Treatment Centers for Eating Disorders

Services for treating eating disorders range on a continuum of intensity from inpatient hospitalization to residential care to partial hospitalization programs to varying levels of outpatient treatment. Decisions about the best treatment setting in which to manage a person with an eating disorder depend on the nature of the disorder, the level of risk, physical and psychological complications, and patient preference. There is evidence that those with eating disorders have better outcomes when treated in specialized eating disorder facilities where staff has experience and expertise in treating eating disorders. Major deterrents in selecting the most appropriate treatment include geographic [Page 753]proximity to specialist centers that limit access, lack of data for comparing cost and effectiveness of different settings, inadequate insurance coverage, and managed care decisions that limit access to effective care.

Diagnostic Groups

Anorexia nervosa occurs in about 1 in 250 females and 1 in 2,000 males and is estimated to be the third most common chronic medical illness in girls 15–19 years of age. Bulimia nervosa is about five times more common than anorexia nervosa. The mortality rates for anorexia nervosa are more than 12-fold the number of deaths expected from all causes among women 15–24 years of age and two to three times as high as any other psychiatric disorder. Mortality rates for bulimia nervosa are lower but still not insignificant. Medical complications are typical during the acute phase of an eating disorder and persist among those not successfully treated, leading to a wide range of physical and emotional disorders into early adulthood.

An even larger diagnostic category consists of patients with “atypical eating disorders,” or “eating disorders not otherwise specified.” These are conditions of clinical severity that do not conform to the diagnostic criteria for anorexia nervosa or bulimia nervosa, but nevertheless closely resemble these disorders. An example would be someone who possesses all of the features of bulimia nervosa but purges only after consuming small amounts of food (does not have objectively large binge-eating episodes). Another example is an individual at low weight with the features of anorexia nervosa who is still menstruating. Yet another example would be a person who maintains a low normal weight by engaging in extreme restrictive dieting, compulsive exercise and vomits only one time a week on average.

Many people with atypical eating disorders have suffered with anorexia nervosa or bulimia nervosa in the past. Binge eating disorder (BED) has been more recently identified and refers to individuals who engage in uncontrollable episodes of binge eating but do not use compensatory behaviors. Many BED patients are obese and may or may not be accepted into treatment facilities that routinely accept those with anorexia and bulimia nervosa.

Current systems of diagnosing eating disorders into mutually exclusive categories based largely on body weight, bingeing, and purging fail to emphasize the overlap between these conditions in terms of core psychological features, behavioral symptoms, medical symptoms, motivation for change, and social supports. Moreover, there is extraordinary variability within each of the diagnostic subgroups on these key variables. It is well known that individuals with eating disorders can move between the diagnostic categories at different points in time based only on variations in body weight and symptoms such as binge eating and vomiting. Therefore, it is important to avoid generalizations based only upon diagnosis.

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