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Bulimia treatment therapy plans with proven results

Bulimia nervosa (BN) is a dangerous and potentially deadly disorder, affecting someone’s mental, physical, and emotional health. Thankfully, there are many treatments for bulimia.

A number of therapeutic techniques and modalities have been developed to help people with eating disorders of all kinds, including bulimia nervosa. Cognitive behavioral therapy (CBT) and dialectical behavioral therapy (DBT) have been found especially helpful, but a number of other therapies can help ease mental and physical symptoms of BN.

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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.

15
 minute read
Last updated on 
October 23, 2023
June 3, 2024
Bulimia treatment
In this article
therapy session in person

How to treat bulimia nervosa

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

Inpatient programs represent the most intensive form of treatment for bulimia nervosa.

They can be voluntary or involuntary and are typically only administered in extreme cases, such as when a patient:

  • Needs life saving interventions
  • Exhibits signs of suicidal ideation
  • Has rapidly worsening symptoms, such as drastic weight loss in a short period of time2
  • Shows signs of a physical or mental health crisis, or other serious health complications2

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

The type of care a patient receives at an inpatient program includes:

  • Lifesaving medical interventions, if necessary
  • Individual, group, or family therapy sessions
  • A physician-developed care plan, which could include medication routines and additional therapeutic recommendations
  • Nutrition counseling
  • Supervised daily meals and snacks
  • Coping skills development

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Residential

Residential treatment is often considered a “step down” from inpatient care due to its lower intensity. It’s best suited for patients who:

  • Are medically stable or have had immediate physical health needs met
  • Could still benefit from around-the-clock medical care and monitoring

Patients still live at a facility, but the environment is more home-like than hospital-like. Treatment options are similar to those administered in inpatient care, but with more focus on psychotherapy, establishing long-term goals, and building healthy routines.

Residential programs can also offer many benefits for patients who didn’t require inpatient care treatment, including:

  • A regimented schedule that emphasizes structure and healthy routines
  • Living away from their regular environment, which often includes a number of triggers or temptations

These programs require a much longer stay than inpatient care. Many residential programs have no prescribed length, with patients potentially staying in the facility for several months before feeling ready to leave.3

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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.

This level of care is often considered a good match for patients who:

  • Can still benefit from daily mental health check-ins
  • Have trouble maintaining school, social, or work schedules due to their eating disorder
  • Sometimes see a relapse of bulimia symptoms
  • Have adopted different extreme weight control techniques, including limited food intake or extreme exercise 4

Types of treatment in these programs often include:

  • Supervised meals and snacks
  • Nutritional counseling
  • Medication management
  • Ongoing individual, group, or family therapy sessions

The frequency of these visits and the length of the program are also determined on a case-by-case basis, but the program often lasts around 4-6 weeks.4

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 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.

Patients are typically enrolled in these programs once they:

  • No longer need daily monitoring or mental health check-ins
  • Have their bulimia symptoms under sufficient control
  • Are ready for a return to school, work, and social situations
  • Feel dedicated to their continued recovery 

‍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.

woman writing in notebook

Fully remote recovery

Online therapy sessions
Meal kit deliveries
Remote vitals monitoring

We will help get the most out of your insurance.

Outpatient

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 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.

The Within Experience
Online PHP and IOP treatment options
Meals delivered weekly to your home
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Effective bulimia nervosa 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.

Six major tenets

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)

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.

Major areas of focus

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

woman in nature with sunshine

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.

Different types of techniques

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.

Different types of techniques

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

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.

Different types of exposure

Exposure therapy is thought to help in four distinct ways:10

  • Habituation: With increased exposure to the discomfort, the feeling of stress reduces.
  • Extinction: Unwanted associations linked to previous experiences can be undone and changed with exposure.
  • Self-efficacy: Through exposure, the person can begin seeing their strength and capability.
  • Emotional processing: Rather than only feeling fear, the person can connect new, rational beliefs and feelings to the situation.

Group therapy

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.

Techniques used

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
group of friends

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.

Sorting relationships into four major categories

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.

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 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.

A registered or licensed professional–a therapist, nutritionist, or nurse–administers nutrition counseling. The focus is on education, with practitioners helping a patient learn more about:13
  • The types of foods and drinks a body needs to be healthy
  • How the body uses different vitamins, minerals, and nutrients
  • How to plan meals to ensure these needs are met

Nutrition counseling also educates individuals on the mental aspect of eating, including topics like:

  • How eating habits can be linked to emotions
  • How to recognize and overcome fear of certain foods/food groups
  • Why even “feared” foods can be healthy

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”:

  • Remaining calm while eating
  • Being confident about diet choices
  • Being consistent with healthy diet choices
  • Having compassion for oneself

Experiential bulimia nervosa treatments

Experiential treatments for bulimia nervosa help a person heal by getting them out of their mind and into their body.

This can be done through a number of mediums, including:
  • Art therapy
  • Dance therapy
  • Music therapy
  • Psychodrama
  • Wilderness therapy
  • Recreational therapy
  • Yoga therapy
  • Adventure therapy

‍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.

recovery rate of bulimia graphic


Treatment for bulimia 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.14

That may sound like a long time, but it’s worth a lifetime. And it’s never too late to start.

Learn more about remote treatment for bulimia
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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 two levels of care:

  • Partial hospitalization program
  • Intensive outpatient program
86%

of those who complete our treatment program report reduced eating disorder symptoms

The Within results

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.

Resources

  1. Levels of Care. (n.d.). University of California San Diego. Accessed October 2023.
  2. Level of Care Guidelines for Patients With Eating Disorders. (n.d.). Massachusetts General Hospital. Accessed October 2023. 
  3. Woodside, D. B., Carter, J.C., Blackmore, E. (2004). Predictors of Premature Termination of Inpatient Treatment for Anorexia Nervosa, 161(12), 2277-2281.
  4. Levels of Care in Eating Disorder Treatment. (2020). National Eating Disorders Association. Accessed October 2023.
  5. Patino, L. D., Yudchak, C. G., Barbieri, D. P., Stramesi, J. M., Champagne, V., Ramundo, M. P. (2018). Comparative Study on the Effectiveness Between Intensive Outpatient Care and Partial Hospitalization Treatments in Patients Diagnosed with Eating Disorders. Archives of Medicine, 10, 1.   
  6. About ACT. (n.d.). Association for Contextual Behavioral Science. Accessed October 2023.
  7. Twohig, M. P., & Levin, M. E. (2017). Acceptance and Commitment Therapy as a Treatment for Anxiety and Depression: A Review. The Psychiatric Clinics of North America, 40(4), 751–770.
  8. Fan, Q., Liao, L., & Pan, G. (2017). The Application of Cognitive Remediation Therapy in The Treatment of Mental Disorders. Shanghai Archives of Psychiatry, 29(6), 373–375.
  9. 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.
  10. What Is Exposure Therapy? (2017, July). American Psychological Association. Accessed October 2023.
  11. Malhotra, A., Baker, J. (2022). Group Therapy. StatPearls. Accessed October 2023.
  12. Markowitz, J. C., & Weissman, M. M. (2004). Interpersonal psychotherapy: principles and applications. World Psychiatry, 3(3), 136–139.
  13. How do you treat an eating disorder? (2022). Kelty Mental Health Resource Center. Accessed October 2023.
  14. Given time, most women with anorexia or bulimia will recover. (2016). Massachusetts General Hospital. Accessed October 2023.
  15. Murphy, R., Straebler, S., Cooper, Z., & Fairburn, C. G. (2010). Cognitive behavioral therapy for eating disorders. The Psychiatric Clinics of North America, 33(3), 611–627.
  16. Carter, J. C., Olmsted, M. P., Kaplan, A. S., McCabe, R. E., Mills, J. S., & Aimé, A. (2003). Self-help for bulimia nervosa: a randomized controlled trial. The American Journal of Psychiatry, 160(5), 973–978.

FAQs

What is the best treatment for bulimia nervosa?

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.

Can bulimia be cured without treatment?

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

How long is treatment for bulimia?

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.

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Further reading

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