Choosing Between Inpatient and Outpatient for Bulimia Treatment

The binges and purges that characterize bulimia can devastate a person’s life.

Even so, many people with bulimia go to great lengths to keep their disorder under wraps. In fact, according to Psychology Today, many people with bulimia keep their symptoms completely hidden until they reach their 30s or 40s.

Living with an eating disorder for years or even decades can complicate the recovery process. Someone like this has many habits that have been laid down and solidified through routines that have been repeated over and over again. Someone like this might walk into treatment with physical and psychological wounds that are incredibly deep, and that may take a long time of intensive work to heal.

But some people who have bulimia are not adept at hiding their disordered behaviors. These people might be pulled into treatment programs within just a few days or weeks of initiating the behavior. These people need help, but they may not need significant, intensive help.

Do these people need the same program? Of course not. Thankfully, they do not need to enroll in the same program.

There are two types of programs for bulimia treatment: inpatient and outpatient. While one might be right for some types of people with bulimia, the other might be best for different types of people with bulimia. Read on to find out which type of care is recommended for which class of people.

Outpatient Care

outpatient care An outpatient program for bulimia provides people with counseling, medication support, and/or ancillary services (like exercise and nutrition counseling), while people continue to live at home. People in an outpatient program do not need to move into the facility in which they will get care. Instead, they can continue to live at home, as long as they keep their treatment appointments.

This form of care is typically suggested for people with mild or new cases of bulimia. People like this need help in order to get better, but they may not have such intense symptoms that they require the assistance of a staff that is available around the clock. These people may be able to stay healthy and on track, even while they are living at home.

People in an outpatient program might rely on their family members for help, and according to the National Alliance on Mental Illness, these concerned family members can be an amazing source of support for someone with bulimia. These people will need to have an abundance of both patience and kindness, and they’ll need to focus on providing assistance that is nonjudgmental. But when that community of people surrounds someone with bulimia, it makes sense to tap into the help by enrolling in outpatient care.
An outpatient program might also be a good choice for people who have reliable transportation and/or who live close to the treatment center in which they will be receiving care. Enrolling in outpatient means going to each and every appointment, without missing even one, and that can be hard for people who do not have the means to travel regularly. If people live close enough to treatment and/or they can get to appointments easily, outpatient programs might work.

Outpatient programs can be a good option for people who work, and who get a great deal of satisfaction from the work they do.

Holding down a job provides some people with a real sense of accomplishment, especially since that job helps them to pay for the things their families need in order to stay healthy, happy, and fed. People who might be devastated to leave a job, even for the short time it might take to begin to recover from bulimia, might do better in an outpatient program, as they may still be able to work while they recover.

The National Eating Disorders Alliance reports that many people with eating disorders respond well to outpatient therapy. They get the care they need in these programs, and they gain the control they have been looking for, but these programs are not right for everyone.


When Inpatient Care Is Best

treatment infoPeople with longstanding cases of bulimia might do a little better in inpatient programs. That might be due, in part, to the severe medical consequences this eating disorder can cause.

According to the National Health Service in the United Kingdom, bulimia can cause some health issues that could be severe, including:

  • Sore throat due to excessive vomiting
  • Swollen saliva glands
  • Kidney damage
  • Muscle spasms
  • Permanent constipation
  • Heart damage

Some of these medical problems can be addressed with proper care. For example, kidney damage associated with bulimia is sparked, in part, by chemical imbalances caused by the excessive use of laxatives and vomiting. Those chemical imbalances could be addressed through diet, medications, or both.

People with bulimia may need these lifesaving interventions. If they do, it might be best to get those interventions within the walls of an inpatient treatment program.

Getting better also means steering clear of some very serious and persistent bulimia relapse triggers. Sometimes, those triggers can be lurking around every corner of a traditional American home.

For example, Mayo Clinic suggests that people working to overcome a bulimia issue will need to attend to issues of exercise. Many people with bulimia use exercise as a way to prompt weight loss, and as they recover, they may need to stop exercising altogether, or they may need to work with a trainer or some other professional, so they do not slip back into bulimia habits.

Someone living at home might be forced to walk by exercise equipment each and every day. Rowing machines, bicycles, and jump ropes might be a constant temptation, and they might be readily available within the home. Even a computer could be a temptation, as an exercise routine could be just a click away.

These sorts of temptations are just not available within a treatment program. The designers of these therapeutic programs work hard to ensure that there are no open triggers for people to slip and trip on. It can be a safer choice for people who face many triggers at home, or for people who do not have the willpower to handle the triggers they face at home.

Clinicians may also suggest, according to documents released by Priority Health, that people get inpatient care if they have lost a great deal of weight. A loss of weight of more than 15 percent of bodyweight in one month (if the person meets the criteria for obesity) could suggest that this person is using dangerous methods in order to lose weight. That might suggest that inpatient care is needed.Finally, some people need inpatient care due to severe psychiatric stress caused by bulimia. An article in American Family Physician suggests that some people with bulimia could become so upset and so distressed that they exhibit behaviors associated with suicide. They may talk about ending their lives, or they may talk about what the world would be like if they weren’t forced to live in it. That sort of talk is generally considered to be a medical crisis, and someone who discusses things in this manner might need inpatient help in order to stay safe.

This is not, by any means, an exhaustive list of everyone who needs inpatient care. The reasons for enrolling in an intensive program like this can be very personal, and they can be hard to explain to outsiders. Someone who simply feels unable to handle the demands of outside life and bulimia might do well to enroll in inpatient care, even if that sort of care isn’t typically recommended for people like that. The goal is healing, and people should use whatever means they think of as necessary in order to achieve that very real goal.


Continued Care

When people choose a treatment provider, they may find that they need to shift strategies in time. Someone who enrolled in outpatient care may find that all of the freedom these programs provide allows for too many relapse opportunities. Or, conversely, someone in an inpatient program may do so well in therapy and make such great strides that an outpatient program seems like the best place for continued care.

But regardless of what setting people choose, and regardless of the path to healing that choice might dictate, people who have bulimia might need to enroll in some form of care that lasts for years. According to Mayo Clinic, managing an eating disorder means doing a great deal of work over a long period of time. It is not a task someone might be able to complete in just a day or two. By enrolling in the right form of care at the start of treatment, people might ensure that they learn the right lessons early in recovery, and that might smooth the path to long-term success.

Reputable providers can help, too, by providing people with ongoing care through alumni meetings, support group meetings, and touchup counseling sessions. Remaining connected to care in this way, even when formal treatment ends, could help people to handle the new challenges that appear as their lives change in recovery.

Disclaimer: Facilities in the American Addiction Centers family do not treat bulimia directly, but if you come to us for another issue, we can refer you to programs that can help.

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