What Eating Disorder Treatment is Really Like: A Day in the Life

Written by CCTC Staff Writer

One of the scariest parts of eating disorder treatment is actually not related to food or weight: it's all the unknowns of treatment. What's it like to go to a treatment center, if you are able to receive adequate care? What's it like to spend several hours a day focused on both stopping behaviors and on working through the issues behind your disorder?

To alleviate your fears, we'll take you through a typical day in the life of eating disorder treatment. Learn about:

Levels of care and how that may affect your treatment experience
Some types of eating disorder therapies you may encounter in treatment
What to expect when it comes to meals and snacks
The team of trained professionals that is usually assembled to meet your recovery needs

This "day in the life" is based on our programming at Central Coast Treatment Center. To view a 2021 sample schedule, go here.

Levels of Care in Eating Disorder Treatment

Levels of care simply refers to how often you go to a treatment program. Your level of care also determines whether you can go home at night or if you have to stay at the residence 24/7.

There are 5 levels of care in eating disorder treatment. Individuals may move up and down in levels of care as they need more or less formal support.

Inpatient and residential treatment requires you to stay on the premises, to keep you safe and to help you stop behaviors if you can't avoid them for any length of time at home.

People in partial hospitalization programs (PHP) and intensive outpatient programs (IOP) may stay at home or near the treatment center. Many programs offer housing for PHP and IOP patients, or they can recommend local residences to stay in for the duration of treatment.

PHP patients go to treatment 5 days a week for several hours a day, and eat around 2 meals and 1-2 snacks under the therapeutic guidance of a center staff member. Those in IOP meet for 3-5 days a week for 3-4 hours. They eat at least a meal and a snack together, also under the support of a center staff member.

Most treatment centers require a steep step down, from 5 days/week for the whole day to 3 hours, 3-4 days/week.

But at Central Coast, we recognize that the step down process should be gradual. This way, you ease back into daily life without too many slips.

So, we offer patients the option to come to IOP for all 5 weekdays, then gradually move down to 3-4 days a week. Individuals may come to IOP in the morning, afternoon, or evening. We work with you to accommodate school, work, or other obligations that might otherwise keep you from receiving the support you need.

Related: It's more than moving out: why college students develop eating disorders.

Finally, there is the outpatient level of care. Patients meet their outpatient treatment team on a weekly basis, as they can mostly manage symptoms on their own.

What about treatment during COVID-19? Or what if you're too far away for in-person treatment?

Many treatment centers, including Central Coast, now offer virtual treatment programs due to COVID-19.

They have all the same elements of in-person programs. You simply find a safe space in your home, log into the virtual therapy room, and start your day in eating disorder treatment. Of course, you do have to eat what you have in the house, but program dietitians will help you navigate a meal plan from a distance.

Related: Not everyone has access to the same level of nutritionally balanced foods. This is how to handle food insecurity and an eating disorder.

What is an eating disorder treatment team?

Eating disorders are complex illnesses that can sometimes involve comorbid diagnoses, physical side effects, and a number of other issues.

That's why a complete eating disorder treatment team typically includes:

Individual therapist: to help you delve into the issues behind your eating disorder, eliminate maladaptive coping mechanisms, and replace harmful behaviors with more positive ones
Psychiatrist: to (sometimes) prescribe medications for comorbid diagnoses, such as an anxiety disorder or depression
Registered Dietitian: to educate you about nutrition and help you meet nutritional goals; they may prescribe a meal plan and then help you shift towards intuitive eating
Primary care doctor: to monitor for possible physical side effects of an eating disorder

Note: You do not need to show any physical side effects of an eating disorder to have one. You also do not need a professional to diagnose you with an eating disorder to have one. You are valid with or without a treatment team. But you have a better chance of recovery with a dedicated team of specialists, if you can afford it.

What does meal support mean in eating disorder treatment?

In treatment, most meals/snacks are eaten as a group, with a staff member of the treatment center acting as a support during the allotted time to eat.

Depending on the program, you have anywhere from 30-60 minutes to eat meals, and 15-30 minutes for snacks.

Some programs have patients plan meals ahead of time, while snacks are chosen a few minutes before sitting down as a group in a dining room. Less "planned out" snacks increase patients' ability to be spontaneous and challenge fear foods.

Support staff may help distract patients with games or appropriate conversation, steer the conversation away from any triggering topics, and help struggling individuals cope during distress.

In inpatient and residential treatment, liquid supplements are offered to patients if they do not finish a meal or snack.

However, in lower levels of care patients are better able to cope with meals and snacks. Supplements are not typically given in lower levels of care.

Can you be vegetarian or vegan in eating disorder treatment?

Sometimes, dietary choices such as vegetarianism and veganism are actually driven by one's eating disorder as a way to restrict the types of food eaten.

And sometimes, allergies or conditions such as lactose intolerance and gluten sensitivity are eating disorder driven. This is especially true for individuals struggling with avoidant/restrictive food intake disorder (ARFID).

At Central Coast (and most other treatment centers), meal plans are adjusted to accommodate diagnosed medical conditions. Some treatment centers (ours included), offer vegetarian options.

Throughout the treatment process, a therapist and/or dietitian will work with you to differentiate between what you want to eat, and what your eating disorder has convinced you to eat.

Note: Lifestyles such as vegetarianism and veganism are not inherently disordered. But for total food freedom, you have to parse out what you believe and what your eating disorder believes is right for you.

Related: Read more about ARFID, a lesser-known but common eating disorder.

How does individual therapy work in treatment?

Individuals will meet with their therapist one time per week for psychotherapy. Therapists may assign "homework" to help you prepare for a session. This may include:

Worksheets or journal prompts to help you analyze your thought processes around times when you feel the urge to restrict, binge, purge, overexercise, etc.
Practicing a coping skill you learn in a session
Doing an exposure such as eating out with family or not weighing yourself for a period of time

Related: This is how exposure therapy works in eating disorder treatment. It's extremely useful when it comes to facing fear foods, improving body image, and remaining strong in triggering situations.

Sessions usually run for an hour and may involve going over homework, talking through issues in your life right now, or doing trauma work.

If you already have an outpatient therapist, you may continue working with them during your time at Central Coast. Your CCTC therapist will remain the same in both PHP and IOP levels of care.

What kind of group therapy do you do in eating disorder treatment?

We'll get more into the specifics of group therapy in another post. But for now, here's a general overview of some therapies we offer:

Weekend Planning (Friday) and Weekend Review (Monday): Prepare for challenges that may arise at home over the weekend, then review how you handled those challenges.
CBT/DBT Skills Group: Learn several skills to help you improve cognitive processes (CBT) and cope with distress (DBT).
Processing Group: Individuals in the group have a safe space to address issues and get feedback from other patients about how to cope with situations in a healthier way.
Nutrition Group: Meal planning, cooking classes, shopping outings, and lessons about meeting nutritional needs may be included in this type of therapy.
Art/Media Therapy: Use art as a way to explore emotions and/or as a tool to cope in periods of distress.

Group therapy is an effective mode of treatment because no one understands what you're going through more than other people in the same treatment program. You can learn together with other people and form meaningful, supportive bonds throughout the treatment process.

While treatment varies from program to program, these are the basic ideas of what to expect in eating disorder treatment.

Inpatient eating disorder programs focus more on medical stabilization and ensuring patient safety. But after that, you can (for the most part) expect these types of therapies and activities in treatment.

If you or a loved one is suffering from an eating disorder, take the first step today and talk to someone about recovery or simply learn more about the holistic, flexible eating disorder recovery programs we offer.

Ai PonoSeptember 9, 2021