Inpatient Hospitalization vs. Partial Hospitalization

There is considerable discussion throughout the eating disorders field about what is the most appropriate level of care for people who suffer from serious eating disorders. For example, the American Psychiatric Association (APA) Practice Guidelines (2000) specify inpatient hospitalization as the most appropriate level of care for eating disorder patients who are less than 75 percent of a “healthy body weight.” However, data we have collected at River Centre Clinic for more than a decade does not support this recommendation.

Anorexia Nervosa Patients

About half the eating disorder patients admitted to River Centre Clinic meet very conservative weight standards for anorexia nervosa proposed by some researchers, which is a Body Mass Index (BMI) of 17.5 or less. Out of all anorexia nervosa patients admitted to River Centre Clinic, 91 percent have been at a body weight below the APA weight standard for partial hospitalization and residential care, as shown in Figure 1. The 9 percent of anorexia nervosa patients who had a body weight above a BMI of 17.5 had lost an average of more than 24 percent of their former body weight.

Figure 1

Bulimia Nervosa & EDNOS Patients

About half of patients admitted to 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 shown in Figure 2, patients in this group have body weights all along the weight spectrum. Even though individuals with these disorders do not have a Body Mass Index (BMI) of 17.5 or less, their eating disorder can be every bit as severe as anorexia nervosa.

In fact, a common mistake made by those who suffer 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 other patients, they may mistakenly assume that they are not “ill enough” to warrant intensive treatment at the partial hospitalization level of care or higher. It is best for these individuals to trust the judgment of professionals who specialize in the assessment and treatment of eating disorders. These professionals are the best information sources regarding the most appropriate level of care, given all factors that must be considered.

APA eating disorder practice guidelines would recommend inpatient hospitalization for many individuals in this group because of mood instability, poor symptom control, lack of motivation, or physical complications. However, the Partial Hospitalization Program at River Centre Clinic has formulated treatment principles that enable the vast majority of these patients to be successfully managed at the partial hospitalization level of care, with the added component of on‑site independent living facilities.

Figure 2

Partial Hospitalization — Benefits Most Eating Disorder Patients

Although the vast majority of eating disorder patients can be successfully managed at the partial hospitalization level of care, it is not appropriate for all eating disorder patients. River Centre Clinic does not admit some patients because of acute medical complications. Other patients must be transferred to an inpatient program after admission because they are not able to make progress in our Partial Hospitalization Program.

River Centre Clinic’s expertise and innovative treatment technology has enabled the vast majority of severely ill eating disorder patients to be safely and successfully managed at the partial hospitalization level of care. Partial hospitalization provides patients and their families with an economical alternative to inpatient hospitalization, which is more restrictive and more expensive. In addition, patients have a high acceptance of this program because it allows them sufficient structure to address nutritional needs and medical concerns while simultaneously fostering a safe level of autonomy and self-sufficiency.