How to treat bulimia nervosa through different plans and options
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 around two weeks or less, and the focus is often on stabilizing a person who may be in immediate need of help.
Partial hospitalization program (PHP)
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.
Intensive outpatient (IOP)
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 just 3-5 hours per day, as opposed to the all-day sessions of PHPs. (5) Patients also usually receive treatment between 3-5 days per week. (5)
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.
But to encourage their patients’ progress, many IOPs include offsite 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)
- Healthcare facilities
- Eating disorder specialists
- Health insurance providers
The patient is also involved in the decision-making process and is typically asked to talk about:
- Their detailed personal history
- Any past or present bulimia symptoms they’ve struggled with
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 or medication management.
Most importantly, patients at this stage have often embraced their recovery journey and are committed to continue working on healing.
Effective bulimia therapy techniques
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.
Acceptance and commitment therapy (ACT)
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)
Cognitive behavioral therapy (CBT)
By far the most frequently-recommended treatment 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 brain, breaking up neurological pathways that have been built around unhelpful thoughts or behaviors, and constructing new, healthier paths for those thoughts to take instead.
These methods have proven successful for many types of disorders and have been especially helpful for people recovering from bulimia nervosa. (8)
Cognitive remediation therapy (CRT)
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.
Patients are then encouraged to connect changes they see in response to these games to changes they can make in other areas of their lives, such as the maladaptive behaviors that help sustain an eating disorder.
Usually employed in conjunction with other types of therapy, such as CBT, cognitive remediation therapy has also been known to help increase mental flexibility.
Dialectical behavior therapy (DBT)
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. (11)
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.
While a majority of this work may involve tangible objects or physical confrontation, much of the therapeutic effect of exposure therapy goes on under the surface, with these incidents helping remodel what are, in many cases, automatic or even subconscious responses.
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. Groups can also include strangers, family members, or members of the same treatment program.
Aside from a source of socialization, group therapy sessions can also help by providing:
- A sense of catharsis
- An opportunity to help others
- A larger/different perspective
- A sense of belonging
- A safe space to practice new skills
Interpersonal psychotherapy (IPT)
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.
Interpersonal psychotherapy typically helps a person sort through these issues with a short-term and largely pre-prescribed program.
Nutrition counseling and meal support
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, unfortunately, in many cases, a patient’s diet 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.
Experiential bulimia nervosa treatments
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.
Treating bulimia nervosa at Within Health
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. (16)
That may sound like a long time, but it’s worth a lifetime. And it’s never too late to start.
You can find help and treatment for bulimia nervosa at Within Health.
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:
- Partial hospitalization program
- Intensive outpatient program
- Outpatient program
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.
- Authored by Editorial Staff. (2018, November 7). What are the real facts about bulimia? American Addiction Centers. https://americanaddictioncenters.org/bulimia-treatment/facts-and-statistics
- Authored by Editorial Staff (2021, October 13). Inpatient vs outpatient bulimia treatment. American Addiction Centers. https://americanaddictioncenters.org/bulimia-treatment/inpatient-outpatient
- Differences between inpatient vs residential treatment. Pasadena Villa. (2020, October 11). Retrieved from https://www.pasadenavilla.com/inpatient-vs-residential-treatment/
- Levels of Care in Eating Disorder Treatment. National Eating Disorders Association. (2020). https://www.nationaleatingdisorders.org/sites/default/files/NEDA%20Webinar%20Levels%20of%20Treatment.pdf
- What is Intensive Outpatient Treatment for Eating Disorders? Center for Discovery Eating Disorder Treatment. (2021). https://centerfordiscovery.com/blog/intensive-outpatient-treatment-eating-disorders/
- What Is Acceptance and Commitment Therapy (ACT)? VeryWell Mind. (2021, September). https://www.verywellmind.com/acceptance-commitment-therapy-gad-1393175
- Acceptance and Commitment Therapy as a Treatment for Anxiety and Depression: A Review. Psychiatric Clinics of North America. (2017, December). https://linkinghub.elsevier.com/retrieve/pii/S0193953X17300771
- The Efficacy of Cognitive Behavioral Therapy: A Review of Meta-analyses. Cognitive Therapy and Research. (2012, July). https://link.springer.com/article/10.1007/s10608-012-9476-1
- Cognitive Remediation Therapy (CRT) for Anorexia Nervosa. VeryWell Mind. (2020, December). https://www.verywellmind.com/cognitive-remediation-therapy-for-anorexia-nervosa-4003481
- The Application of Cognitive Remediation Therapy in The Treatment of Mental Disorders. Shanghai Arch Psychiatry. (2017, December). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5925589/
- Van Dijk, S., Jeffrey, J., & Katz, M. R. (2013). A randomized, controlled, pilot study of dialectical behavior therapy skills in a psychoeducational group for individuals with bipolar disorder. Journal of Affective Disorders, 145(3), 386–393. https://doi.org/10.1016/j.jad.2012.05.054
- What Is Exposure Therapy? American Psychological Association. (2017, July). https://www.apa.org/ptsd-guideline/patients-and-families/exposure-therapy
- What Is Group Therapy? VeryWell Mind. (2021, July). https://www.verywellmind.com/what-is-group-therapy-2795760
- What Is Interpersonal Therapy (IPT)? VeryWell Mind. (2021, August). https://www.verywellmind.com/interpersonal-therapy-1067404
- How do you treat an eating disorder? Kelty Mental Health Resource Center. (2022). https://keltyeatingdisorders.ca/treatment-options/nutritional-counselling
- Given time, most women with anorexia or bulimia will recover. Massachusetts General Hospital. (2016, December). https://www.sciencedaily.com/releases/2016/12/161220140917.htm