Are You Medically Stable for Outpatient Eating Disorder Therapy?

Photo by CDC on Unsplash

Learn about medical stability and why we are concerned about it.

When you contact us to schedule an appointment for yourself or your loved one, our program manager will gather some information that helps determine whether you (or they) need an immediate medical screening and whether the therapy we provide is likely to be effective.

At Eating Disorder Therapy LA, we only provide therapy at the outpatient level of care. This is the lowest of the eating disorder care levels as defined by the American Psychiatric Association. This may not be appropriate for all people with eating disorders.

Eating Disorder Levels of Care

Photo by CDC on Unsplash

The care levels ranked from highest to lowest are:

Medical hospitalization provides 24-hour care in a medical hospital, typically required for patients who are medically unstable (low heart rate, low blood pressure, or electrolyte imbalances) and need round-the-clock medical monitoring. Care can include intravenous replacement of electrolytes (salts in our blood), tube feeds, and constant monitoring of vital signs.

Residential treatment (RTC) provides 24-hour care for those who are mostly medically stable but require round-the-clock supervision of behaviors and meals to remain stable. Patients attend group therapy and sessions with a psychiatrist, therapist, and dietitian between meals and snacks.

Partial hospitalization (PHP) allows the patient to sleep at home and attend a treatment center during the day. Individuals can attend the program a minimum of five days a week for times usually ranging from six to 11 hours per day. Most meals are taken at the treatment center, but the patient has some meals at home. Patients attend groups and individual sessions as they do in RTC.

Intensive outpatient treatment (IOP) usually includes three hours of programming for three to five days a week. Usually, each visit includes one meal or snack and two hours of group and individual counseling. At this level of care, the patient lives at home and is often able to work or attend school outside of treatment hours.

Outpatient treatment (which we provide) usually consists of individual meetings once or twice a week with a therapist, a dietitian, or both. The patient lives at home and usually attends work or school or participates in other activities.

Criteria for Outpatient Eating Disorder Therapy

Per the APA guidelines, in order to receive treatment at the outpatient level of care, individuals should:

Be medically stable as demonstrated by:
- Heart rate greater than 50 during the day
- Blood Pressure greater than 90/50
- Normal blood panel
- Negative orthostatic tachycardia
Be at a high enough weight
Be able to manage suicidal thoughts if they have them
Have fair to good motivation to recover
Be able to independently manage the meals needed to gain or maintain weight
Be able to manage compulsive exercise
Exhibit minimal incidents of purging in an unstructured setting

The exception to this is teens (or adults) receiving Family Based Treatment (FBT) and living in the care of their parents —which equates to a PHP or RTC level of care. They may still need to go into a medical hospital for acute stabilization first.

Why Is Medical Stability Important to Us?

At Eating Disorder Therapy LA, we employ only eating disorder therapists. We have no medical staff to take vitals or run labs. Thus, it is essential that you (or your loved one) be cleared for outpatient therapy by a doctor—preferably one trained in the various complications of eating disorders. This applies to people of all sizes of bodies with eating disorders. If you need a referral to an eating disorder specialist doctor, we are happy to provide one. Alternatively, you can go to your local hospital and request clearance for outpatient eating disorder therapy or outpatient refeeding. If you choose to go to your own doctor, we can provide a document that explains what tests should be completed.

If you are—or your loved one is—at a very low weight for your body, have been eating very little, or are purging or exercising a lot, serious medical problems may follow, including dizziness, lightheadedness, fainting, and heart failure. And while it might seem innocuous, the process of starting to eat again can be potentially fatal for a seriously malnourished person. Starting to eat more can cause Refeeding Syndrome, a sudden shift in electrolytes that requires medical monitoring in the hospital.

Medical Stability for an Eating Disorder

Dall.e

Most medical doctors receive almost no medical training in the diagnosis and treatment of complications of eating disorders. Medical screening for an eating disorder should include at a minimum:

Full physical examination including
- Listening to lungs and heart
- Feeling the abdomen
- Feeling the temperature of the hands and feet
Measurement of height and weight
Lying and standing heart rate and blood pressure (orthostatic vitals)
Oral temperature
Labs to include full metabolic panel including electrolytes, renal function tests, liver enzymes, hormones, and nutritional panel
Potentially an electrocardiogram

To provide you with an overview of orthostasis, it refers to a drop in blood pressure, known as orthostatic hypotension, or an increase in heart rate upon standing, known as tachycardia. A simple explanation is outlined in this reference: Orthostatic Hypotension and Tachycardia in Adolescent Patients with Anorexia Nervosa. If you are asked to see a medical doctor before seeing us, please know that it is for your own safety. Once you receive clearance from a medical doctor, please reach back out and we can get you assigned to one of our therapists.

Learn more about preparing for disorder therapy.