Inpatient and Outpatient Treatment Plans for Bulimia Nervosa


Bulimia nervosa, a grave eating disorder, is also regarded as a major mental illness affecting a wide swath of the populace, especially young women, and has a devastating effect on the patients. Since bulimics, like anorexics, have the tendency to mask the symptoms associated with the eating disorder as well as keep the mental issues they might be facing, under wraps, diagnosing the issue becomes difficult. The longer the bulimic conceals his or her eating disorder (along with the accompanying psychological issues termed as dual diagnosis disorder or co-morbidity), the more complicated will be the recuperation or healing plan.

Someone who is struggling with an eating disorder may attempt to eat “normally” in the presence of others, and then look for opportunities to be alone to find ways to binge or purge. — Lisa Ferentz LCSW-C, DAPA

A patient who reports his bulimia nervosa disorder, after several years of having lived with the issue, should be mentally prepared to go through a protracted treatment plan before he recovers sufficiently enough.  On the other hand, bulimics who are forthcoming about their eating disorderliness and seek timely treatment start responding positively to a therapeutic program within a few days after induction into the process. Bulimia patients can opt for any or both the treatment programs available at medical facilities or centers-inpatient treatment therapy and outpatient treatment therapy.

Outpatient Treatment Plan for Bulimics                                              

Outpatient treatment plan works best for individuals who’ve been recently diagnosed with bulimia nervosa. This mode of treatment is usually the first line of treatment for those with a mild form of the disorder. There are several benefits to registering for an outpatient treatment therapy including cost-effectiveness and the leeway to continue with a normal lifestyle.

Now, there are different kinds of outpatient treatment plans including but not limited to medication plan, dietary counseling, interpersonal psychotherapy, group psychotherapy, and behavioral/cognitive therapy. Patients undergoing outpatient treatment are not required to take admission in a medical facility but rather continue staying in their homes. Since they display symptoms that happen to be mild, they may not need to be kept under round the clock supervision.

Balancing serotonin levels with nutrition is central to managing the range of symptoms that occur along the eating disorders continuum. — Leslie E. Korn Ph.D., MPH, LMHC, ACS, NTP

The sort of outpatient treatment procedure that a bulimic individual needs to go for considerably depends on the extent of care required and the medical professionals who will be offering support. Usually, such a patient will have to consult a nutritionist, psychotherapist, and a psychiatrist at the least. The family, eating disorder support groups, general practitioner, social worker, and other caregivers function as supplementary resources.

Outpatient treatment is generally non-residential in nature as the patient carries on with his or her daily life while periodically reporting to a care center for interpersonal therapy and/or group therapy sessions. Broadly speaking, there are three distinct kinds of outpatient treatments for bulimics-day treatment or partial hospitalization, intensive treatment, and general treatment. In a partial hospitalization program, the patient is able to access group therapy sessions and is also offered highly nutritious meals 3-4 times in a day.

Intensive treatment plans last for 3-6 months where the patient needs to devote some hours spread over days in a week and is most suitable for those with encumbrances. An intensive treatment program incorporates group therapy, one-to-one therapy, nutritional counseling, and controlled meals. General treatment is a specialized form of intensive treatment where the assistance of medical specialists like a naturopath, chiropractor or acupuncturist is sought.

The lack of seriousness taken by many patients regarding the medical sequeale of Anorexia and Bulimia, contributes to the inability to choose the best protocol for care and therefore increases the likelihood of treatment failure. — Judy Scheel Ph.D., L.C.S.W., CEDS  

Inpatient Treatment Plan

Inpatient treatment is recommended for bulimics who’ve had the disorder for many years and are completely unable to control their cravings for bingeing and purging. Keeping such patients under constant supervision in a medical facility will go a long way in coping with the chemical imbalances that result from excessive use of laxatives, emetics or diuretics. Supervised dietary and medicinal plans help in mitigating the chemical imbalances.

The temptations that trigger bingeing or purging are not available in a medical center.


Regardless of whether someone suffers from a mild or a grave form of bulimia, the fact that the person has to seek a treatment plan is inescapable. Additionally, the bulimia patient needs to be extremely patient in persevering with the treatment plan as it might take years before he or she can recover fully.

Some Surprising And Alarming Statistics About Bulimia



The lack of seriousness taken by many patients regarding the medical sequeale of Anorexia and Bulimia, contributes to the inability to choose the best protocol for care and therefore increases the likelihood of treatment failure. — Judy Scheel Ph.D., L.C.S.W., CEDS

Of all the different types of eating disorders that adversely affect people across all age spectrums, especially female teenagers and young adults, bulimia nervosa is one of the most predominant. An individual is said to be suffering from bulimia if he or she has an obsessive compulsion for staying lean and wiry, but at the same time is unable to control bingeing and maintain a disciplined dietary plan. Though bulimia can affect people of both sexes, regardless of their socioeconomic status or ethnicity, it is majorly prevalent in young women in the age group of 15-35 years.

Statistically speaking, bulimia nervosa affects 1.5% females and 0.5% females in the US which implies that about 4.7 million women and 1.5 million men are in the throes of this eating disorder. Bulimia nervosa is an idiopathic eating disorder as the exact causative factors behind it are yet to be pinpointed. However, it is believed that bulimia can result from the interplay of temperamental, environmental, and genetic factors.

Startling Statistics about Bulimia Nervosa


Sadly, there is a lot of guilt and shame attached to these behaviors so they tend to be done in private. — Lisa Ferentz LCSW-C, DAPA

The following are some surprising and alarming statistics about bulimia:-

  • Bulimia, more often than not, stems from starting out with and sticking to a dietary program intended to enable the individual to lose weight and become more self-confident
  • According to the National Institute of Mental Health, about 2%-4.2% females are inconvenienced by the eating disorder at some stage of their life
  • An individual is most likely to be diagnosed with bulimia when he or she is 20 years old
  • Bulimia is most prevalent in individuals aged between 18 and 59 years
  • About 0.6% of the adult populace in North America is affected by bulimia nervosa
  • Women showing symptoms of bulimia are more likely to report for drug abuse compared to females suffering from anorexia nervosa
  • There is a widespread misconception that bulimia causes an individual to lose excess weight. But in reality, some bulimics happen to be obese or overweight while others tend to have a normal weight
  • A professional treatment program to help an individual exercise control over his or her bingeing habit as well as assist in shedding the fixation to stay really thin lasts for a maximum of 6 months. The bulimic is kept under direct supervision in a medically assisted and controlled environment.
  • Approximately 10% of the American population troubled by bulimia are likely to seek treatment
  • About 80% of American women who have undergone treatment for bulimia have been discharged or released from the facility earlier than then they should have been
  • Recent studies and surveys have found that bulimic women are more vulnerable to getting addicted to marijuana, cannabis, heroin, tranquilizers, and alcohol
  • An individual is more likely to respond better to a treatment program or therapy in a care center in comparison to family or home-based treatment
  • Medical insurance schemes offered by insurance companies are very unlikely to offer coverage for bulimia treatment
  • 8% of bulimics show a high preponderance for bingeing without the urge to purge or vomit
  • A typical bulimic may consume over 2,000 calories at one go before having the urge to regurgitate
  • Racial minorities and youngsters in the age group of 8-12 are presently at a high risk of getting diagnosed with bulimia
  • An individual is most likely to develop bulimia nervosa because of a genetic predisposition, to the extent of 50%-80%
  • About 3.9% of bulimics are likely to die as a result of the eating disorder
  • 50% of anorexics have a high probability of developing symptoms of bulimia

Balancing serotonin levels with nutrition is central to managing the range of symptoms that occur along the eating disorders continuum. — Leslie E. Korn Ph.D., MPH, LMHC, ACS, NTP



Bulimia nervosa, despite being a grave eating disorder, is rarely fatalistic, and almost everybody suffering from the psychological condition can expect a full and speedy remission. However, one needs to be committed and extremely patient, as it takes many months or even several years to recover completely from the affliction.


Talking About Bulimia




Bulimia is a severe mental health disorder and one that is associated with a number of serious medical concerns. Supporting a loved one with bulimia can be a very challenging task. Your support may well be one of the things that helps them finally tackle this horrible eating disorder. Often it can be hard to know what to say and when to say it and with such a controversial subject, you may be concerned about saying the wrong thing, making it worse or even pushing them away. Below are some tips on how to speak with someone about bulimia at different stages of their recovery process.

The behaviors might get downplayed or even flat out denied by the person who is trying to sustain them. — Lisa Ferentz LCSW-C, DAPA

The First Conversation:

Talking with a loved one about bulimia can be extremely difficult. Not only is this a very controversial and often ‘touchy’ subject, due to the feelings your loved one is likely experiencing (such as shame or embarrassment), it is hard to approach this subject without them becoming defensive or very upset. Below are a few do’s and don’ts to help you engage in a productive conversation without pushing your loved one away.


  • Speak in a non-judgmental and caring way.
  • Use “I” statements to communicate this. For example, “I noticed……. and I am worried about you.
  • Give them time and space to communicate how they are feeling. This is not something that will be fixed with one conversation. It is also important to understand the feelings that are underneath the eating disorder, so giving them this time and space is very helpful.
  • Encourage them to seek help and let them know you will be there to support them in any way they need.
  • Be direct and honest, but in a caring way.

Balancing serotonin levels with nutrition is central to managing the range of symptoms that occur along the eating disorders continuum. — Leslie E. Korn Ph.D., MPH, LMHC, ACS, NTP


  • Avoid language that places blame or suggests that you are criticizing them or their behavior.
  • Try not to be a therapist and remember it is okay for you not to have the answer to everything. It’s more about letting them know you are concerned and offering them a chance to discuss their feelings.
  • Don’t focus the conversation on food and instead keep it centered on their feelings.
  • Never try and threaten them or manipulate them. This will likely only increase their anxiety and make it worse (as well as making them less likely to approach you in the future for support).


What if they deny it?



For people suffering from bulimia, it has often become their way of coping. So denying that their eating disorder is a problem, or that they even have one is a way that they protect themselves. As tackling the eating disorder will require taking a coping strategy away from them, you need to continue to offer them lots of love and support. Be non-judgmental in your approach and let them know you will be there every step of the way if required.

 In order to understand how to treat, understanding what we are treating makes sense. — Judy Scheel Ph.D., L.C.S.W., CEDS

While They are Going through Treatment:




  • Praise – Let them know that you have noticed they are making changes. Tell them you know how difficult it is for them and that you are really proud of how they are going.
  • Separate – Separate them from the eating disorder. Often they can feel as though they are one and the same, and reminding them that this is not the case is very helpful. Separating the two helps them to see that there is a possible future where they can exist without the bulimia.
  • Tell them to rest – Let them know that it is okay to take a break. Tackling the bulimia is likely to take a significant emotional toll on them and this takes a lot of energy. They may feel the need to continue with their normal goals and tasks, but sometimes they may just need a little break. Let them know that this is okay, and sometimes it is necessary.
  • Be normal ­- Invite them to do tasks you used to do together and try not to focus on the bulimia or food every time you see them. This will again remind them that they are not the disorder.
  • Compliment – Give them compliments to boost their confidence. Don’t focus these on their body or weight. Try and ideally choose personality traits that you can praise. If this doesn’t work, focus on other aspects of appearance such as their hair, color of their nail polish or even their new bag.

For further guidance on talking about bulimia or talking to someone who is fighting bulimia, please see the links below.