There are many factors to keep in mind, including program specifics, insurance specifics, and the aspects of recovery that matter most to you. Not every program or center will work for everyone. The key is to find the specific program that fits well with your goals, preferences, and needs.
If this is already starting to feel like a staggering task, don’t worry. There are some tips that can help you break down the process into more easily achievable steps and help you find your best option for treating bulimia nervosa (BN).
What to Look for When Choosing a Bulimia Treatment Program
Eating disorder treatment is a long-term process. And while you generally maintain the option to switch providers mid-treatment, this can be logistically complicated and a potentially troubling disruption for the person in the program.
That’s why taking a little extra time at the beginning of the process to find a treatment center that hits all your goals, or as many as possible, is worth the effort.
To help you determine which center may be the best fit, there are some key factors to keep in mind.
Clinician Quality
The expertise and bedside manner physicians and other medical professionals bring to the table can make a big difference in someone’s BN recovery.
A combination of federal statutes and state-by-state laws are in place to ensure that clinicians working at treatment facilities have certain levels of training or other qualifications. [1] And medical professionals specializing in mental health treatment must also meet certain designations in order to be licensed to practice.
With that said, some clinicians may technically meet these standards but practice in a way that might work better or worse for certain patients.
Comparing Clinicians
It’s likely that in your research, you’ll come across the situation of comparing professionals with similar qualifications against one another. In this case, you may want to look for clinicians who have more specific experience in the aspects of care you’re interested in.
A number of these physicians might have specialties, such as focusing on treating people with bulimia nervosa, working with cognitive behavior therapy (CBT), or helping patients with a comorbid psychiatric illness.
When possible, you want to find professionals whose experiences and overall treatment philosophies most align with your own.
Cost
For most Americans, the cost of treating eating disorders is one of the most important considerations regarding the option they choose. A majority of people need to work with their health insurance companies in order to afford care.
When thinking of insurance, it’s important to keep in mind not just whether a certain center is in-network with your provider (which should drastically lower how much you pay for the program), but whether they provide care options your insurance company considers necessary and will therefore cover.
Each insurance policy uses different metrics to determine the types of treatments it will cover. Some providers also only cover treatment for certain eating disorders or mental disorders. You’ll have to check the specifics of your policy or call a representative from your insurance company for more specific details of your plan.
Determining Cost
Choosing the right care provider in order to keep costs down can potentially save you thousands of dollars over time without a meaningful sacrifice in care quality.
Take the time to confirm the provider in question accepts your insurance. Many centers have employees dedicated to helping people iron out the specifics of cost and insurance. You can also speak with representatives of your insurance company to be sure they will cover the program you’re interested in.
Make sure to ask upfront about how much you should expect to pay out of pocket before treatment begins. And keep in mind that many insurance companies may offer different levels of coverage depending on how long someone remains in treatment.
If you’re anticipating a longer stay in a care facility, make sure to ask how much your insurance will cover over the duration of treatment.
Location
An old saying in the medical world says, “The best medicine for a patient is the one they’ll be able to take.” The location of a treatment center can make a big difference in how convenient it may be to receive care and, therefore, how likely it will be for a patient to stick with a full course of treatment.
Still, the closest or most well-located centers, unfortunately, aren’t always the best option.
If you start your search by looking for the treatment centers closest to you, keep in mind that some may not fall under your insurance network. This can make a big difference in how much treatment will cost.
Additional Location Factors
The importance of distance traveled for care varies from person to person, depending on personal tastes and circumstances.
Some people may not mind the distance and find it relatively easy to travel to providers. Others may experience mobility issues, have inconsistent access to transportation, or have schedules that make frequent traveling to care difficult.
All of these should be kept in mind when considering where the treatment center you work with is located.
Reputation & History
Before committing to any care provider, it’s important to research their reputation and history.
Online reviews, both good and bad, can provide valuable insights into the type of care a particular facility or the individuals at that facility can offer. You also want to check if a company has any history of legal troubles or similar controversies.
Some red flags to watch out for include:
- A history or reports of abuse
- Non-accredited programs
- Use of non-evidence-based treatments
- Numerous negative reviews
Some unscrupulous companies may also inflate their number of good reviews, either by paying people to submit them or having other interested parties write phony reviews.
These can be hard to differentiate from real reviews, but many false reviews often make similar claims or use similar language. They may also be resoundingly and almost unrealistically positive in their assessment of the center.
Types of Treatment Used
Eating disorders are complex, manifesting as physical symptoms as well as emotional and behavioral issues. Successfully treating an eating disorder, then, often requires several approaches to care that are customized to an individual patient’s needs.
While there are numerous methods that may help people struggling with an eating disorder, a few forms of care are more commonly recommended.
Cognitive behavioral therapy is widely considered to be one of the most successful approaches for treating bulimia nervosa and other eating disorders. [2]
The idea behind CBT is that unhelpful thoughts are what lead to unhelpful behaviors. As such, the therapy focuses on helping someone first identify, then redirect, and ultimately stop these unhelpful thought patterns.
A therapist will also work with you to identify potential triggers that may lead to a bulimia nervosa binge or inappropriate compensatory behaviors, such as self-induced vomiting.
Toward the end of CBT treatment, your therapist will help you devise and practice strategies to keep a look out for these disordered thoughts in the future and to put a stop to them if they should occur.
Exposure therapy is a type of treatment where one works with a mental health professional to reduce or eliminate the negative responses they have to triggering situations.
When working with people with bulimia nervosa or other eating disorders, this could include exercises to develop a healthier body image or confront the fear of weight gain. Patients may look at their own bodies in the mirror and be given prompts to help view their healthy weight and body shape as “normal” or even beautiful.
Exposure therapy for BN can also help reduce binge eating and confront other disordered eating habits. This can be done by sitting with a mental health professional through meals or slowly reintroducing certain types of food into someone’s regular diet, among other techniques. [3]
Exposure therapy can be stressful, but it’s important to note that it’s controlled stress. Part of the mental health professional’s job during these treatments is to pull things back if the situation becomes too intense or anxious.
Nutritional counseling takes more of an educational approach to treatment, to help promote harm reduction. Through this method, you’ll work with a professional to learn about the importance of a balanced and nutritious diet, and how certain foods can help build a stronger, healthier body.
Nutritional counseling is an important part of most eating disorder treatment plans, especially in the early stages. Eating disorders like BN often result in serious health complications due to malnutrition. With purging-type BN in particular, the concern is around someone developing dangerous electrolyte imbalances. [4]
Nutrition counselors may also help you develop an eating plan to help make sure food intake remains steady and healthy eating habits are practiced in the future.
While medications are often not imagined as a primary treatment for bulimia nervosa, some have been found to be helpful for managing sustained recovery.
A class of drugs called selective serotonin reuptake inhibitors (SSRIs) has been found to be especially helpful for people in recovery from BN. Still, these medications can be powerful, and they shouldn’t be taken without the approval of a medical professional.
Levels of Care for Bulimia Nervosa
On top of different treatment modalities, there are also several levels of care for people with bulimia nervosa or other eating disorders. This can range from inpatient treatment, during which a patient needs near-constant care or observation, to outpatient treatment, where a patient sees a therapist on a regular basis but otherwise lives at home and has a regular schedule.
When determining the type of treatment you may want to pursue, it’s important to keep in mind not just the specific therapies that may work best but which level of care will be most helpful.
Inpatient Programs
Inpatient treatment is essentially the most intensive form of eating disorder care, during which a patient stays full-time at a treatment facility for an extended period of time.
This is a highly-focused, regimented type of care that is good for people in crisis or those with severe eating disorder symptoms who may need to be medically or emotionally stabilized before they can continue with more targeted care.
Due to its intensive nature, and the fact that patients live full-time at the facility, inpatient programs are often the most expensive type of BN treatment. But this set-up also gives a person 24/7 access to medical care and allows them to focus completely on recovery, giving them a break from the outside world.
Partial Hospitalization Programs (PHPs)
Partial hospitalization programs are the middle-ground of eating disorder treatment.
During this phase of care, a patient lives at home but is expected to commute to a treatment center anywhere from 4-6 days per week, for anywhere from a half-day to a full day. Often, patients will start with a more intensive schedule, and as they begin feeling more comfortable with managing their eating disorder symptoms, their schedule is reduced to allow them the chance to take on more social responsibilities.
Patients who are transitioning out of inpatient treatment will likely receive a continuation of the care they were previously participating in, including individual therapy, family-based therapy, group therapy, nutritional counseling, medication management, or other treatments.
Intensive Outpatient Programs (IOPs)
Outpatient care represents the majority of eating disorder treatment.
Patients visit a care provider, such as a therapist or nutritional counselor, on a regular basis, but they otherwise live their lives as normal, allowing them to perform important activities like going to school or work.
Some patients further benefit from an intensive outpatient program, which is essentially a slightly more intensive version of this setup. These programs still allow a patient the freedom to live at home and dictate their own schedule, but it involves more or longer sessions of therapy.
IOPs can make a good option for patients who are transitioning out of more intensive forms of treatment, such as inpatient or partial hospitalization programs. It can also be helpful for someone in recovery who is concerned about potential relapse and would like to receive more active help.
Virtual Care
Virtual care is an umbrella term that describes any care option administered through the internet. It can be used for outpatient or intensive outpatient treatment and sometimes even partial hospitalization programs. It may also be used within inpatient facilities, connecting patients to physicians at other treatment centers.
Within Health is one such company that offers fully remote care for eating disorders.
This type of care has grown in popularity since the COVID-19 pandemic, with many people turning to the method for its convenience and ease of use, among other benefits.
Virtual care can’t replace all types of in-person care, but it may help open up options for people who otherwise struggle to receive care, including those with mobility or transportation challenges or those who live in under-serviced areas.
Finding Help for Bulimia Nervosa
Bulimia nervosa is a serious, dangerous, and potentially deadly illness. If you or a loved one are struggling with BN, it’s important to seek help.
If you don’t know where to start your search, you can speak with your physician, therapist, or other trusted medical professionals. You can also call your insurance company for a list of potential providers who are in-network. And a number of eating disorder hotlines may be able to provide you with additional information, resources, and help.
Finding the right kind of treatment for bulimia nervosa can be a difficult process, but it’s an important step on the road to recovery, which can lead to a healthier and happier future.
Resources
- Eating Disorders. National Institute on Mental Health. (2023, January). Retrieved February 8, 2023.
- 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.
- Butler, R. M., & Heimberg, R. G. (2020). Exposure therapy for eating disorders: A systematic review. Clinical Psychology Review; 78:101851.
- Nitsch, A., Dlugsoz, H., Gibson, D., Mehler, P. (2011). Medical Complications of Bulimia Nervosa. Cleveland Clinic Journal of Medicine; 88(6):333-343.