Managing eating disorders in the natural environment: intensive vs. limited programs.

Objective: To evaluate stratified management of care for eating disorders in community services using a personalized program (2-20 hours weekly) delivered in a therapeutic center by a multidisciplinary team, or in the patients' natural environment by clinical mentors.

Method: Sixty females with anorexia nervosa and 63 with bulimia nervosa attended the program voluntarily. Symptoms and global outcome were assessed using the Anorexic Outcome Scale.

Results: At termination of treatment, 66% of the anorexics and 78% of the bulimics were in fully recovered or good condition. At four-year follow-up, 68% of the treated anorexic patients and 73% of the treated bulimic patients were categorized as fully recovered or in good condition. The improvement in social functioning and occupation status was greater among subjects treated in the extensive, compared with limited, programs. All patients who completed the program had regular occupations.

Conclusions: The proposed treatment model addresses the heterogeneous needs of patients with eating disorders and, at the same time, allows them to stay in the community. It can serve as an alternative to hospitalization whenever patients are able and willing to cooperate with their treatment, and their medical condition allows for ambulatory treatment.