Residential BED Treatment Programs and Why They Work

Spotlight Article by Katie Thompson, MS, LPC, NCC

Residential BED Treatment Programs and Why They Work



Katie Thompson, MS, LPC, NCC, has been a primary therapist at Castlewood Treatment Center for two years.  Katie graduated from Marquette University with a BA in Communications, Education.  She later earned a Masters of Science in Counseling Psychology from the University of Wisconsin- Milwaukee. Previously, she was a therapist at Rogers Memorial Hospital in the residential program for eating disorders and anxiety disorders.  Katie facilitates various groups at Castlewood, including all of the Eating Disorder groups, is an active participant in the research team and specializes in eating disorders and anxiety disorders; specifically binge eating disorder. Katie coordinates the Binge Eating Disorder Program at Castlewood Treatment Center and facilitates the BED groups in both the residential and PHP levels of care. She is skilled in using DBT, CBT, IFS, ERP and group therapy. Katie is trained in Exposure and Response Prevention (ERP) and has earned her certification in Internal Family Systems Level 2. Katie lectures regionally and nationally on Eating Disorders, Binge Eating Disorder and treatment interventions.

Residential BED Treatment Programs and Why They Work

For an individual struggling with Binge Eating Disorder (BED), therapy is an absolute necessity.  In fact, long-term recovery and reaching a “recovered” lifestyle is rarely, if at all possible without effective therapeutic interventions.  For some, BED becomes so disruptive that they can no longer function in their day to day lives.  BED has rendered them a ghost in their relationships, professions, obligations and in these cases, living becomes painfully unmanageable.  When this happens, residential treatment, Partial Hospitalization Programming (PHP) and Intensive Outpatient (IOP) are treatment options that can allow an individual to break the cycle and habitual dynamic of Binge Eating Disorder.

As an individual and group therapist in a residential treatment center that treats BED, I am fully aware of the spectrum of “costs” associated with untreated BED.  Often clients come into treatment; their financial lives are in chaos from the amount of money they spend on binge food and other items that they purchase in a “binge” manner; clothing, alcohol and other out of control purchases.  While there has been little research completed on the actual cost of binge disorders, it is accurate that often BED can create financial disruption to all afflicted and their loved ones; often resulting in financial ruin. If imaginable, the emotional, physiological and psychological destruction are comparable to the financial.

Most often, when a client enters residential treatment it is because they are so imbedded in the loop of behaviors, emotions and cognitive distortions that they have not been able to break the cycle of the BED, but not for lack of effort, professional supports and psychological intervention.  There is no version of “will power” that can effectively break the cycle of:  stress→binge→guilt→emotional overwhelm→binge→shame→cognitive distortion loops→binge→self-hate→binge→resolution-making (cognitive distortions)→self-punishment→binge.  This is one unique version of the BED cycle that millions of individuals struggle with daily.  Each individual struggling with BED has their own personal story and BED manifests differently for everyone.

Often, BED is present with one or more mental health conditions and this complicates the need for specific treatment intervention.  The co-morbidity has a direct impact on the intensity of the function of the BED.  For instance, perhaps the BED originally developed as a means for the individual to numb out from the intensity of the presence of one or more anxiety disorder; it is not possible to effectively treat the BED without treating the co-morbid anxiety disorders. If a person merely works on symptom containment and management they will continue to lapse and relapse into behaviors anytime their anxiety is triggered.  Perhaps the BED developed as a response to manage the PTSD symptoms related to a traumatic event or a series of traumatic experiences, a person in this situation will not find reprieve from the eating disorder unless the underlying causes are treated as well.  BED is often the best response an individual can identify (albeit subconsciously) at that time to deal with extreme distress and psychological disruption.  It is not ever about “will power” or simple behavioral modification or finding the “right diet” for the person.  There is no “right diet,” there will never be a “right diet” or magical behavioral plan for BED.  BED is a psychological condition that requires specific interventions for the BED itself and any underlying causes or co-morbid disorders.


In a residential setting an individual struggling with BED may present with a multitude of struggles and often past treatments and lower level of care interventions have not been effective due to the “whack-a-mole phenomenon.” Whack-a-Mole references the infuriating game at Chuck-E-Cheese that most of us played as children in which we had a large mallet to strike plastic moles popping up from several mole holes.  This was frustrating as a game, but Whack-a-Mole is a realistic struggle that clinicians witness their clients struggling with.  This phenomenon is better known as “symptom substitution” or symptom-swapping.  Regardless to what it is called, it is one of the reasons that outpatient and lower levels of care are not effective for individuals who need residential care.  In residential care, a clinician can teach a client how to address all of their struggles simultaneously and break the constant cycle of symptom swapping that happens naturally when a person works to remove maladaptive coping mechanisms for distress and psychological upheaval.

In effective residential treatment for BED, a client will go through a thorough intake and evaluation processes in attempts to gather a comprehensive picture of all that the client is struggling with.  This intake process also incorporates past struggles and a familial history to identify some of the genetic and environmental components that may have had an impact of the individual’s development of the BED.   Once a clear picture of the individual’s unique struggle has been gathered, a team can be created for the needs of the client.

If the client struggles with BED, OCD, has a Mood Disorder and also has three children at home and a partner, the treatment team will consists of an individual therapist that can treat all of the aforementioned disorders, an adjunctive anxiety therapist to address the OCD, an adjunctive family therapist to work with the client’s support system, a psychiatrist to help address the psychiatric medication component of the BED, OCD and the Mood Disorder.  The client will also have access to any other adjunctive services that may present as necessary throughout their residential treatment.  Perhaps the habitual and compulsive nature of the BED and the co-morbid OCD had wreaked havoc on the family’s finances and the individual needs support to sort through their financial ruin, a life skills coach or therapist can adjunctively work on this so that upon discharge, the financial ruin does not become a main stressor which could ultimately be a set up for relapse.

The moment a client enters residential care for BED they will be focusing on symptom containment and management, adhering to a medically prescribed meal plan monitored by the dietitian and physician and they will be learning the immediate skills and tools necessary to be in therapy and create balanced living.  Once a client creates sound symptom management, has developed a set of adaptive tools for urge intervention and demonstrates the ability and willingness to use said skills when urges are present, then a client is ready to begin doing the deeper work to resolve the underlying causes of the BED.

Throughout the course of residential treatment a client in recovery from BED will change the relationship they have with food and with their body, begin to meet unmet needs related to the function of the BED, and process through intrusive thoughts, images, emotions and memories.  Residential treatment and other intensive levels of treatment offer recovery to individuals struggling with BED so that a balanced recovery lifestyle is not only an option, but a reality.


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