Bulimia treatment settings range from strict (in a hospital) to loose (in a home), and most people use several modalities as they work on getting better. You might start out in a hospital during the initial more intensive phase of treatment and then progress to outpatient care where you live at home once you are more stable in your recovery. (1)
Your doctor can help you select the right setting for your bulimia treatment. You’ll need to work with your insurance provider to ensure your treatment is covered.
Bulimia Treatment Levels Explained
Bulimia treatment often involves nutritional support, counseling, support groups, and medications. The term treatment level refers to where that care is provided.
Four main bulimia treatment levels exist. (2)
The person moves into a facility (such as a hospital) for around-the-clock care, including medical treatment. This is the most comprehensive and intense form of bulimia treatment.
It’s typically best for people who are medically or psychiatrically unstable. For example, inpatient treatment will generally be recommended for people who are malnourished or underweight. It is also recommended for those who have engaged in self-harming behaviors.
The person moves into a treatment facility for dedicated psychiatric care. Some places also offer limited physical treatments, such as nutrition care and medication management, but people using this option don’t need constant supervision from doctors or nurses.
They do need regular support from treatment teams to help with psychiatric problems, including depression and suicidal ideas. In residential care, patients often work with therapists and other professionals regularly to address underlying issues that contributed to their eating disorder.
The person goes into a facility regularly for medical and psychiatric treatments. Treatment aims to help stop the person from bingeing and purging, and the person isn’t well enough to avoid those temptations without intensive contact from a treatment team.
While the person remains at the treatment facility for a portion of the day, they head home in the evenings. Treatment often takes place on weekdays with weekends off.
The person can live at home, but they engage in regular care from a team to avoid relapse risks. Two main forms of outpatient care exist:
- Intensive outpatient programs (IOPs): The person visits the facility for care nearly every day and spends a good amount of time in treatment every week. IOPs tend to involve fewer hours of total treatment per week than partial hospitalization programs.
- Standard outpatient treatment: The person visits the facility on a schedule set by symptom severity. This can vary from once per week to longer, more frequent sessions.
Which Treatment Solution Is Best for Bulimia?
Your treatment program should be tailored to meet your needs as an individual. No program is right for every person at every stage.
Your treatment team will find the best setting for your care based on the following:
- Symptom severity
- How long you’ve lived with bulimia
- Overall mental health, including co-existing conditions like depression and anxiety
- Your support system and home environment
- Your motivation to get better
- Overall medical stability
- Location, including the availability of treatment programs near you (3)
Most people with bulimia begin their treatment journey with inpatient or residential care, and they move on to outpatient programs as they improve.
If you’re frail and very ill when diagnosed, a hospital is the best place for you to get help. But as you get better, moving home can help you practice your skills in real time and ensure you can live independently in recovery.
There’s no shame in shifting between treatment settings. Some people move back and forth between inpatient and outpatient programs multiple times before they feel strong in their recovery. You should do what is right for you, your health, and your recovery.
How Do Doctors Determine the Best Bulimia Treatment Settings?
Doctors use the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (or DSM-5), to diagnose and assess bulimia. This manual includes guidelines about bulimia severity, and your doctor can use those to find the right care for you.
Per the DSM-5, four bulimia severity levels exist. The number of bingeing and purging episodes the person engages in per week separates them:
- Mild: 1–3 episodes per week
- Moderate: 4–7 episodes per week
- Severe: 8–13 episodes per week
- Extreme: 14 or more episodes per week (4)
If your doctor determines you have a severe or extreme case of bulimia and your health is at risk, hospitalization is best. If you have mild symptoms, outpatient care could be better.
You won’t determine your bulimia severity on your own. Your doctor and other providers will assess your condition and determine the best path forward for you.
Treatment Cost Considerations: Will Insurance Pay?
Your doctor will diagnose bulimia in your medical record. Those notes can help you prove to your insurance company that you have a medical condition your doctor wants to address to preserve your life.
You should always get a formal diagnosis from a doctor before you consider enrolling in a bulimia treatment program. Without this diagnosis, it is unlikely that insurance will cover the cost of your care. With the diagnosis, your care is deemed medically necessary.
Bulimia treatment costs range between $500 and $2,000 per day, depending on the severity of treatment and the setting of your care. Most people need up to six months of inpatient care to improve. (5)
It’s quite common that some form of treatment will continue for years or even indefinitely. The intensity of treatment tapers off as you grow more stable in your recovery.
In the past, insurance companies could skirt their responsibilities and deny coverage for eating disorders. That situation is improving as lawmakers pass bills that protect patient rights. (6)
Your insurance company should work with you to cover your care. But you may still face unexpected expenses due to these issues:
- Limits: Your insurance plan could cap how long you can stay in treatment. And some cap how much coverage you can use for any medical condition, including an eating disorder.
- Settings: Some insurance plans balk at inpatient care costs, and they entice members to move home as soon as possible. They may require that you attempt outpatient treatment first before they cover the cost of inpatient care.
- Copayments: Some plans require you to pay a portion of your treatment costs. It’s common to pay a set amount each visit, and insurance will cover the remainder of the bill.
- Deductibles: Most plans require that you spend a set amount before they’ll pay anything at all. Once you hit this deductible amount, your coverage will kick in.
All of these fees could make your bulimia treatment costs rise. Talk with your insurance company, doctor, and treatment team before care begins so you know what to expect. And if you see a bill you don’t understand, speak up right away.
Your treatment center may have options to make the out-of-pocket cost of care easier for you to manage. Some centers offer payment plans where you can finance the cost of your care over time. You might not even have to begin making payments until you leave treatment.
What Comes Next?
Talk with your doctor about your bulimia symptoms and ensure that you have a diagnosis documented in your medical record. Ask your doctor what treatment setting is right for you, and ask your insurance company what providers offer covered care.
If you’re too unwell to tackle these steps alone, don’t worry. Ask your doctor, your treatment provider, or a close friend to help. You deserve to get the treatment you need.
With the right support and care, you can get the bulimia treatment you need to get well and live a healthier life.
- Eating Disorders. National Institute of Mental Health.
- Types of Treatment. National Eating Disorders Association.
- Initial Evaluation, Diagnosis, and Treatment of Anorexia Nervosa and Bulimia Nervosa. (2015). American Family Physician.
- Evaluation of the DSM-5 Severity Indicator for Bulimia Nervosa. (February 2015). Behaviour Research and Therapy.
- Eating Disorder Statistics. South Carolina Department of Mental Health.
- Despite Progress, Patients Still Struggle With Insurance Coverage for Eating Disorder Treatment. (February 2021). Forbes.