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How do I find a suitable treatment setting?

Several considerations enter into finding a suitable treatment setting for the patient. Options may be limited by the patient's available insurance coverage, by whether or not a particular center or therapist accepts insurance, and by the ability of the patient to pay in the absence of insurance. Primary care physicians (family doctor, gynecologist, pediatrician, internal medicine doctor) can often play a valuable advisory role in referring patients for treatment because they may have experience with various centers or outpatient therapists.

We surveyed eating disorder centers nationwide about their treatment philosophies for bulimia nervosa, their treatment approach, whether they accept insurance, their staffing model, and the clinical and support services they offer. Profiles of more than 100 inpatient and outpatient centers are in a searchable database.

Determining quality of care for bulimia

Determining the quality of care for bulimia at a center is difficult at this time. As of 2007, no organization yet exists to accredit eating disorder treatment centers specifically for their quality of care and ability to treat eating disorders. Efforts have been in the works for a few years now by clinical leaders within the national eating disorders community to carefully develop a process and independent organization for accrediting eating disorder centers and credentialing staff who work at those centers.

Another issue regarding quality of care is that much care is delivered on an outpatient basis. For individual psychotherapists or psychiatrists in private practice, no special credentialing or board certification exists for treatment of eating disorders, including bulimia nervosa. Efforts are ongoing to establish formal programs for focused training in eating disorders at a few academic institutions. At this time, however, any mental healthcare professional can offer to treat an eating disorder whether or not he or she has experience or training in this specific area. Therefore, it is important to ask a prospective therapist being considered to treat bulimia nervosa about his/her knowledge about eating disorders and years of experience treating them. Some important questions to ask a therapist are provided here in the check list Questions to Ask an Outpatient Therapist.

Other types of accreditation

One national organization, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), provides generic accreditation for healthcare facilities. Some eating disorder centers advertise "JCAHO accreditation." JCAHO accreditation addresses some general quality issues related to the facilities, but does not directly address bulimia-specific quality of care.

Other factors affecting access to care

For insured patients, the choice of treatment center is often dictated by the beneficiary's health insurance plan. Health insurers should provide a list of in-network (covered) treatment centers. If the treatment center is outside of the health insurer's system (out-of-network), the insurer might pay a percentage of the treatment costs leaving the patient responsible for the remainder. It is best to negotiate this percentage with the insurer before starting treatment. A small number of treatment centers offer financial assistance; but most do not. However, inquiring about treatment scholarships, as they are termed, may be worth investigating if the patient does not have financial resources or insurance. Click here for more information about treatment costs.

Costs aside, other factors may be important to the patient in selecting a treatment center: the treatment center's philosophy (or religious affiliation, if any), multidisciplinary approach to care, distance from home, staff/patient ratio, professional qualifications of staff, their experience in treating bulimia nervosa, adjunct therapies offered. Some treatment centers provide therapies in addition to psychiatric counseling and pharmacotherapy, like equine, massage, dance, or art therapy. These therapies may be appealing; although it is important to first make sure they're covered by health insurance or what fees the patient will be expected to pay out of pocket. Some important questions to ask treatment centers are provided in the check list Questions to Ask When Seeking a Treatment Center.

Also important in the considerations are the type of care team a facility typically uses. The chart below lists the types of professionals that are generally recommended to be on the care team to ensure well-rounded care. Once a treatment facility decision has been made, there is another check list of questions, Questions to Ask the Care Team, you may want to ask the care team.

Lastly, there are some questions a patient or family may want to ask the treatment facility and care team separately. See Questions Patients May Want to Ask Treatment Providers Privately and Questions Family/partners/friends May Want to Ask Treatment Providers Privately. Depending on the patient's age, you may need written permission to speak about the patient with a treatment facility or member of the care team. Please see Confidentiality Issues.

Professionals in a multi-disciplinary care team for bulimia nervosa

  • 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
  • Other professionals who administer supplemental services such as massage, yoga, exercise programs, art therapy

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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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