Level 1: Outpatient | Level 2: Intensive outpatient | Level 3: Partial hospitalization (full-day outpatient care)* | Level 4: Residential treatment center | Level 5: Inpatient hospitalization | |
Medical status | Medically stable to the extent that more extensive medical monitoring, as defined in levels 4 and 5, is not required | Medically stable to the extent that intravenous fluids, nasogastric tube feedings, or multiple daily laboratory tests are not needed | For adults: Heart rate <40 bpm; blood pressure <90/60 mmHg; glucose <60 mg/dL; potassium <3 mEq/L; electrolyte imbalance; temperature <97.0°F; dehydration; hepatic, renal, or cardiovascular organ compromise requiring acute treatment; poorly controlled diabetes For children and adolescents: Heart rate near 40 bpm, orthostatic blood pressure changes (>20 bpm increase in heart rate or >10 mmHg to 20 mmHg drop), blood pressure <80/50 mmHg, hypokalemia¶, hypophosphatemia, or hypomagnesemia | ||
SuicidalityΔ | If suicidality is present, inpatient monitoring and treatment may be needed depending on the estimated level of risk | Specific plan with high lethality or intent; admission may also be indicated in patient with suicidal ideas or after a suicide attempt or aborted attempt, depending on the presence or absence of other factors modulating suicide risk | |||
Weight as percentage of healthy body weight◊ | Generally >85% | Generally >80%§ | Generally >80%§ | Generally <85% | Generally <70%; acute weight decline with food refusal even if not <70% of healthy body weight |
Motivation to recover, including cooperativeness, insight, and ability to control obsessive thoughts | Fair-to-good motivation | Fair motivation | Partial motivation; cooperative; patient preoccupied with intrusive, repetitive thoughts¥ >3 hours/day | Poor-to-fair motivation; patient preoccupied with intrusive repetitive thoughts¥ 4 to 6 hours a day; patient cooperative with highly structured treatment | Very poor to poor motivation; patient preoccupied with intrusive repetitive thoughts¥; patient uncooperative with treatment or cooperative only in highly structured environment |
Co-occurring disorders (substance use, depression, anxiety) | Presence of comorbid condition may influence choice of level of care | Any existing psychiatric disorder that would require hospitalization | |||
Structure needed for eating/gaining weight | Self-sufficient | Self-sufficient | Needs some structure to gain weight | Needs supervision at all meals or will restrict eating | Needs supervision during and after all meals or nasogastric/special feeding modality |
Ability to control compulsive exercising | Can manage compulsive exercising through self-control | Some degree of external structure beyond self-control required to prevent patient from compulsive exercising; rarely a sole indication for increasing the level of care | |||
Purging behavior (laxatives and diuretics) | Can greatly reduce incidents of purging in an unstructured setting; no significant medical complications, such as electrocardiographic or other abnormalities, suggesting the need for hospitalization | Can ask for and use support from others or use cognitive and behavioral skills to inhibit purging | Needs supervision during and after all meals and in bathrooms; unable to control multiple daily episodes of purging that are severe, persistent, and disabling, despite appropriate trials of outpatient care, even if routine laboratory test results reveal no obvious metabolic abnormalities | ||
Environmental stress | Others able to provide adequate emotional and practical support and structure | Others able to provide at least limited support and structure | Severe family conflict or problems or absence of family so patient is unable to receive structured treatment in home; patient lives alone without adequate support system | ||
Geographic availability of treatment program | Patient lives near treatment setting | Treatment program is too distant for patient to participate from home |
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