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Introduction Levels of Care Acute Care Hospitalization Residential Care Partial Hospitalization Outpatient Care Psychotherapy Pharmacotherapy Primary Care Taking the History Physical Findings Laboratory Findings Medical Treatment Educating Patient & Family Nutritional Support Dental Care	Acute Care Hospitalization Please note: Eating disorders develop in men, women, girls, and boys. For ease in reading, we have used "she" and "her" in the text below. Inpatient treatment is appropriate when a patient’s safety is at risk: Heart rate: < 40 beats per minute for adults. For children and adolescents, <50 b.p.m. during the day and < 45 b.p.m. at night. Blood pressure: <90/60 mmHg for adults and <80/50 mmHg for children and adolescents Orthostatic BP Changes: > 20 b.p.m. rise in HR or > 10 mmHg fall in BP Body temperature: < 97 degrees Fahrenheit Dehydration Electrolyte imbalance Severe depression, suicidality Weight :< 85% of healthy body weight generally. Rapid weight loss may indicate hospitalization even if weight is not <85%. A rapid weight drop in an adolescent or child with an eating disorder may be an indication for hospitalization even if the amount of weight lost is not extreme. Children who do not take in enough food or fluid are quite vulnerable to dehydration and -- in comparison to adult patients -- may be at risk of medical compromise from a proportionately smaller decline in weight. Patient cannot modify abnormal eating habits without staff support during and after meals. Severe, frequent purging may necessitate hospitalization even if lab tests show no significant problems. Inpatient Services Inpatient care, which generally lasts from several days to a couple of months, focuses on medical monitoring and management of complications resulting from the eating disorder. Whether the patient is admitted to a medical or psychiatric unit is highly individualized. Based on the results of periodic laboratory testing, intravenous fluids may be needed to stabilize the patient’s electrolytes. Inpatients who are underweight work with a registered dietitian to restore their nutritional health. Many have pursued thinness at all cost and feel unduly anxious about ingesting foods that they consider “unsafe.” A key component of hospital programs is positive reinforcement for progress toward healthy behaviors. One-on-one psychotherapy offers the patient empathy and helps motivate her to participate in her program. Nursing staff is instrumental in supporting and encouraging individuals during meals and snacks. Some hospital units provide group therapy sessions, giving patients opportunities to share their feelings with each other and with staff. Family education-support groups are often available as well. Discharge planning is based not on weight status alone, but rather on a combination of variables, including how motivated the patient is to follow her nutrition program. Individuals discharged to outpatient care after gaining weight in the hospital may be at risk of relapse if they have not made emotional progress in support of recovery. References Number of different purging behaviors used among women with eating disorders: psychological, behavioral, self-efficacy and quality of life outcomes Ackard, D.M., Cronemeyer, C.L., Franzen, L.M., Richter, S.A., Norstrom, J. Number of different purging behaviors used among women with eating disorders: psychological, behavioral, self-efficacy and quality of life outcomes. Eating Disorders. 2011; 19: 156-74. Practice guideline for the treatment of patients with eating disorders American Psychiatric Association (APA). Practice guideline for the treatment of patients with eating disorders. 3rd ed. Washington (DC): American Psychiatric Association ; 2006 Jun. 128 p. [765 references]. Readiness to change mediates the impact of eating disorder symptomatology on treatment outcome in anorexia nervosa Bewell, C.V., Carter, J.C. Readiness to change mediates the impact of eating disorder symptomatology on treatment outcome in anorexia nervosa. International Journal of Eating Disorders. 2008; 41: 368-71. Percent body fat is a risk factor for relapse in anorexia nervosa: a replication study Bodell, L.P., Mayer, L.E. Percent body fat is a risk factor for relapse in anorexia nervosa: a replication study. International Journal of Eating Disorders. 2011; 44: 118-23. The effectiveness of cognitive behavioral therapy on changing eating disorder symptoms and psychopathology of 32 anorexia nervosa patients at hospital discharge and one year follow-up Bowers, W.A., Ansher, L.S. The effectiveness of cognitive behavioral therapy on changing eating disorder symptoms and psychopathology of 32 anorexia nervosa patients at hospital discharge and one year follow-up. Annals of Clinical Psychiatry. 2008; 20: 79-86. The effectiveness of, and predictors of response to, inpatient treatment of anorexia nervosa Collin, P., Power, K., Karatzias, T., Grierson, D., Yellowlees, A. The effectiveness of, and predictors of response to, inpatient treatment of anorexia nervosa. European Eating Disorders Review. 2010; 18: 464-74. The effect of bed rest on bone turnover in young women hospitalized for anorexia nervosa: a pilot study DiVasta, A.D., Feldman, H.A., Quach, A.E., Balestrino, M., Gordon, C.M. The effect of bed rest on bone turnover in young women hospitalized for anorexia nervosa: a pilot study. Journal of Clinical Endocrinology and Metabolism. 2009; 94: 1650-5. Malnutrition and hemodynamic status in adolescents hospitalized for anorexia nervosa DiVasta, A.D., Walls, C.E., Feldman, H.A., Quach, A.E., Woods, E.R., Gordon, C.M., Alexander, M.E. . Malnutrition and hemodynamic status in adolescents hospitalized for anorexia nervosa. Archives of Pediatrics & Adolescent Medicine. 2010; 164: 706 -13. Case records of the Massachusetts General Hospital. Case 29-2008. A 19-year-old man with weight loss and abdominal pain Goldstein, M.A., Herzog, D.B., Misra, M., Sagar, P. Case records of the Massachusetts General Hospital. Case 29-2008. A 19-year-old man with weight loss and abdominal pain. New England Journal of Medicine. 2008; 359: 1272-83. Treatment of chronic anorexia nervosa: a 4-year follow-up of adult patients treated in an acute inpatient setting Long, C.G., Fitzgerald, K.A., Hollin, C.R. Treatment of chronic anorexia nervosa: a 4-year follow-up of adult patients treated in an acute inpatient setting. Clinical Psychology & Psychotherapy. (In press). Mealtimes on eating disorder wards: A two-study investigation Long, S., Wallis, D.J., Leung, N., Arcelus, J., Meyer, C. Mealtimes on eating disorder wards: A two-study investigation. International Journal of Eating Disorders. (In press). Un/imaginable future selves: a discourse analysis of in-patients' talk about recovery from an 'eating disorder ' Malson, H., Bailey, L., Clarke, S., Treasure, J., Anderson, G., Kohn, M. Un/imaginable future selves: a discourse analysis of in-patients' talk about recovery from an 'eating disorder.' European Eating Disorders Review. 2011; 19: 25-36. Clinicians' perspectives on the premature termination of treatment in patients with eating disorders Masson, P.C., Sheeshka, J.D. Clinicians' perspectives on the premature termination of treatment in patients with eating disorders. Eating Disorders. 2009; 17: 109-25. Medical management of acute severe anorexia nervosa Norrington, A., Stanley, R., Tremlett, M., Birrell, G. Medical management of acute severe anorexia nervosa. Archives of Disease in Childhood . (In press). Normal late ventricular potentials in hospitalized patients with eating disorders Nussinovitch, M., Gur, E., Kaminer, K., Volovitz, B., Nussinovitch, N., Nussinovitch, U. Normal late ventricular potentials in hospitalized patients with eating disorders. International Journal of Eating Disorders . (In press). Position of the American Dietetic Association: nutrition intervention in the treatment of eating disorders Ozier, A.D., Henry, B.W. American Dietetic Association. Position of the American Dietetic Association: nutrition intervention in the treatment of eating disorders. Journal of the American Dietetic Association. 2011; 111: 1236-41. Bradycardia: an important physical finding in anorexia nervosa Portilla, M.G. Bradycardia: an important physical finding in anorexia nervosa. Journal of the Arkansas Medical Society. 2011; 107: 206-8. Nutrition therapy for eating disorders Reiter, C.S., Graves, L. Nutrition therapy for eating disorders. Nutrition in Clinical Practice. 2010; 25: 122-36. Changes in implicit and explicit measures of ego functions and distress among two eating disorder subgroups: outcomes of integrative treatment Rothschild, L., Lacoua, L., Stein, D. Changes in implicit and explicit measures of ego functions and distress among two eating disorder subgroups: outcomes of integrative treatment. Eating Disorders. 2009; 17: 242-59. Predictive factors of length of inpatient treatment in anorexia nervosa Strik Lievers, L., Curt, F., Wallier, J., Perdereau, F., Rein, Z., Jeammet, P., Godart, N. Predictive factors of length of inpatient treatment in anorexia nervosa. European Child & Adolescent Psychiatry. 2009; 18: 75-84. Motivational change in an inpatient anorexia nervosa population and implications for treatment Wade, T.D., Frayne, A., Edwards, S.A., Robertson, T., Gilchrist, P. Motivational change in an inpatient anorexia nervosa population and implications for treatment. Australian and New Zealand Journal of Psychiatry. 2009; 43: 235-43. Dropout from inpatient treatment for anorexia nervosa: Critical review of the literature Wallier, J., Vibert, S., Berthoz, S., Huas, C., Hubert, T., Godart, N. Dropout from inpatient treatment for anorexia nervosa: Critical review of the literature. International Journal of Eating Disorders. 2009; 42: 636-47. A practical comparison of two types of family intervention: An exploratory RCT of family day workshops and individual family work as a supplement to inpatient care for adults with anorexia nervosa Whitney, J., Murphy, T., Landau, S., Gavan, K., Todd, G., Whitaker, W., Treasure, J. A practical comparison of two types of family intervention: An exploratory RCT of family day workshops and individual family work as a supplement to inpatient care for adults with anorexia nervosa. European Eating Disorders Review. (In press). Group cognitive remediation therapy for adolescents with anorexia nervosa Wood L., Al-Khairulla, H., Lask, B. Group cognitive remediation therapy for adolescents with anorexia nervosa. Clinical Child Psychology and Psychiatry. 2011; 16: 225-31. Inpatient versus day clinic treatment for bulimia nervosa: a randomized trial Zeeck, A., Weber, S., Sandholz, A., Wetzler-Burmeister, E., Wirsching, M., Hartmann, A. Inpatient versus day clinic treatment for bulimia nervosa: a randomized trial. Psychotherapy and Psychosomatics. 2009; 78: 152-60. An update on hospitalizations for eating disorders, 1999 to 2009: Statistical brief #120 Zhao, Y., Encinosa, W. An update on hospitalizations for eating disorders, 1999 to 2009: Statistical brief #120. Healthcare Cost and Utilization Project (HCUP) Statistical Briefs [Internet]. Rockville (MD): Agency for Health Care Policy and Research (US); 2006- 2011 Sep. A group parent-training program: a novel approach for eating disorder management Zucker, N.L., Marcus, M., Bulik, C. A group parent-training program: a novel approach for eating disorder management. Eating and Weight Disorders. 2006; 78: 78-82. Photo credits: My First Stethoscope Digital Thermometer Depressed Making Weight All other photos on this page are from Microsoft Office. This page was last updated on December 10, 2011.