How to Know When It’s Time to Get Help for Disordered Eating
The Slippery Slope of Disordered Eating
When it comes to food, exercise, bodies, and health, this world can be overwhelming (to put it lightly). There are messages constantly whizzing from all directions about the latest nutrition finding, diet recommendation, health buzz, and exercise routine. At first, learning more information about “healthy” habits can be exciting. Trying a new food? Learning a new way to move your body? No harm in that!
The tricky part is that these new interests can be a slippery slope into “just” cutting out some foods, “prioritizing health” by ranking the exercise routine above all other activities or opting out of social situations that might include “forbidden” foods. Next thing you know…it becomes hard to remember the last time you weren’t thinking about what you did or will eat, how you want to change your body, or if the exercise you did earlier today “actually counted.”
Look – consistent nourishment, joyful movement, and health-promoting behaviors are wonderful pieces to incorporate in a values-aligned life! However, when routines become rigid, and exploration turns to obsession, it may be time to evaluate if these behaviors are still serving you – or if you’ve become enslaved to them.
Wondering if it’s time for you to reach out and seek support? It’s important to emphasize that EVERYONE deserves a peaceful relationship with their food, body, and movement. There is no such thing as “I’m not sick enough” or “it’s not that bad.” If it’s causing you distress, it’s worth it to address!
If some of the following ring true for you, seeking support from an eating-disorder informed therapist and/or dietitian may be helpful:
My thoughts are often about food, exercise, or my body, and these thoughts often distract me from what I’m doing.
I feel guilty after I eat food or if I take a rest day from exercise.
My mood is dependent on the number I see when I step on the scale.
I never allow myself to feel full, and/or I can’t stop eating until I’m uncomfortably full.
I avoid social situations that may involve foods I can’t eat on my diet.
If it comes to choosing between a social event or exercise, I always choose exercise.
I’m constantly worrying about how my body looks and try to find new, more effective ways to change it.
Navigating the diet-culture fueled messages circulating in the world can be challenging – a professional can help you identify what behaviors are and are not supporting the life you truly want – and deserve! – to live.
Seeking out support from an outpatient provider like a therapist or dietitian can be a beneficial, and important, first step. But what if it’s not enough?
The Levels of Care for Eating Disorder Treatment
As they progress in severity, eating disorders become more complex and may require support beyond what the outpatient level of care can provide. Eating disorder-informed clinicians can help in recommending the appropriate level of care beyond outpatient. The continuum of care looks like this:
The Eating Disorder Treatment Continuum of Care
Higher levels of care (HLOCs) provide increasing support (left to right) in the form of group therapy, individual/family therapy, nutrition therapy, psychiatry, meal support, structure, and predictability. Factors such as eating disorder symptoms, frequency and duration of behaviors, mood symptoms, medical stability, and extent to which all of these interfere with one’s life are all taken into consideration when recommending the level of care. Here’s a quick breakdown of what you might experience at each level of care:
Outpatient: A weekly or bi-weekly session with a therapist and/or dietitian to manage symptoms while living your daily life (i.e. – going to school or work daily, living at home, etc.)
Intensive Outpatient Program: Multiple sessions weekly (usually 3-5 days/week), each day including a couple group therapy sessions and a supported meal, while still having the support of a therapist and dietitian.
Partial Hospitalization Program: Day treatment that’s (depending on the program) 5-7 days weekly, 5-10 hours per day, consisting of group therapy, individual sessions with all treatment team providers (psychiatrist, individual/family therapist, dietitian), and multiple supported meals and snacks. Monitoring of labs and vital signs.
Residential Treatment Center: 24/7 care, including support at all snacks and meals, group therapy, sessions with all treatment team members, and more frequent monitoring of labs and vital signs.
Inpatient: 24/7 care intended to medically stabilize before stepping down to RTC (usually).
Although committing to a higher level of care can be challenging, following eating disorder clinicians’ recommendations for which level of care to pursue can not only shorten overall length of stay in treatment, but dramatically improves lasting recovery outcomes. The goal is to provide the appropriate type of treatment depending on the presenting symptoms and seeking a lower level of care than recommended can prolong suffering and increase risk of treatment burnout.
Generally, a HLOC is recommended when response to treatment is too challenging at the lower level of care and change is either not happening or happening more slowly than indicated. Examples of changes can include increasing consistency of eating, decreasing engagement in eating disorder symptoms, rate of weight restoration (if warranted), mood stability, medical stability, etc.
Remember that no matter what your symptoms look like, you deserve support in fostering a peaceful relationship with food, body, and movement. There is hope for full and lasting recovery – your life can be different!
Adee Levinstein, MS, RD, CSSD, LD, CEDS-S earned her medical dietetics degree from the University of Missouri’s Coordinated Program in Dietetics, where she also completed her dietetic internship. She was then selected to the Gatorade Sports Nutrition Immersion Program Fellowship at Auburn University, in which she worked as a sports dietitian for multiple teams. Following the fellowship, she continued at Auburn as a graduate assistant sports dietitian while completing her master’s degree in exercise physiology and earning her certified specialist in sports dietetics (CSSD) designation. Adee now works as a Nutrition Manager at the Eating Recovery Center of Baltimore, supervising nutrition staff and working with patients with eating disorders in the outpatient through residential levels of care as a certified eating disorders specialist – supervisor. Her passion lies in improving the way patients relate to food, movement, and their bodies in order to nourish their whole person – physically, mentally, emotionally and socially.