Out of the Shadows: Outpatient Treatment For Bulimia

In the secret life of teenagers, it’s a dangerous silent threat to physical and mental health. Young people with bulimia nervosa may hide this eating disorder long into adulthood because they feel guilty and ashamed. The disorder can continue for years before anyone notices because the person’s outward physical appearance or size may offer no obvious clues. As Australian journalist and writer June Alexander reveals, on the National Association of Eating Disorders blog, “My life, from the age of 15 to 30 years was a struggle – no wonder my family, husband and friends had trouble understanding me, and no wonder I had trouble understanding myself.” Most people respond first to residential treatment or a partial hospitalization program, but if their physical and emotional health and are determined to be stable, outpatient (OP), or intensive outpatient care (IOP), for bulimia can be an option.

What is Bulimia?

“Bulimia Nervosa is characterized by binge eating and purging. When I was struggling, purging was often mistakenly understood only as vomiting, but we now know that it can include taking laxatives, diuretics, or stimulants, and/or excessive exercise,” June Alexander told NEDA. “My struggle was marked with occasional laxative abuse and excessive exercise.”

Teens and adolescents with bulimia often become very secretive and use trips to the bathroom or take long showers in an attempt to hide their purging behavior. Both males and females that suffer from this eating disorder often use the bathroom immediately after or during meals and frequently follow very strict diets. In many cases, young people with bulimia may also engage in oppositional behavior and experience severe mood swings.


NEDA offers this list of common symptoms for bulimia nervosa:

  • Frequent episodes of consuming a very large amount of food followed by purging behaviors to prevent weight gain, such as self-induced vomiting, laxative use, or excessive exercise.
  • A feeling of being out of control during the binge-eating episodes.
  • Self-esteem is overly related to body image.

Warning Signs

The chance for recovery increases the sooner that bulimia nervosa is detected. NEDA encourages parents to be aware of the typical warning signs of bulimia nervosa:

  • Evidence of binge eating, including disappearance of large amounts of food in short periods of time or finding wrappers and containers indicating the consumption of large amounts of food.
  • Evidence of purging behaviors, including frequent trips to the bathroom after meals, signs and/or smells of vomiting, presence of wrappers or packages of laxatives or diuretics.
  • Excessive, rigid exercise regimen–despite weather, fatigue, illness, or injury, the compulsive need to “burn off” calories taken in.
  • Unusual swelling of the cheeks or jaw area.
  • Calluses on the back of the hands and knuckles from self-induced vomiting.
  • Discoloration or staining of the teeth.
  • Creation of lifestyle schedules or rituals to make time for binge-and-purge sessions.
  • Withdrawal from usual friends and activities.
  • In general, behaviors and attitudes indicating that weight loss, dieting, and control of food are becoming primary concerns.
  • Continued exercise despite injury; overuse injuries.

Treatment For Bulimia

The ECRI institute defines the levels of care for bulimia in the terms listed below. They urge you to understand the terms used to describe the treatment setting because insurance benefits are frequently tied not only to a patient’s diagnosis, but also to the type of treatment setting and level of care. A treatment program may be in a hospital, a residential treatment center, or a private office setting. The levels of care may consist of:

  • short-term inpatient care
  • partial inpatient care
  • intensive outpatient care (by day or evening)
  • outpatient care

According to the ECRI Institute, acute inpatient or partial hospitalization may be necessary when a patient is medically or psychiatrically unstable. Once a patient is medically stable, he or she is discharged from a hospital, and ongoing care is typically delivered at a residential treatment center. The level of care in such a center may progress from full-time inpatient, partial inpatient, intensive outpatient by day or evening, to outpatient.

There are also centers that operate only as outpatient centers. Outpatient psychotherapy and medical follow-up may also be available in a private office setting. The treatment setting and level of care should complement the general goals of treatment for bulimia nervosa. Generally, the goals are:

  • To medically stabilize the patient
  • Help the patient to stop binge eating and purging/non-purging behaviors
  • Address and resolve any co-existing mental health problems that may be triggering the behavior

Outpatient Treatment for Bulimia

If outpatient care is your preference, due to location convenience, or financial limitations, the patient must meet certain standards:

  • Patient is medically stable
  • No longer needs daily medical monitoring
  • Patient is psychiatrically stable
  • Symptoms are under sufficient control to be able to function in normal social, educational, or vocational situations and continue to make progress in recovery

Outpatient treatment for bulimia may be recommended when the patient is recovering and making a transition back to daily life, but still needs structure to continue the healing process. Some eating disorder treatment programs provide additional care options that can be included as part of a personalized treatment plan. Support groups may help a patient maintain mental health resilience and prevent relapse after discharge from a more intensive program. Outpatient care may also be an option for recovering clients that have relapsed and feel they need additional help.

An effective outpatient treatment program may offer:

  • hands-on practical training for nutrition
  • daily meal supervision and support
  • individual therapy
  • family therapy
  • group therapy
  • creative therapies or activities
  • support groups for families and loved ones
  • support groups for clients in recovery

At a leading eating disorder treatment center, the experienced professionals on a multi-disciplinary care team for outpatient treatment for bulimia nervosa may include:

  • Primary care physician (family doctor, internal medicine doctor, pediatrician, gynecologist)
  • Psychiatrist
  • Nutritionist
  • Clinical psychologist
  • Psychopharmacologist (psychiatrist, clinical psychologist, pharmacologist with special knowledge about medications used for mental disorders)
  • Social worker
  • Claims advocate for reimbursement
  • Counselors or other trained professionals that administer supplemental services such as music, movement, yoga, or art therapy


ED advocate and author June Alexander likens recovery from bulimia to riding a bicycle: “At first, it is wobbly, dangerous, and difficult,” she told NEDA. “Taking both feet off the ground and pushing on the pedals in a bid to move forward is plain scary. Time and repeated efforts are necessary to develop a sense of trust and balance. Only when we achieve this do we start to feel safe and secure; slowly we feel confident enough to start looking around, engaging in life, and accelerate our progress.”

Need More Information?

If someone you love suffers from bulimia, anorexia, or binge eating disorder, Center for Discovery can help. Our effective cutting edge approach to behavior modification is personalized and tailored to fit your needs. For more information, call us now at 800.760.3934. We’ve been helping families find their way to recovery and lifelong healing for nearly 20 years. Call today and speak with one of our highly trained admission specialists. Or click on the link below for a FREE assessment or virtual tour to see the treatment center closest to you. All calls are completely FREE and strictly confidential.

Call Us Now at 800.760.3934

Center for Discovery provides advanced, integrated multifaceted methods of care that range from residential treatment, intensive outpatient programs, to partial hospitalization programs for adults, adolescents, and teens that are struggling with anorexia, bulimia, binge eating disorder, depression, anxiety disorders, bipolar disorder, and most major mental health disorders.




NEDA: Breaking Free from the Illness that Hides – Bulimia Nervosa, by June Alexander. Retrieved December 28, 2016.

BulimiaGuide.org: Bulimia Nervosa Resource Guide. Retrieved December 28, 2016.

NEDA: Signs of bulimia nervosa. Retrieved December 28, 2016.

NEDA: Recovery – It’s Like Learning to Ride a Bicycle, By June Alexander. Retrieved December 28, 2016.