When Do You Need a Higher Level of Care for an Eating Disorder? How to Know When Outpatient Treatment Isn't Enough
Here’s a clear, compassionate, and evidence-informed blog post titled:
When Do You Need a Higher Level of Care for an Eating Disorder?
How to Know When Outpatient Treatment Isn't Enough
Eating disorder recovery isn’t one-size-fits-all. Some people do well with weekly outpatient therapy and dietitian support. Others need more intensive care to break free from the cycle of disordered behaviors, restore physical health, and feel emotionally safe enough to heal.
If you're wondering whether it’s time to consider a higher level of care — like intensive outpatient (IOP), partial hospitalization (PHP), residential, or inpatient treatment — you're not alone.
Here’s what you need to know about when to take that next step, and why it's a critical part of protecting health and restoring hope.
What Is a Higher Level of Care?
A higher level of care (HLOC) refers to structured, multidisciplinary treatment beyond weekly outpatient therapy. It includes:
1. Intensive Outpatient (IOP)
3–5 days/week
3–4 hours/day
Includes group therapy, meal support, and continued outpatient work
2. Partial Hospitalization Program (PHP)
5–7 days/week
~6–10 hours/day
Medical monitoring, group and individual therapy, supervised meals
3. Residential Treatment
24/7 care in a live-in setting
For those needing full support but not medical hospitalization
4. Inpatient Hospitalization
Short-term, medically necessary care
For patients who are medically unstable or at imminent psychiatric risk
Each level serves a purpose — and stepping up is a sign of commitment, not failure.
Signs You May Need a Higher Level of Care
The Academy for Eating Disorders (AED) and the American Psychiatric Association (APA) recommend considering higher care if any of the following are present:
1. Medical Instability
Heart rate <50 bpm (day), <45 bpm (night)
Blood pressure <90/45 mmHg
Dehydration or electrolyte imbalance
Rapid or significant weight loss
Fainting, dizziness, cold intolerance
Body mass index (BMI) <75% of expected for age/gender
(APA Guidelines, 2023)
2. Severe Psychological Distress
Suicidal thoughts or self-harm
Severe anxiety, depression, or trauma symptoms
Intense body image distortion
Inability to function at school/work
Avoidance of therapy or refusal to engage in outpatient care
3. Inability to Eat or Maintain Weight on Your Own
Ongoing restriction despite outpatient support
Purging multiple times per day
Bingeing episodes that are frequent and distressing
Weight suppression without physical or psychological improvement
4. Lack of Progress in Outpatient Therapy
If you've been working hard in therapy but:
Symptoms aren’t improving
Weight is not restoring
Behaviors are worsening
Emotional overwhelm is rising
…it may be time to increase support rather than blame yourself.
“It’s not about willpower. Sometimes, your environment needs to change before you can.”
Why Early Intervention at the Right Level Matters
Faster symptom reduction
Greater chance of full recovery
Lower risk of long-term complications (bone loss, infertility, cognitive changes)
More comprehensive care from a full team: medical, nutritional, psychiatric, and therapeutic
A higher level of care isn’t the last resort — it’s often the turning point.
What a Higher Level of Care Offers
Supervised meals and snacks
24/7 support in residential or inpatient settings
Group and individual therapy
Medical and psychiatric oversight
Skills to manage distress and triggers
Family therapy and education
It creates a safe container to begin healing when the outside world feels overwhelming.
Final Thought
If you or your loved one is struggling with an eating disorder and outpatient treatment isn’t enough, it’s not a sign of failure — it’s a sign that more support is needed and deserved.
The earlier you match the level of care to the severity of symptoms, the better the chance of full, lasting recovery.
References
American Psychiatric Association. (2023). Practice Guideline for the Treatment of Patients with Eating Disorders. https://www.psychiatry.org
Academy for Eating Disorders (AED). (2022). Medical Care Standards. https://www.aedweb.org
Golden, N. H., & Katzman, D. K. (2011). Eating disorders in adolescents: Position paper of the Society for Adolescent Health and Medicine. Journal of Adolescent Health, 49(1), 86–97.
Le Grange, D., et al. (2012). Randomized clinical trial of family-based treatment vs. supportive psychotherapy for adolescents with anorexia nervosa. Archives of General Psychiatry, 69(1), 51–58.
Need help finding the right level of care?
We specialize in helping children, teens, and young adults (ages 5–25) find the support they need — whether it’s outpatient therapy or connection to a higher level of care.
