Most Patients with an Eating Disorder can be managed safely at the Partial Hospital Level of Care

The decision to follow the River Centre Clinic’s treatment model was based on data provided by that program indicating a high level of success using the partial hospital level of care. Their experience over the past 10 years indicates that most of those suffering from severe eating disorders can be successfully treated in a 5-day-a-week, 7-hour-a-day specialized Partial Hospital Program rather than requiring expensive and highly restrictive inpatient hospitalization. About half of the patients admitted to the River Centre Clinic with eating disorders meet very conservative weight standards for anorexia nervosa (a Body Mass Index or BMI of 17.5 or less).

The American Psychiatric Association (APA) Practice Guidelines (2000) specified that inpatient hospitalization is the most appropriate level of care for eating disorder patients who are less than 75% of a “healthy body weight.” However, data we have collected over the past 10 years does not support this recommendation. As indicated in Figure 1 below, 91% of the anorexia nervosa patients admitted to the River Centre Clinic have been at a body weight well below the APA weight standard for partial hospitalization and residential care. The River Centre Clinic, the program on which Centre Syracuse is based, has admitted more than 300 anorexia nervosa patients to their partial hospital program over the past 10 years (this figure does not include readmissions) and there have been no deaths during treatment. Thus, it has been our experience that, when managed by a highly trained treatment team using clearly defined principles developed at the River Centre Clinic, most anorexia nervosa patients can safely be treated at the partial hospitalization level of care.

Figure 1

This does not mean that all eating disorder patients can be successfully managed at this level of care. Some patients are not admitted to the RCC or CS because of acute medical complications and others must be transferred to an inpatient program after admission because they are not able to make progress in our Partial Hospital Program.

The other 50% of patients admitted to the River Centre Clinic have other serious eating disorders such as treatment resistant bulimia nervosa or a broad classification of eating disorders referred to as “Eating Disorders, Not Otherwise Specified” (EDNOS). As indicated in Figure 2, program participants in this group have body weights all along the weight spectrum. Even though individuals with these disorders do not have a body mass index below 17.5, they suffer from an eating disorder that can be every bit as serious as a person with anorexia nervosa. In fact, a common mistake made by those suffering from an eating disorder but who are not emaciated is to underestimate the seriousness of their disorder. Because they may not be as thin as others patients, they assume that they are not “ill enough” to warrant intensive treatment at the partial hospital level of care or higher. Please do not judge the seriousness of your eating disorder yourself. This is a place to rely on the judgments of professionals who specialize in the assessment and treatment of eating disorders. They are the best sources of information regarding the level of care that is the most appropriate given all of the factors that need to be considered.

According to the APA eating disorder practice guidelines, inpatient hospitalization would be recommended for many of the individuals in this group because of mood instability, poor symptom control, lack of motivation or physical complications. However, the Centre Syracuse Partial Hospital Program utilizes carefully formulated treatment principles that have allowed the vast majority of these patients to be successfully managed at the partial hospital level of care.

Figure 2

Main Point: The expertise of the staff at Centre Syracuse, along with an innovative treatment technology developed at the River Centre Clinic means that we can expect to safely and successfully manage the vast majority of severely ill eating disorder patients at the partial hospital level of care. This provides patients and their families with an economical alternative to a more restrictive and expensive inpatient hospitalization. Moreover, patient acceptance of this program is high since it allows sufficient structure for most participants to address nutritional needs and medical concerns while at the same time fostering a safe level of autonomy and self-sufficiency.