Eating · Level of Care
Higher Level of Care — Decision Criteria
Medical and behavioral triggers for stepping up — data, not shame
Deciding when outpatient care is no longer enough is one of the hardest conversations in ED treatment. This page lays out the criteria most programs use for stepping up to PHP, IOP, residential, or medical hospitalization — so the decision is data-driven, not shame-driven.
Medical criteria for hospitalization (any single item can qualify)
- Heart rate < 40 bpm (adult) or < 50 (adolescent)
- Blood pressure < 90/60 (adult) or orthostatic drop with symptoms
- Body temperature < 96°F / 35.6°C
- Electrolyte disturbance (K, Mg, Phos)
- Rapid weight loss / < 75% expected body weight
- Uncontrolled purging / laxative abuse with medical signs
- Syncope, chest pain, arrhythmia, seizure
- Suicidal intent or acute self-harm risk
Behavioral criteria for higher LOC
- Multiple behaviors per day despite outpatient work
- Inability to interrupt restriction / purging / binging without supervision
- No weight gain over 4+ weeks when restoration is the goal
- Rapidly worsening body image, checking, or avoidance
- Meal support at home is unavailable or insufficient
- Co-occurring condition (substance use, active suicidality) outpacing care
Where I am on these criteria today
What outpatient care has and hasn't held
Barriers to stepping up (financial, logistical, fear)
What stepping up would make possible
Higher care is not failure
It is the correct dose for the current severity. Many clients who resist a step-up later name it as the moment recovery actually started. The illness will call it failure. It isn't.