Residential treatment for bulimia: Did it help you?
September 21, 2015 12:17 PM Subscribe
A reticent doctor doesn't want to refer me to residential treatment for my bulimia, claiming that bulimic patients are not usually treated this way, and arguing that it's nothing more than expensive housing. Did it help you?
Without going into my full medical history and back-and-forth with this doctor, my insurance is through Kaiser Permanente and the psych social worker who is my case manager also runs their eating disorder program for this county, and is also my therapist. I can't get into a residential treatment program or intensive outpatient program outside of Kaiser without his referral.
The in-network program consists mostly of support groups twice a week, a food plan with a nutritionist (otherwise unsupervised except for my weekly appt. to tell my doc how I'm doing with it) and twice-a-week CBT classes which aren't progressive -- meaning the doc repeats the same spiel every class.
I have not found it helpful and frankly it feels like a way to take up my time and keep me from complaining.
I've had bulimia for four years and recently took a medical leave to seek treatment. At this point I am not doing the worst I ever have, and that's why I'm seeking help now, because I feel strong enough to. But I do feel very fragile and hopeless.
Kaiser wants patients to try every lower level of treatment and fail before trying more costly forms -- and it makes me feel like I have to get a lot worse in order to get any help. This doc in question told me he typically only refers very medically fragile anorexic patients.
Anyway, the point is, I am fairly certain he doesn't want to refer me because of the cost but he keep arguing that it won't help me anyway, and I sort of need reassurance and to hear how it might have helped other bulimic patients in order to keep up my resolve and resilience while I push for better treatment.
If you went to residential treatment, how did your doc. approach the situation? What did you do in treatment? What was it like getting out and how was life afterward?
If your program was less than helpful, why?
Thanks a bunch.
Without going into my full medical history and back-and-forth with this doctor, my insurance is through Kaiser Permanente and the psych social worker who is my case manager also runs their eating disorder program for this county, and is also my therapist. I can't get into a residential treatment program or intensive outpatient program outside of Kaiser without his referral.
The in-network program consists mostly of support groups twice a week, a food plan with a nutritionist (otherwise unsupervised except for my weekly appt. to tell my doc how I'm doing with it) and twice-a-week CBT classes which aren't progressive -- meaning the doc repeats the same spiel every class.
I have not found it helpful and frankly it feels like a way to take up my time and keep me from complaining.
I've had bulimia for four years and recently took a medical leave to seek treatment. At this point I am not doing the worst I ever have, and that's why I'm seeking help now, because I feel strong enough to. But I do feel very fragile and hopeless.
Kaiser wants patients to try every lower level of treatment and fail before trying more costly forms -- and it makes me feel like I have to get a lot worse in order to get any help. This doc in question told me he typically only refers very medically fragile anorexic patients.
Anyway, the point is, I am fairly certain he doesn't want to refer me because of the cost but he keep arguing that it won't help me anyway, and I sort of need reassurance and to hear how it might have helped other bulimic patients in order to keep up my resolve and resilience while I push for better treatment.
If you went to residential treatment, how did your doc. approach the situation? What did you do in treatment? What was it like getting out and how was life afterward?
If your program was less than helpful, why?
Thanks a bunch.
I did two inpatient stays for bulimia around five years ago through UCLA's adult eating disorder program (the adult inpatient program is unfortunately now closed, but I think the intensive outpatient program is still open).
It's not exactly the same as a residential program, but I think it's similar enough. I had a five week stay in the inpatient program, then around six weeks in the intensive outpatient program (which they call a partial hospitalization program - it was six days a week, from before breakfast to after dinner). Unfortunately I relapsed very soon after leaving, and went back for six weeks inpatient plus about six or seven weeks in the intensive outpatient program. I then moved to a less intensive program. I am happy to say that I have been doing well since - I would still consider myself in recovery to some extent, but I haven't had any major eating disordered behaviors since the second time through, with a few minor slip ups.
I don't think I would have recovered if my only option had been outpatient treatment (though I think residential treatment would have been fine - I was medically stable & didn't actually need a hospital setting). I needed to be in a setting where my access to food was 100% controlled and my ability to purge was basically eliminated. Living at home, I wasn't eating enough / couldn't make myself eat enough to stop binging, and if I binged, I couldn't stop myself from purging. I tried to recover for years before going inpatient, and I was not able to make significant progress.
We actually had a patient or two from Kaiser when I was in the UCLA program, but they were all medically unstable and/or drastically underweight - Kaiser does try to push people into a lower level of care than they actually need.
Please feel free to memail me if you'd like more information about my experience. I also have a really excellent therapist and previously worked with a really excellent nutritionist if you'd like their contact information, though I don't think either of them would be covered by Kaiser.
posted by puppetshow at 1:59 PM on September 21, 2015 [3 favorites]
It's not exactly the same as a residential program, but I think it's similar enough. I had a five week stay in the inpatient program, then around six weeks in the intensive outpatient program (which they call a partial hospitalization program - it was six days a week, from before breakfast to after dinner). Unfortunately I relapsed very soon after leaving, and went back for six weeks inpatient plus about six or seven weeks in the intensive outpatient program. I then moved to a less intensive program. I am happy to say that I have been doing well since - I would still consider myself in recovery to some extent, but I haven't had any major eating disordered behaviors since the second time through, with a few minor slip ups.
I don't think I would have recovered if my only option had been outpatient treatment (though I think residential treatment would have been fine - I was medically stable & didn't actually need a hospital setting). I needed to be in a setting where my access to food was 100% controlled and my ability to purge was basically eliminated. Living at home, I wasn't eating enough / couldn't make myself eat enough to stop binging, and if I binged, I couldn't stop myself from purging. I tried to recover for years before going inpatient, and I was not able to make significant progress.
We actually had a patient or two from Kaiser when I was in the UCLA program, but they were all medically unstable and/or drastically underweight - Kaiser does try to push people into a lower level of care than they actually need.
Please feel free to memail me if you'd like more information about my experience. I also have a really excellent therapist and previously worked with a really excellent nutritionist if you'd like their contact information, though I don't think either of them would be covered by Kaiser.
posted by puppetshow at 1:59 PM on September 21, 2015 [3 favorites]
Anecdotal information from the Internet is not likely to sway your doctor's opinion, but scientific literature might.
I searched for you in Medline and found a small number of relevant articles. Much of the research in this area is done in anorexia and not bulimia, so the articles that do discuss bulimia frequently cover both anorexia and bulimia. Also note that most of the research in this area is done with women.
Brewerton, T. D., & Costin, C. (2011). Treatment results of anorexia nervosa and bulimia nervosa in a residential treatment program. Brunner-Mazel Eating Disorders Monograph Series, 19(2), 117–131. http://dx.doi.org/10.1080/10640266.2011.551629
A survey study over 10 years with patients who had been in residential treatment for over 30 days at one facility; 75% of bulimia nervosa patients had long-lasting significant improvements in depression, eating disorder inventories, and in frequencies of binging and purging. Best predictor of long-term recovery was cessation of bulimic symptoms upon discharge from the residential program.
Frisch, M. J., Herzog, D. B., & Franko, D. L. (2006). Residential treatment for eating disorders. Journal of Eating Disorders, 39(5), 434–442.
National survey of 22 residential eating disorder programs. Average length of stay of treatment was 83 days and cost $956 a day. Residential treatment is growing but is not regulated well, so future research must show how to quantify treatment effectiveness.
Hartmann, A., Orlinsky, D., Weber, S., Sandholz, A., & Zeeck, A. (2010). Session and intersession experience related to treatment outcome in bulimia nervosa. Psychotherapy: Theory, Research, Practice, Training, 47(3), 355–370. http://doi.org/10.1037/a0021166
This article suggests that therapy-related intersession experiences - as in, how people process what they learned in therapy in between sessions - is the best predictor of effectiveness. Uses data from Zeeck et al.'s RCT cited below.
Hoffart, A., Lysebo, H., Sommerfeldt, B., & Ro, O. (2010). Change processes in residential cognitive therapy for bulimia nervosa. European Eating Disorders Review, 18(5), 367–375. http://dx.doi.org/10.1002/erv.980
This article indicates several potential variables that residential programs should pinpoint, including self-efficacy, distorted beliefs, and negative and positive affect; these variables were all found to have significant effects on variations in treatment efficacy in 39 patients diagnosed with bulimia in inpatient treatment.
Zeeck, A., Weber, S., Sandholz, A., Wetzler-Burmeister, E., Wirsching, M., & Hartmann, A. (2009). Inpatient versus day clinic treatment for bulimia nervosa: a randomized trial. Psychotherapy and Psychosomatics, 78(3), 152–160. http://dx.doi.org/10.1159/000206869
Randomized controlled trial comparing inpatient vs. day clinic treatment for bulimia. 22 day clinic patients and 21 inpatients; both groups experiences significant reduction of general and specific pathology after treatment. Immediately following discharge there was more success with inpatient treatment, but the difference was not statistically significant after a three-month follow-up.
Zeeck, A., Weber, S., Sandholz, A., Joos, A., & Hartmann, A. (2011). Stability of long-term outcome in bulimia nervosa: a 3-year follow-up. Journal of Clinical Psychology, 67(3), 318–327. http://doi.org/10.1002/jclp.20766
Three year follow up to the above article indicates that both day clinic and inpatient treatments are effective long-term, and that most changes occur during treatment.
My basic take from this is: in-patient residential treatments, if they are well-designed, work - but so do day clinic treatments, again, if they are well-designed and aim to treat important variables that predict success like self-efficacy, affect, and distorted beliefs. If what you are trying now is not working, that is an indicator that switching to a different option might be right for you. You might want to bring some of these articles in to your doctor to speak about this with them. If you need access to any of the above articles for scientific purposes, please let me know and I am happy to send them along.
Take care.
posted by sockermom at 3:49 PM on September 21, 2015 [7 favorites]
I searched for you in Medline and found a small number of relevant articles. Much of the research in this area is done in anorexia and not bulimia, so the articles that do discuss bulimia frequently cover both anorexia and bulimia. Also note that most of the research in this area is done with women.
Brewerton, T. D., & Costin, C. (2011). Treatment results of anorexia nervosa and bulimia nervosa in a residential treatment program. Brunner-Mazel Eating Disorders Monograph Series, 19(2), 117–131. http://dx.doi.org/10.1080/10640266.2011.551629
A survey study over 10 years with patients who had been in residential treatment for over 30 days at one facility; 75% of bulimia nervosa patients had long-lasting significant improvements in depression, eating disorder inventories, and in frequencies of binging and purging. Best predictor of long-term recovery was cessation of bulimic symptoms upon discharge from the residential program.
Frisch, M. J., Herzog, D. B., & Franko, D. L. (2006). Residential treatment for eating disorders. Journal of Eating Disorders, 39(5), 434–442.
National survey of 22 residential eating disorder programs. Average length of stay of treatment was 83 days and cost $956 a day. Residential treatment is growing but is not regulated well, so future research must show how to quantify treatment effectiveness.
Hartmann, A., Orlinsky, D., Weber, S., Sandholz, A., & Zeeck, A. (2010). Session and intersession experience related to treatment outcome in bulimia nervosa. Psychotherapy: Theory, Research, Practice, Training, 47(3), 355–370. http://doi.org/10.1037/a0021166
This article suggests that therapy-related intersession experiences - as in, how people process what they learned in therapy in between sessions - is the best predictor of effectiveness. Uses data from Zeeck et al.'s RCT cited below.
Hoffart, A., Lysebo, H., Sommerfeldt, B., & Ro, O. (2010). Change processes in residential cognitive therapy for bulimia nervosa. European Eating Disorders Review, 18(5), 367–375. http://dx.doi.org/10.1002/erv.980
This article indicates several potential variables that residential programs should pinpoint, including self-efficacy, distorted beliefs, and negative and positive affect; these variables were all found to have significant effects on variations in treatment efficacy in 39 patients diagnosed with bulimia in inpatient treatment.
Zeeck, A., Weber, S., Sandholz, A., Wetzler-Burmeister, E., Wirsching, M., & Hartmann, A. (2009). Inpatient versus day clinic treatment for bulimia nervosa: a randomized trial. Psychotherapy and Psychosomatics, 78(3), 152–160. http://dx.doi.org/10.1159/000206869
Randomized controlled trial comparing inpatient vs. day clinic treatment for bulimia. 22 day clinic patients and 21 inpatients; both groups experiences significant reduction of general and specific pathology after treatment. Immediately following discharge there was more success with inpatient treatment, but the difference was not statistically significant after a three-month follow-up.
Zeeck, A., Weber, S., Sandholz, A., Joos, A., & Hartmann, A. (2011). Stability of long-term outcome in bulimia nervosa: a 3-year follow-up. Journal of Clinical Psychology, 67(3), 318–327. http://doi.org/10.1002/jclp.20766
Three year follow up to the above article indicates that both day clinic and inpatient treatments are effective long-term, and that most changes occur during treatment.
My basic take from this is: in-patient residential treatments, if they are well-designed, work - but so do day clinic treatments, again, if they are well-designed and aim to treat important variables that predict success like self-efficacy, affect, and distorted beliefs. If what you are trying now is not working, that is an indicator that switching to a different option might be right for you. You might want to bring some of these articles in to your doctor to speak about this with them. If you need access to any of the above articles for scientific purposes, please let me know and I am happy to send them along.
Take care.
posted by sockermom at 3:49 PM on September 21, 2015 [7 favorites]
Response by poster: Thanks sockermom for the research!
I am definitely still looking for anecdotal experiences, for the sake of my own morale.
posted by mmmleaf at 6:02 PM on September 21, 2015
I am definitely still looking for anecdotal experiences, for the sake of my own morale.
posted by mmmleaf at 6:02 PM on September 21, 2015
I did a residential program (as a young person, which may be different from doing it as an adult) and the parts that I found helpful did not balance out the parts that I found unhelpful. It felt good to have intensive therapy and get away from my life stressors so I could focus on treatment. On the other hand, the social environment was not supportive--putting a group of eating disordered adolescents together led to a very competitive environment, as if there was some prize for who could be most sick, or most successfully manipulative, etc. And because I did this work in a "bubble" outside of my normal life, I had a very difficult time maintaining my good habits once I was returned to my normal life. I relapsed approximately 4 months after leaving inpatient care--I went right back to all the problems I had before, because I had done internal work, but no work on rearranging my life for recovery. In retrospect, I think I would have recovered more slowly, but maybe more fully, if I had done that work in my regular life and dealt with the parts of my life (at home, at school, with friends, hobbies) that were triggering my poor coping.
There is a blog I like that has done a couple of round-ups of peer-reviewed research on the effectiveness of residential treatment. It is written by people with ED experience so they have a different take than you might find elsewhere. The comments are interesting too. See this post, this post, and this one on relevant topics.
posted by epanalepsis at 7:08 AM on September 22, 2015 [3 favorites]
There is a blog I like that has done a couple of round-ups of peer-reviewed research on the effectiveness of residential treatment. It is written by people with ED experience so they have a different take than you might find elsewhere. The comments are interesting too. See this post, this post, and this one on relevant topics.
posted by epanalepsis at 7:08 AM on September 22, 2015 [3 favorites]
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If you've had good experiences with intensive outpatient programs I would love to hear about those too.
Also, I'm in Southern California.
posted by mmmleaf at 12:19 PM on September 21, 2015