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Anorexia nervosa in adolescence is a terrifying scenario for both parents and their kids. Despite a continuing lack of knowledge about the severity of anorexia, it can be hugely destructive to a teenager, and even fatal in some cases. In fact, anorexia nervosa is the most dangerous kind of mental health condition – the mortality rate associated with anorexia nervosa is 12 times higher than the death rate of ALL causes of death for females 15 – 24 years old.The disorder is known to affect about 0.6% – 2% of people in the United States – and although it affects more women than men, the split is higher than many assume. About 25% of new anorexia nervosa cases are in boys and men.

Thankfully, in the past twenty years or so, awareness of eating disorders has increased. Once, disorders like anorexia or bulimia nervosa were made fun of, even in mainstream entertainment like movies or TV. With the rise of social media and a more inclusive society, however, they are beginning to be treated with the seriousness they deserve (although social media can certainly act as a trigger for their development).

With the rise of awareness, there has also been an increase in the availability of specialized treatment. Both evidence-based, experiential, and medical care platforms have proliferated, and particular focus has been placed on adolescent treatment. Now, anorexia nervosa treatment comes in a variety of forms, ranging from weekly outpatient sessions to day treatment on a regular schedule, and for the most intense cases, residential anorexia nervosa treatment.

With a mental health disorder as potentially deadly as anorexia nervosa, the margin of error for getting treatment is very small – and that’s why parents need to know what type of treatment is necessary. Just as importantly, the adolescent who gets the treatment also needs to know what to expect when they go in for residential, the most intensive form of treatment.

Day Treatment or Residential Treatment?

The simplest way to determine if an adolescent needs residential anorexia nervosa treatment is to assess the physical and emotional risk they carry. A doctor and psychiatrist should be consulted for an official diagnosis. In the early stages, the signs of anorexia nervosa are often subtle – dieting, excessive exercise, and some weight loss may not seem incredibly harmful, but when they progress, they can endanger their health and even their lives. Parents might also wish to look out for behavioral signs of the disorder – wearing baggy clothing to hide their body’s shape, noticeable discomfort at mealtimes, constantly comparing their body to their peers or social media personalities, or obsessive calorie counting.

Early on, if the symptoms are caught before intense weight loss or calorie restriction is present, many care professionals will recommend enrollment in a day treatment program. Most if not all of the treatments used in this format will be the same as those used in residential treatment, simply on a less-intensive basis. Virtual treatment is also an important form of day treatment, especially in the wake of COVID-19. All these options are useful, especially as a step-down from residential treatment.

However, day treatment can’t provide the kind of medical and nutritional care that is required for severe cases of anorexia nervosa. A newly admitted client may need strict medical care and supervision, to restore their nutritional balance and avoid malnutrition. Suicide is a common risk for people with anorexia nervosa, so a special psychiatric watch may also be necessary. When the disordered behaviors surrounding the disease are endangering the teen’s life, parents should seek out a residential program.

How to Prepare Teens for Residential Anorexia Nervosa Treatment Programs

Residential treatment centersprovide clients with a safe haven from their day-to-day lives, making it easy to focus on treatment in a structured and safe setting. This kind of treatment by design removes the adolescent from their schooling and work schedules so that all their energy can be focused on recovery. However, these are major lifestyle changes that can affect anyone’s comfort levels – so the teenager and their family should be ready. Educating them about what to expect can go a long way towards decreasing their trepidation about going into treatment.

What Is Residential Treatment Like?

Before learning about what it entails, many people think that residential anorexia nervosa treatment, sometimes called inpatient treatment, is like something out of a movie or TV show, with linoleum floors and lock-and-key dormitories. While this may have been true in the 1950s, today nothing could be further from the truth. Normally, the facility will be comfortably appointed with furnished rooms and shared spaces, including entertainment rooms, classrooms, and a well-stocked communal kitchen and pantry. A feeling of safety and comfort is essential for creating a conducive environment for treatment, so quality facilities will feel more like a home than an asylum.

Day-to-day activities are centered around rebuilding the client’s relationship with food, eating, and movement. There will be frequent daily therapy sessions that allow for peer support and growth. Normally there will be daily group sessions that emphasize recovery paths, such as:

  • Dialectical behavioral therapy (DBT)
  • Cognitive behavioral therapy (CBT)
  • Body image therapy
  • Art and expressive therapies
  • Family and relationships
  • Interpersonal process
  • Self-esteem
  • Relapse prevention

The first two therapies are cornerstones of eating disorder treatment. Both are techniques that allow a client and therapist to engage in dialogue that highlights objective understanding of the client’s emotions and thoughts about eating and their body image. Although they follow precise steps that have been honed by therapists, each client will receive an individualized program that addresses their unique needs. This might include co-occurring disorders such as anxiety, depression, or substance abuse. Cognitive processing therapy is also a useful technique for people with past trauma. PTSD is a common trigger for anorexia nervosa, so this therapy is a mainstay in eating disorder treatment.

Keeping up with education and schooling is essential – some of the best centers even have certified teachers on hand to teach classes. They will coordinate with the client’s school to keep up with their present curriculum, take in homework assignments, and administer tests, etc. Even if they don’t have staff on the premises, the prevalence of Zoom classes and other virtual interfaces for education has made it easier than ever to maintain each client’s education. In a post-pandemic world, it’s practically a necessity.

Finally, experiential therapies like hiking, gardening, attending concerts, or going food shopping also round out the activities involved in residential treatment. These provide a nice break from the daily routine imposed by residential treatment, and in many cases serve as practice for returning to “real life” after discharging. They can also act as a form of exposure therapy – when they are far enough along in their recovery, going on a supervised visit to a restaurant or grocery store can instill confidence in their ability to overcome their eating disorder.

How to Prepare Before Entering an Anorexia Nervosa Treatment Center

Managing expectations – positive and negative – is important for anyone ready to go into residential treatment for anorexia nervosa. Because they will be entering a highly structured environment, teens should understand that they may only have designated free time and/or restricted use f phones and the internet.

While parents should always listen carefully to their child’s fears, especially when making a major life change like entering residential treatment, they should frame the discussion about treatment in a positive way. This can help calm their nerves and give them an idea of what to expect over the next several weeks. It’s also important to find out what items can and can’t be brought to the facility, and how much outside contact will be allowed.

Some key facts to discuss with teens as they prepare for eating disorder treatment include:

  • The length of the treatment program
  • Therapy options available during treatment
  • How their progress will be monitored
  • When they can expect to phone/visit with family
  • What an average day in treatment may look like

Parents should also make sure they know what their child should bring to the residential center. Amount and types of clothing, cosmetics, and toiletries, cell phones and computers, personal items like journals, musical instruments, or books – all should be discussed with the admissions staff before heading off to the facility. The more the adolescent understands about what they can bring, the better.

Give Your Teen a Chance to Ask Questions, Too

It’s also important to give children the opportunity to ask questions about the recovery process and the benefits of residential treatment programs. They should list their questions or concernswhile considering the move to the facility, and discuss them with both their parents and the admissions specialists at the facility. Parents should let them voice their concerns and do their best to provide accurate information – and they should be careful not to downplay or dismiss any concerns. Going to a residential anorexia nervosa treatment can be a stressful experience, especially before the client gets used to life in treatment. There should always be open and honest communication about what to expect, and fears should be validated.


Melissa Spann, PhD, LMHC, CEDS-S

Melissa Orshan Spann, PhD, LMHC, RTY 200, is Chief Clinical Officer at Monte Nido & Affiliates, overseeing the clinical operations and programming for over 50 programs across the U.S. Dr. Spann is a Certified Eating Disorder Specialist and clinical supervisor as well as an accomplished presenter and passionate clinician who has spent her career working in the eating disorder field in higher levels of care. She is a member of the Academy for Eating Disorders and the International Association of Eating Disorder Professionals where she serves on the national certification committee, supervision faculty, and is on the board of her local chapter. She received her doctoral degree from Drexel University, master’s degree from the University of Miami, and bachelor’s degree from the University of Florida.