The journey towards recovery can take many forms, but every person has to follow their own path towards health and make choices along the way. Some of these choices may come in the form of different treatment centers or levels of care to address the difficulties someone is having at that stage of their recovery. Every person’s process is different.

Eating disorders are very complex illnesses that require specialists to treat not only the emotional and behavioral facets of an illness, but the medical one as well. For these reasons, the American Psychological Association (APA) established guidelines for appropriate levels of care with eating disorders.

Chrysalis Center is an outpatient program and will soon be adding intensive outpatient (IOP) services. The other levels include partial hospital (PHP), residential, and inpatient levels; these last two are sometimes combined into an “IP-Res” format. To see the full APA criteria for eating disorders, click here. There are some other resources for eating disorder treatment in North Carolina, including Veritas Collaborative, Carolina House, and UNC’s Center for Eating Disorders.  Other treatment centers around the country specialize in eating disorders as well, and sometimes these other programs are a better fit for clients in terms of their individual needs and experiences.  Though not for eating disorders, there are several other levels of care in the Wilmington area for adolescents and adults in general psychiatry.

Usually, these difficult conversations start when we as clinicians recommend a higher level of care for someone who we do not think is appropriate for outpatient or IOP treatment. To be appropriate for outpatient or IOP, a person must be:

  • Medically and psychologically stable to the point that they are not a danger to themselves or others
  • Motivated to recover
  • Cooperative
  • Self-sufficient
  • Able to control their thoughts and behaviors using appropriate social support


When someone needs a higher level of care, they are usually:

  • Medically compromised (by weight, bloodwork, EKG, etc.)
  • Unable to manage their behavior
  • Un- or under-motivated
  • Not functioning in their lives in some significant way (work, family, relationships, etc.)
  • Unable to manage a co-morbid condition (psychological or medical) because of their eating disorder

Levels of care indicate how much structure, support, and observation a client requires at that stage in their recovery.

When someone needs a higher level of care, it can be a very difficult discussion between provider and client. Sometimes, we all know it is coming and have been trying to avoid it but it just is not working. Other times, clients may take a sudden turn. This could be for many reasons, but the important thing is that clients get the help that they need to recover from their eating disorder and co-occurring disorders. Our goal is always to help our clients and keep them focused on living healthy and productive lives, and we try to balance all their individual needs while keeping the goal of a full recovery foremost in our minds.

It is important to use the right tool to complete a task, and sometimes that tool needs to be a higher level of care in order for someone to truly recover. Often, IP-Res levels of care can get clients back on track faster than outpatient could and sometimes that is necessary for someone’s well being or even survival. PHP and IOP levels can provide support to keep someone out of the hospital or they can provide support as a step-down program. The transition between inpatient and home can be very stressful and there are a lot of facets to consider including social, family, academic, or work stressors. All of these are affected by or contribute to eating disorder behavior. A person cannot live in a vacuum so all of these need to be managed before someone goes back to their regularly scheduled lives.

By adding IOP services, Chrysalis hopes to provide a bridge for clients on their journey in recovery. It is an important stage or facet in that process. If you need us, we will be honored to work with you on that journey.


Kendra is a Senior Staff Therapist and soon to be Clinical Director of Chrysalis’s new Intensive Outpatient (IOP) program with 13 years of experience working with eating disorders in various settings, including inpatient, PHP, IOP, and outpatient treatment facilities.

There are many different approaches that we use as therapists, and most of us use more than one to make sure that our clients get the treatment that is the best fit for them. You may have heard some of the many acronyms – CBT, DBT, ACT, MI, MBSR, TF-CBT, RO-DBT, EMDR, ERP, SFBT, IPT – to name a few. For many years CBT (Cognitive Behavioral Therapy) has been the modality of choice and the basis for most therapists’ education.

When Marcia Linehan published a book on DBT (Dialectical Behavior Therapy) in 1993, it was part of the first wave of different therapies based on “evidenced based practice” that has become the gold standard for treatment of mental health disorders since. DBT incorporates cognitive behavioral therapy with elements of mindfulness and acceptance from Zen Buddhist practice. The goal of DBT is to help the most difficult clients and situations feel better and to learn skills that manage reactivity more effectively. Originally developed for borderline personality disorder or highly suicidal clients, it has found to be effective amongst a much wider variety of populations and concerns.

The Mindful Living Group at Chrysalis is based on DBT, but also builds in concepts from ACT (Acceptance and Commitment Therapy) such as values identification and acceptance. The goal of group is to teach skills to clients, but also give them a framework for communication and problem solving that they can use throughout their lives.

The different skills of Mindful Living and DBT are Distress Tolerance, Mindfulness, Emotion Regulation, and Interpersonal Effectiveness. Each of these builds on and overlaps with the other skills sets. Distress Tolerance helps you develop skills that let you make decisions about what you want to do instead of reacting to situations. Mindfulness helps you be aware of what is going on with yourself and the world in a way that is non-judgmental. Emotion Regulation helps you identify and manage your emotions effectively. Interpersonal Effectiveness helps you be assertive and set boundaries with others so that you can negotiate and get your needs met in all of your relationships.

Using DBT as a therapy or going to Mindful Living Group does not mean that you have borderline personality disorder. The therapy has expanded over the years to treat eating disorders, depression, and any kind of negative reactivity. There is even a subset of DBT called Radically Open DBT that was developed specifically for working with anorexic and anxious clients.

I choose DBT as my primary modality because it emphasizes the importance of genuineness, openness, and honesty in the client/therapist relationship and those values are incredibly important to me in both my professional and personal life. Sometimes, this makes for a more confrontational or directive relationship, but I find that most clients appreciate a direct approach. DBT pushes you to challenge yourself and your beliefs about the world so you do not get stuck in a rut.
The Mindful Living groups at Chrysalis run for 12 consecutive weeks. Building upon the curriculum, we also offer an 8 week Advanced Mindful Living group. If you are interested in joining one of these groups, please call to find out more about the schedule.


Kendra is a Senior Staff Therapist and soon to be Clinical Director of Chrysalis’s new Intensive Outpatient (IOP) program, where Mindful Living will be one of the groups offered. She is currently completing her DBTNCAA certification and has been working in this modality since 2004.

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