Bulimia Nervosa is characterized by episodes of binge eating that are followed by compensatory behaviors such as purging, fasting, and/or excessive exercise. The physical, emotional, and psychological impact of bulimia nervosa behaviors are devastating, therefore, identifying the disorder and intervening as soon as possible is important.
How to Help Someone with Bulimia
More people are faced with supporting an individual with bulimia nervosa than you might think. From family members to friends to romantic partners and even coaches, teachers, bosses, or co-workers, bulimia nervosa impacts all those around the individual.
If you are concerned that someone you know is struggling with bulimia nervosa, it is important to bring your concerns to that person. Doing so aggressively or with assumptions that you know what they are going through can backfire, however, approaching them non-judgmentally and creating space for them can be a valuable start to their recovery journey. Creating space for these individuals to share their experiences allows them to express how bulimia nervosa uniquely impacts them. It can also provide valuable information that can support future interventions.
After listening to your loved one, simply asking “how can I support you?” is a great way to open the door to the next steps. You might approach this conversation with some resources already prepared in case they ask for further help. Have an open discussion on how you can help them to access appropriate professional help as well as how you, as peripheral support, can be there for them. Depending on your relationship with the individual, this might look like simply checking in with them, being penpals in treatment, helping them to find treatment centers and/or professionals, or even engaging in family therapy sessions.
Be open to helping this individual in the ways that they need but also be sure to set your own boundaries to protect your mental health and well-being. It is not helpful to do some or all of the things above if you, yourself, are struggling, as this will likely lead to resentment or conflict that can impact the individual and your relationship.
Bulimia Recovery Stages
The treatment and recovery process for bulimia nervosa will look different for every individual. As far as treatment, what it will look like depends on two major factors: the severity of the individual’s disorder and their willingness to engage in treatment.
The severity of an individual’s bulimia nervosa will dictate what level of care they require. If they are severely medically compromised by their behaviors, they will need Inpatient Treatment at a hospital. Once medically stabilized, they will step down to residential treatment, Partial Hospitalization Program, or Intensive Outpatient. Often, the individual will go through all of these levels as they involve various degrees of monitoring, program length, and services that are titrated down as the individual gains more autonomy and works on maintaining recovery along with their daily lives.
The most important predictor of treatment effectiveness is an individual’s engagement in their treatment. If an individual is struggling with motivation and not actively involved in group therapy, individual therapy, family therapy, dietary work, and all other program requirements, it is less likely that treatment will be helpful to them. This can be comforting for individuals, as the effectiveness of treatment lies in their own choices. This does not mean ambivalence to recovery does not exist, however, individuals will benefit more from processing this ambivalence and engaging in treatment anyways as opposed to making choices based on this ambivalence.
Bulimia Therapy Essentials
The most effective treatment methodologies for bulimia nervosa include Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), Exposure and Response Prevention (ERP), and holistic therapies.
Cognitive Behavioral Therapy is the most evidence-based treatment approach for all mental illnesses. CBT interventions are rooted in the foundational belief that thoughts lead to feelings which lead to behaviors. CBT involves supporting individuals in learning the core beliefs and thought processes behind their eating disorder behaviors and altering these in order to alter behaviors.
Dialectical Behavior Therapy is a type of cognitive therapy based on the concept of integrating seemingly opposing beliefs to challenge black-and-white thinking. The treatment involves educating individuals on how to accept these opposites at once while teaching them skills to regulate emotions, engage in the moment mindfully and nonjudgmentally, tolerate distress, and effectively communicate boundaries and needs.
Exposure Response Prevention is also a type of cognitive therapy that intertwines exposure therapy with skill-building and cognitive reframing. This treatment involves exposing individuals to things that trigger their behaviors such as fear foods, uncomfortable emotions, or social situations/activities. Without the option to cope with these using behaviors, the individuals are taught more effective coping skills and encouraged to utilize these instead.
Many of the therapies above are often combined as the skills and interventions in each are effective. They are also often combined with holistic therapies such as yoga, dance, and art therapies. These can support an individual in learning alternative methods to communicate or cope as well as helping them become connected with their body and movement.
Finally, research indicates that involving an individual’s support system in treatment and therapy is hugely beneficial to their recovery. The treatment team is helpful but will not always be there. As such, an individual’s support system needs to be informed on their loved one’s struggles and how to best help them.
Bulimia Treatment Cost
Treatment cost for bulimia nervosa varies depending on the level of care needed, the amount of time an individual will be in treatment, and their insurance. Some insurances might cover treatment in its entirety but limit the amount of time they are willing to cover. Others might limit time as well as involve a co-pay.
Regardless of your insurance, every treatment center has a Case Management team there to support individuals in navigating how they can finance their treatment. These individuals will provide information on what coverage looks like for the patient as well as communicate with the insurance company to explain the need for treatment. This can be comforting as patients will not need to navigate a confusing and complex system alone.
How to Find Treatment Programs for Bulimia
If you or a loved one are identifying a need for bulimia nervosa treatment, there are many ways to learn your options. First, go to your primary care doctor, therapist, or psychiatrist and let them know what you are experiencing so that they can refer you to resources and professionals in your area. Second, call your insurance company to learn what eating disorder treatment professionals are covered in their network. These may not be in your area, however, some insurance companies will agree to pay for an individual to go to another state to receive treatment. Finally, the internet has many helpful resources on fighting bulimia nervosa, receiving treatment, and learning about the disorder and recovery. These sites often have directories listing eating disorder professionals as well as many articles that can provide education and support.
As you seek treatment for bulimia nervosa, recognize that you do not need to know exactly what you need or where you need to go before contacting professional help. The professionals will help you to determine all this. The best thing you can do to begin your recovery process is to reach out.
Author: Margot Rittenhouse, MS, LPC, NCC
Page Last Reviewed and Approved By: Jacquelyn Ekern, MS, LPC / 12.2.21