and face shield, having less time outside of the room, and not being able to go on field trips for meal outings or clothing exposures. Families are also unable to visit or engage in face-to-face family therapy sessions due to COVID-19 but these restrictions will change as COVID-19 numbers improve in the United States.

Step-Down

The likely recommendation once an individual is appropriate for step-down will be a Partial Hospitalization Program (PHP).

These programs involve attending treatment 5 days a week for 6 to 11 hours per day. Individuals will live at home while attending this, allowing them to build on the independence they began developing in residential.

COVID-19 has resulted in many facilities doing PHP virtually, however, it is still possible to find in-person programs.

It is important to engage in this level of treatment regardless of progress so that an individual can ease back into their daily life and environment while practicing recovery.