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Types of treatment settings and levels of care
Knowing the terms used to describe the treatment setting is important because insurance benefits are tied not only to a patient's diagnosis, but also to the type of treatment setting and level of care.

There are several types of treatment centers and levels of care for treating bulimia nervosa. Knowing the terms used to describe these is important because insurance benefits (and the duration of benefits) are tied not only to a patient's diagnosis, but also to the type of treatment setting and level of care.

Treatment is delivered in hospitals, residential treatment facilities, and private office settings. Levels of care consist of acute short-term inpatient care, partial inpatient care, intensive outpatient care (by day or evening) and outpatient care. Acute inpatient hospitalization is necessary when a patient is medically or psychiatrically unstable. Once a patient is medically stable, s/he is discharged from a hospital, and ongoing care is typically delivered at a sub-acute care residential treatment facility. The level of care in such a facility can be full-time inpatient, partial inpatient, intensive outpatient by day or evening, and outpatient. There are also facilities that operate only as outpatient facilities. Outpatient psychotherapy and medical follow-up may also be delivered in a private office setting.

The treatment setting and level of care should complement the general goals of treatment for bulimia nervosa. Generally, 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
Patients with severe symptoms often begin treatment as inpatients and move to less intensive programs as symptoms subside. Hospitalization may be required for complications of the disorder, such as electrolyte imbalances, irregular heart rhythm, dehydration, severe underweight (although most people with bulimia nervosa are not underweight), or acute life-threatening mental breakdown. Partial hospitalization may be required when the patient is medically stable, and not a threat to himself, herself or others, but still needs structure to continue the healing process. Partial hospitalization programs last between 3 and 12 hours per day, depending on the patient's needs.

Psychotherapy and drug therapy are available in all the care settings. Many settings provide additional care options that can be included as part of a tailored treatment plan. Support groups may help a patient to maintain good mental health and may prevent relapse after discharge from a more intensive program.

The intensity and duration of treatment depends on:

  • Insurance coverage limits and ability to pay for treatment
  • Severity and duration of the disorder
  • Mental health status
  • Co-existing medical or psychological disorders
A health professional on the treatment team will make treatment recommendations after examining and consulting with the patient.

Criteria for Treatment Setting and Levels of Care*

Inpatient

Patient is medically unstable as determined by:

  • Unstable or depressed vital signs
  • Laboratory findings presenting acute health risk
  • Complications due to coexisting medical problems such as diabetes
Patient is psychiatrically unstable as determined by:
  • Rapidly worsening symptoms
  • Suicidal and unable to contract for safety
Residential

Patient is medically stable and requires no intensive medical intervention.

Patient is psychiatrically impaired and unable to respond to partial hospital or outpatient treatment.

Partial Hospital

Patient is medically stable but:

  • Eating disorder impairs functioning, but without immediate risk
  • Needs daily assessment of physiological and mental status
Patient is psychiatrically stable but:
  • Unable to function in normal social, educational, or vocational situations
  • Engages in daily binge eating, purging, fasting or very limited food intake, or other pathogenic weight control techniques
Intensive Outpatient/Outpatient

Patient is medically stable and:

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

*These criteria summarize typical medical necessity criteria for treatment of eating disorders used by many healthcare facilities, eating disorder specialists, and health plans for determining level of care needed.



  
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Bulimia nervosa is an eating disorder in which a person engages in binge eating (eating a lot of food in a short time) followed by some type of behavior to prevent weight gain from the food that was eaten. This behavior can take two forms: self-induced vomiting, misuse of enemas, laxatives, diet pills (called purging) and excessive exercise, fasting, or diabetic omission of insulin (called non-purging). Some people with bulimia nervosa may also starve themselves for periods of time before binge eating again. Bulimia nervosa has important mental, emotional, and physical aspects that require consideration during treatment.

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