Written by Judith Banker, MA, LLP, FAED
When your child or adolescent has an eating disorder, the treatment landscape (levels of care, types of treatment, access to treatment etc.) can be overwhelming and confusing. Eating disorders are complex illnesses, therefore the type, course, and level of treatment can vary from child to child, family to family.
This page describes the levels of care and the types of evidence-based treatments available for all eating disorders including anorexia nervosa, bulimia, binge eating disorder, ARFID, OSFED (Other Specified Feeding and Eating Disorders) and related conditions.
Please note: Current levels of care and evidence-based treatments are not standardized across all regions of the world. While every effort was made to gain information about findings and practices from across the globe, the information presented here is derived primarily from research findings and from treatment guidelines developed in North America, Europe, and Australia. Future advances in cross-cultural research and collaboration will help our field understand and develop treatments and practice guidelines that can be culturally adapted and practiced effectively worldwide.
The term “level of care” refers to the therapeutic setting in which treatment is provided. Levels of care can range from a flexibly structured outpatient therapeutic setting where the patient and family participate in weekly hourly treatment sessions while remaining engaged in most of their usual school and work activities, to a highly structured, inpatient hospital medical unit where the child receives round the clock multidisciplinary care and support.
The appropriate level of care is determined by the severity of the illness including degree of medical stability, the ability to progress at the current level of care, and the family’s ability to provide the support or structure needed for their loved one to progress in treatment. Every family and every child has unique needs as well as strengths and limitations (personal or environmental) that impact treatment. All of these factors are taken into consideration when the appropriate level of care is determined.
As a parent, you do not need to – nor should you – make the decision alone as to what the appropriate level of care is for your child. This is a decision that is best made collaboratively with your treatment team based on your child’s needs, your needs as a family, and the recommendations of the team.
If you are just starting out seeking help for your child, an outpatient evaluation with a specialist physician, or specialist mental health team/professional is the first step to determine the best level of care and/or treatment recommendations.
It is important to be aware that treatment guidelines for children and adolescents with eating disorders strongly recommend that treatment should be offered at the least intensive level of treatment feasible, especially for children/adolescents with anorexia nervosa with a duration of illness less than 3 years. In other words, it may be best to start out with outpatient treatment if possible, and increase gradually to higher levels of care if and when needed.
Research on the effectiveness of treatments for eating disorders is more commonly carried out with adult patients. Available findings for effective treatments with child and adolescent eating disorders are more limited.
Working with a multi-disciplinary eating disorder specialist team treatment is strongly recommended whenever possible – including a psychologist/social worker, a dietitian or nutritionist, and medical management with a pediatrician and, if indicated, a psychiatrist.
The general aim of the treatment team is to work together with the family and patient to address symptom management and physical restoration while also addressing any co-occurring or pre-existing psychological and physical conditions, as well as effects or reactions to current treatment. Toward the end of treatment, the focus is on relapse prevention.
Research on the effectiveness of treatments for eating disorders is more commonly carried out with adult patients. Available findings for effective treatments with child and adolescent eating disorders are more limited.
Working with a multi-disciplinary eating disorder specialist team treatment is strongly recommended whenever possible – including a psychologist/social worker, a dietitian or nutritionist, and medical management with a pediatrician and, if indicated, a psychiatrist.
The general aim of the treatment team is to work together with the family and patient to address symptom management and physical restoration while also addressing any co-occurring or pre-existing psychological and physical conditions, as well as effects or reactions to current treatment. Toward the end of treatment, the focus is on relapse prevention.
Again, it is important to keep in mind that treatment for eating disorders can often be a trial and error process. In some cases, families start out with a professional team and treatment approach that is a good fit. In other cases, due to lack of access to treatment or other variables, it can be more difficult to arrange the type of treatment your child needs. While you are figuring things out, lean on us at F.E.A.S.T. for support and information.
F.E.A.S.T. does not recommend specific treatment providers or treatment centers.