Introduction
Welcome back to Treehouse Counseling’s blog series about eating disorders.
–>Eating Disorder 101: Eating Disorders vs Disordered Eating
–>Eating Disorder 101: Eating Disorder Subtypes
In this article, we address levels of care in eating disorder recovery, including a comparison between the levels themselves, need criteria for each level, moving up and down between levels, and more. For this article, we define a level of care as the intensity and frequency of a given psychiatric service, ranging from the occasional therapy session at the outpatient level to round-the-clock supervision and safety support at the inpatient level. Not enough care, and a person’s physical and mental well-being may be at risk of worsening, but too much care and there may be additional inappropriate financial or functional sacrifices made.
Receiving the appropriate level of care for a psychiatric or socioemotional concern is imperative for many people in jumpstarting and maintaining the healing process.
The Traditional Continuum of Care: From Lowest to Highest
- Outpatient (lowest level of care)
- When someone thinks of traditional therapy or medical check-ups, they often think of outpatient services
- Frequency: twice weekly or less
- Duration: hour long sessions, no set length of time
- Environment: office, clinic, or virtual
- Intensive Outpatient (IOP)
- More structured than outpatient therapy, while generally allowing for daily life engagement (work, school, etc).
- Frequency: 3-5 days/week
- Duration: Approx. 3 hours daily, approx. 1-3 months
- Environment: virtual or physical facility, often with group space
- Partial Hospitalization Program (PHP)
- Daily therapeutic contact, high structure without overnight stay
- Frequency: 5-7 days/week
- Duration: Approx. 7 hours daily, approx. 3-6 months
- Environment: virtual or physical facility, often with group space
- Residential Treatment
- 24/7 structured environment without hospital setting
- Frequency: 7 days/week
- Duration: 24 hours/day, approx. 1-3 months
- Environment: large residential house or dormitory
- Inpatient (highest level of care)
- Highest medical/psychiatric needs and full monitoring
- Frequency: 7 days/week
- Duration: 24 hours/day, approx. 1-3 months
- Environment: hospital
Core Criteria in Level of Care Decisions
- Medical Stability – Vital signs, labs, electrolyte balance
- Severity of Eating Disorder Behaviors – Frequency/intensity of restriction, bingeing, purging, over-exercise, etc.
- Psychiatric Risk – Suicidality, self-harm risk, co-occurring mental health conditions
- Nutritional Status – Trends over time, ability to maintain or restore weight safely
- Daily Life Functioning – Impact on work/school/social life; ability to follow treatment plan
- Support System – Family/social support and capacity for home structure
When to Consider Moving Up or Down Levels
- Signs that you may need to step up to a higher level of care:
- Worsening symptoms despite current treatment
- Medical instability (orthostatic vitals, electrolyte imbalance, etc) or unstructured weight changes
- Escalating psychiatric symptoms (especially increase in risk of harm to self or others)
- Signs that you may need to step down to a lower level of care:
- Sustained stability (especially in the face of variable stressors)
- Effective symptom management
- Strong coping skills and support
Real World Challenges
Making level of care decisions is an imperfect science. Most providers utilize standards within and between agencies to promote as much consistency as possible, but many people seeking services still experience some variability in recommendations for care. There are also practical considerations that can present barriers to treatment and should be considered during the referral process, including: location and accessibility of services, suitability of treatment modalities, and insurance coverage.
Though the first step to seeking treatment is often a self-assessment, eating disorder and other psychiatric specialists are trained to assess symptoms through a biopsychosocial framework. Though the insight of the client or patient is a crucial piece in the diagnostic process, sometimes mental health disorders can cloud one’s judgment about the severity of symptoms, and therefore an external assessment is necessary to accurately gauge level of care need.
Beyond Formal Treatment
This article is limited by sticking to an examination of the traditional level of care framework. However, many people in recovery learn over time what elements of care are the most helpful, and may even piece together their own care structure outside the traditional continuum. Support groups, seminars, community meals, and personalized interdisciplinary care teams (physicians, dietitians, psychiatrists, therapists, etc) can all create tailored means of support.
Conclusion
One way to think about different levels of care is to imagine the scaffolding on a building that is under construction. More scaffolding (i.e. a higher level of care) means more support for the workers and the building itself while it is undergoing change. Care can be highly customized, and moving between levels of care is often not a linear process. The more you know about the resources that are out there, the more power you or your loved ones have in taking charge of your recovery experience.
Future articles will discuss evidence-based therapies for eating disorder treatment.
Thank you for reading, and take care.
References
Dennis, K. (2024, March 4). Eating Disorders Evaluation and Diagnosis – NEDA. National Eating Disorders Association.
https://www.nationaleatingdisorders.org/evaluation-and-diagnosis/
Level of Care Guidelines for Patients With Eating Disorders Level 1: Outpatient Level 2: Intensive Outpatient Level 3: Partial Hospitalization (Full-Day Outpatient Care) a. (n.d.). In Massachusetts General Hospital. Retrieved February 17, 2026, from
https://www.massgeneral.org/assets/mgh/pdf/psychiatry/edcrp_apa_2006_ed_tx_guidelines_table.pdf
National Association of Anorexia Nervosa and Associated Disorders. (2026a, February 16). Eating Disorder Treatment Options. ANAD.
https://anad.org/learning-library/eating-disorder-treatment/
Shamy, C. (2025). What Are the Differences Between Inpatient Medical Hospitalization & Psychiatric Hospitalization? Acute.org.
https://www.acute.org/resources/levels-eating-disorder-care
