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And these treatments are offered through various programs at different levels of intensity, to help cater to different kinds of cases and patients at different points along their recovery journey.
With bulimia nervosa, as with most other eating disorders, there are varying levels of care that can help a patient on their path to recovery.
Which level of care a patient receives depends on several factors, including the severity of the case, the stability of a patient’s mental and physical health, and available options.
Inpatient programs represent the most intensive form of treatment for bulimia nervosa.
Patients stay in a hospital or treatment facility full-time, where they can be actively monitored by healthcare professionals and have access to medical care 24/7. Stays are typically short, with the focus on stabilizing a person who may be in immediate need of help.1
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Partial hospitalization programs (PHPs) are sometimes known as “day programs,” due to their structure: a patient commutes to a hospital for treatment, often between five or six days a week, then returns home in the evenings, after their sessions.
PHPs represent a transitional phase in treatment, allowing a patient to continue receiving regular care and guidance from healthcare professionals, but giving them the opportunity to begin practicing their new, healthier skills and routines at home.
As they continue on their recovery journey, many patients transition from PHPs to intensive outpatient care (IOP).
These programs offer many of the same benefits as partial hospitalizations but are carried out on a less intensive schedule. Programs run for a few hours per day, as opposed to the all-day sessions of PHPs, and patients only go to treatment a few days per week.
IOP programs feature the same type of meal planning, nutrition education, and medication management options as PHPs. Most programs also require at least one day a week of individual, group, or family therapy.
Some IOPs may also include off-site outings to help develop management skills. And their less-intense schedules allow patients to start returning to a more proactive routine by resuming activities like work or school.
The final step in many types of bulimia nervosa treatment plans is outpatient care. Making the transition to this important final step is often a group decision, based on input from:4
The patient is also involved in the decision-making process and is typically asked to talk about:
Once they’re ready to make the transition, people participating in outpatient treatment will live full-time at home and be responsible for all their own dietary decisions.
That’s not to say they’re not in need of any support. Indeed, most people—including those who aren’t struggling with an eating disorder—need some outside help from time to time.
Most often, outpatient treatment looks like one or more therapy sessions per week, which could entail individual, group, or family counseling, and additional nutritional education and medication management.
Most importantly, patients at this stage have often embraced their recovery journey and are committed to continue working on healing. Recovery in an outpatient setting can be a lifelong process.
Most patients seeking treatment for bulimia nervosa will undergo some type of psychotherapy. The term represents a variety of treatment approaches. No single type of care is better or worse to help people struggling with bulimia. Each simply tackles the issue in a different way.
Each word in acceptance and commitment therapy (ACT) represents an important aspect of this mental health practice.
The overall goal is teaching patients to “go with the flow” when encountering unpleasant or unhelpful thoughts, rather than spend precious energy on fighting or eliminating them. When these feelings surface, ACT patients are encouraged to accept them, let them go, and move on.
Acceptance and commitment therapy has also been known to increase mental flexibility. This is often an underlying problem with bulimia nervosa that, if improved, can help manage anxiety and depression.7
One of the leading recommended treatments for people struggling with bulimia nervosa, cognitive behavioral therapy (CBT) centers on the idea of changing unhelpful or distorted thinking patterns.
This is achieved by essentially “rewiring” the person’s thinking and behavior patterns, breaking up pathways that have been built around unhelpful thoughts or behaviors, and constructing new, healthier processes for those thoughts to take instead.
These methods have proven successful for many types of disorders and have been especially effective at helping people with BN reduce binge eating behavior.8
Originally developed to help people recovering from brain injuries, cognitive remediation therapy (CRT) has been developed to help people overcome eating disorders, including bulimia nervosa.
Usually employed in conjunction with other types of therapy, such as CBT, cognitive remediation therapy has also been known to help increase mental flexibility.
Almost like a mix of ACT and CBT, dialectical behavior therapy (DBT) focuses on promoting acceptance of and tolerance for distressing circumstances. DBT also teaches patients how to proactively change some thoughts and behaviors.
Courses of this therapy are usually longer-term, and patients take home skill-building “homework assignments.” As for results, DBT has shown some promising potential in helping people who struggle with bulimia nervosa.9
Exposure therapy operates similarly to how it sounds. It helps people by getting them to directly face their fears.
Patients are intentionally introduced to items, activities, or situations they struggle with in order to break patterns of avoidance or apprehension. When used to help treat bulimia nervosa, exposure therapy may confront patients with certain foods, mealtime routines, or other typical difficulties.
Exposure therapy is thought to help in four distinct ways:10
Another aptly-named type of psychotherapy, group therapy involves one or more therapists working with several people at once.
Sessions can be open, with new participants welcome to join any time, or closed, and accessible only to invited members.
Aside from a source of socialization, group therapy sessions can also help by providing:
Interpersonal therapy (IPT), as its name suggests, focuses on examining how a person’s interpersonal relationships and social interactions may be affecting them or their disorder.
There are several different variations of IPT, but, generally, they all work to educate a patient about their own thoughts and feelings, as well as thoughts and feelings of others. Some versions also incorporate strategies for people who tend to hold back or avoid their emotions.
Bulimia nervosa symptoms treated with interpersonal psychotherapy may subside as a person sorts through these issues. Programs are generally short-term and largely pre-prescribed.
Bulimia nervosa can be a tricky disorder to navigate, since there are a number of varied but related areas of concern.
Aside from helping a person understand their own thoughts and behaviors and their relationships with others, therapists also must help a patient heal their relationship with food and body image. And, unfortunately, in many cases, a patient’s eating habits must be dealt with first, to stabilize their physical health before mental health work can even begin.
That’s why most levels of care for bulimia nervosa include nutritional counseling and meal support.
Nutrition counseling also educates individuals on the mental aspect of eating, including topics like:
Hand-in-hand with these nutritional counseling lessons often comes meal support. This type of care is a bit more hands-on. Practitioners sit with patients through meals, offering support and encouragement to follow the “four c’s”:
Experiential treatments for bulimia nervosa help a person heal by getting them out of their mind and into their body.
These types of treatments work by helping someone struggling with bulimia nervosa feel—or, in the case of psychodrama, act out—their feelings, rather than analyze or talk about them.
Experiential treatments can be immensely beneficial, allowing patients to tap into their “right brain,” the side more responsible for imagination, intuition, and the senses. This can help them “turn off” their conscious brain, leading to the access—or even discovery— of deeper feelings than they’d otherwise be able to articulate.
Experiential therapies can also help both the patient and their therapist gain a different perspective on things and give them access to an entirely new type of vocabulary to express their emotions.
Sadly, bulimia nervosa is a dangerous disorder that can end in death. But it doesn’t have to be.
It is entirely possible to stop bulimia in its tracks and start down the path to healing. In fact, one recent study found that up to 68% of patients with bulimia nervosa had recovered from the disorder within 10 years of first seeking help.14
That may sound like a long time, but it’s worth a lifetime. And it’s never too late to start.
Every patient’s experience with bulimia is unique to them. So we create individual treatment plans for each of our clients. We aim to support our clients with bulimia by helping them learn to embrace flexibility around food and eating, explore what emotions may be driving their disordered eating patterns and accompanying compensatory behaviors, rediscover their bodies’ innate hunger and fullness cues, and enjoy food and healthy social eating rituals again.
Our bulimia treatment program consists of three levels of care:
The level of care required for an individual living with bulimia will be determined depending on the severity of restricting and purging, overall health and wellbeing, and a person’s specific needs.
Our multidisciplinary team of experienced psychotherapists, dietitians, nurses, and other mental health professionals not only provides cutting-edge treatment, but also unconditional compassion, support, and understanding whenever you need it.
We know how hard it is to seek help for bulimia, or any eating disorder, so we ensure you will not have to go through recovery alone. Supported group meals and group psychotherapy are there to make you feel like you’re part of a community, no matter what your gender identity, ethnicity, sexuality, or age, and reassure you that your struggle is not yours alone.At Within Health, help is available wherever you are, whenever you need it. Call our team to learn about the first steps.
Disclaimer about "overeating": Within Health hesitatingly uses the word "overeating" because it is the term currently associated with this condition in society, however, we believe it inherently overlooks the various psychological aspects of this condition which are often interconnected with internalized diet culture, and a restrictive mindset about food. For the remainder of this piece, we will therefore be putting "overeating" in quotations to recognize that the diagnosis itself pathologizes behavior that is potentially hardwired and adaptive to a restrictive mindset.
Disclaimer about weight loss drugs: Within does not endorse the use of any weight loss drug or behavior and seeks to provide education on the insidious nature of diet culture. We understand the complex nature of disordered eating and eating disorders and strongly encourage anyone engaging in these behaviors to reach out for help as soon as possible. No statement should be taken as healthcare advice. All healthcare decisions should be made with your individual healthcare provider.
Cognitive behavioral therapy is widely considered the leading treatment for bulimia nervosa, with a history of helping patients curb binge eating episodes and improve mental health.15
Still, treating eating disorders is not an exact science. Everyone is different and may respond differently to therapies of all types. CBT may be used as a primary therapy, with other modalities used for supplemental treatment, or someone may be put on a different regiment, depending on their particular history and needs.
Eating disorders like bulimia nervosa are complex mental health conditions and generally require outside treatment. But it may be possible to address these concerns through self-help therapy.
This method involves minimal involvement with a licensed therapist and primarily utilizes workbooks, apps, or other self-guided programs for patients to work through their symptoms. And this type of treatment has also been found effective at reducing bulimia nervosa symptoms in many cases.16
The length of bulimia treatment depends on a number of factors. The severity of someone's symptoms is a major consideration, along with how long they've been struggling with the disorder, the state of their physical health, and how much control they have over their unhelpful thoughts and behaviors.
Residential inpatient programs are generally lengthy, lasting at least 30 days and usually longer.1 Partial hospitalization programs can also last several months, and intensive outpatient or outpatient treatment generally last as long as the patient feels they need that additional support.
