Day Hospital Treatment of
Anorexia Nervosa and
MARION P. OLMSTED
Day hospital treatment is intended to provide intensive multimodel treatment for moderately ill patients with anorexia nervosa and severely ill patients with bulimia nervosa. It is a cost-effective alternative to inpatient care and a forum for the provision of treatment that is more intensive and comprehensive than that typically available in an outpatient clinic. Day hospital treatment may also be used as a step-down intervention for patients with anorexia nervosa following complete hospitalization.
Existing day hospital programs run 4, 5, or 7 days weekly. The weekly schedule includes supervised meals, a variety of therapy groups, and, in some programs, time for concurrent in dividual therapy. Family therapy, pharmacotherapy, and medical management are scheduled as needed. In addition to the schedule for patients, the program must include frequent and regular opportunities for staff to share information and make clinical decisions as a team.
Based on a biopsychosocial model of eating disorders, the treatment goals are to (1) normalize eating behaviors by following a balanced meal plan; (2) eliminate bingeing, purging (i.e., vomiting, laxative use, overexercising), and other unhealthy behaviors directed toward weight control; (3) facilitate weight gain for patients who are below a healthy weight range; and (4) address underlying issues. During program hours, patients are supported in their attempts to gain eating and symptom control, and over time, they learn to extend their new behaviors and strategies beyond the treatment setting. There is considerable variability across patients in the speed with which healthy behaviors are generalized. However, the guiding principle is that as treatment progresses, patients should try increasingly difficult eating tasks accompanied by decreasing support (i.e., graded task assignment). Underlying issues and stressors that maintain the eating disorder are identified and processed in group,