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In an age where the coronavirus has upended everyone’s life, bulimia nervosa is every parent’s additional nightmare – a life-threatening disorder that endangers their child’s life, requires intensive treatment and sets them back academically while they enter a residential program.  Bulimia nervosa is a dangerous mental health disorder that affects about 1.5 percent of women in America at some point in their lives. It also tends to first appear and worsen during adolescence, which puts the concepts of academics, socialization, and personality development at greater risk. Especially when it comes to schoolwork, an eating disorder that takes 30 days or more can set them back if there isn’t a program in place to continue education at the bulimia nervosa treatment facility.

That’s why any residential bulimia nervosa treatment program worth its salt will have anacademic component – to keep the client apace at school while saving their life with the eating disorder program. In 2022, it’s even more important that they also offer a virtual component for day treatment. If school time is interrupted by day treatment programs, or the client lives in an area where virtual schooling is not an option, the treatment program might be able to pick up some of the slack.

Additionally, treatment for bulimia nervosa and other eating disorders often includes education about nutrition, meal planning, and emotional coping mechanisms that aren’t taught in schools. To foster a long-lasting recovery, education supplements therapy, and behavior modification – without it, the hard work that’s gone into recovery can succumb to relapses.

Before committing to bulimia nervosa treatment, educational program or not, there needs to be a clear need for it. Let’s take a look at the signs and symptoms of this dangerous eating disorder.

What Are the Signs Bulimia Nervosa Treatment Is Necessary?

The first symptoms of bulimia nervosa (and other eating disorders) normally first appear in mid-to-late adolescence – that is, from age 13 to 18. It’s a severe and medically dangerous behavioral health disorder, following only anorexia nervosa in terms of the death rate among eating disorders. The behaviors that define bulimia nervosa are well-defined by the DSM-V; a person with the disorder will binge eat regularly and then purge that food to remove the calories taken in during the binge eating episodes. The purging behavior is usually self-induced vomiting, but it can also appear as excessive exercising or abuse of medicines like laxatives or diuretics. Before the binge-and-purge eating disorder behavior begins, there are several warning signs of bulimia nervosa to be aware of in children:

  • Preoccupation with weight and body size
  • Engaging in dieting early and frequently
  • Distorted or negative body image (often perceiving themselves as overweight)
  • Eating only certain types of food (no carbs, etc.)
  • Developing food rituals (moving food around on the plate, etc.)

While none of these behavioral symptoms is a guarantee that bulimia nervosa is present, when added to one another they present a warning sign of a potential problem. These symptoms must be addressed sooner rather than later by a professional.

These initial warning signs can lead to a full-blown case of BN if they are left untreated. Bulimia nervosa signs and symptoms include:

  • Repeated and compulsive binge eating episodes
    • Consuming a large amount of food in a short period
    • Experiencing feelings of guilt and shame afterward
    • Secretive behavior and frequent dieting
  • Purging behavior following the binge eating episodes
    • The most common is self-induced vomiting; be aware of frequent trips to the bathroom (especially after meals) and the sounds and smells of vomit
    • Using purging drugs like laxatives – check for pillboxes in the trash
    • Excessive exercise – burning calories after a meal, even past the point of pain or discomfort
  • Distorted body image and low self-esteem
    • People with bulimia nervosa tend to think they are fat or overweight, even if the opposite is true
    • Sense of shame or dislike of their body

If I Put My Child in Residential Bulimia Nervosa Treatment, Won’t They Fall Behind?

Especially in an era when schools are closed and academics are harder than ever to maintain, taking 30 to 90 days off from school can cause all kinds of setbacks, even with distance learning. Taking what amounts to an entire semester off from school can hinder a child’s educational and psychosocial development. Not only can the backlog of schoolwork become insurmountable after an extended absence, but preparation for pre-scheduled events like the SATs or college applications can also be difficult. Especially in the high school years, it is essential for parents seeking bulimia nervosa treatment to find an eating disorder treatment center that focuses on bulimia nervosa but also makes academic integration a part of the program.

The best residential eating disorder treatment programs for adolescents will provide several avenues to continue their clients’ educations, especially in the middle school to high school years. To avoid interruption of their existing curriculum, they normally coordinate the student’s homework and reading assignments with their regular school and teachers.These professionals can help keep the client on track academically. As important as staying current with the curriculum is, the school’s staff can also guide the client towards study guides for academic tests like the SAT, ACT, and AP exams. Although these are not the be-all, end-all to college admission as they used to be, they remain crucial benchmarks for admissions panels.

Coordination with the client’s school is not the only measure treatment centers take to ensure academic achievement. The residential program should also include regular daily study and lesson time. A few hours daily being set aside for schoolwork can help stay current as well as add sorely needed structure. Normally,each day in residential eating disorder treatment is highly structured, with meals, therapy, and mindful movement activities becoming routine. However, the staff is not usually trained as educational professionals. Therefore, if possible, they should have certified teachers and tutors on-site to make sure the education isn’t self-guided, but instead remains the highest quality. If not, the possibility of referring out to trained educators and tutors is recommended.

Day Treatment Has Virtual Options

The traditional model in day treatment (sometimes known in specific circumstances as outpatient treatment) is for the client to visit a facility daily or several times a week to receive therapy and other components of eating disorder treatment. Normally, this happens after school or on weekends, and it’s proven effective as both a primary option and as a step-down measure from residential treatment. However, ever since the social distancing necessitated by COVID-19, this model has been changed. In-person visits are more difficult to schedule and certain activities like group therapy have been restricted.

Although these problems have hampered residential treatment admissions as well, they have made day treatment a less-available option for many. Thankfully, the COVID-19 crisis has foregrounded the telehealth option, in all medical fields, especially in mental health treatment. Many of the treatment techniques (although certainly not all) can be effectively done via Zoom or another teleconferencing app.

For example, group therapy sessions are difficult to do in person with social distancing regulations in place. Unlike residential treatment centers, where new admissions quarantine before entering the milieu, day treatment group therapy sessions require people to come together from disparate locations. With unclear information about vaccinations, masks, etc., it’s difficult to ensure no one in the group will risk spreading the virus. Virtual sessions eliminate this possibility. The therapist can still manage the group as before, and each member can participate from home.

Individual sessions are even easier to arrange via teleconference. Many types of therapy used in eating disorder treatment are based on a one-on-one dynamic between the client and the therapist. These include traditional psychotherapy as well as behavior modification techniques like Cognitive Behavioral Therapy (CBT) or Cognitive Processing Therapy (CPT). Both are highly structured and performed in repeated sessions that are identical whether in person or online.

Virtual Day Treatment Also Takes Education Into Account

Perhaps the largest societal change the coronavirus and its many variants have forced on us is the disruption of normal school routines. Each township has different rules in place, and even some schools in the same area follow separate protocols. When most if not all schools were closed in the spring of 2020, many parents pivoted to a virtual school model. Others chose homeschooling options. In either case, regular schooling was disrupted.

In the past, eating disorder day treatment programs put less of a premium on education than residential programs, because the clients were most likely attending school at the same time as receiving treatment. With virtual education taking prominence, most eating disorder treatment centers have slightly altered their approach. The new focus is on supplementing home school or virtual curriculums and making sure the client’s education is not interrupted. Of course, a bulimia nervosa treatment program can’t replace a school’s curriculum. Instead, the program is likely to coordinate with the school or educator’s planning and ensure no school time is being interrupted by treatment sessions.

As for nutritional education and meal planning, virtual options are every bit as useful as in-person ones. Dieticians and nutritionists can consult as easily with clients as therapists can, and nutrition education lends itself to in-home instruction – after all, that’s where the kitchen is.

Look for a Treatment Center That Offers Education and Virtual Programs

Aside from the life-saving necessity of treatment when an eating disorder is present, building academic coursework into the treatment process is an important way to create an “approximating” challenge to help the adolescent and family prepare for the demands of life at home and school. It helps preserve a recovered life and freedom from disordered eating. When researching how to help a loved one get treatment, make sure their educational process is in line with your child’s educational goals.


Melissa Spann, PhD, LMHC, CEDS-S

Melissa Orshan Spann, PhD, LMHC, RTY 200, is Chief Clinical Officer at Monte Nido & Affiliates, overseeing the clinical operations and programming for over 50 programs across the U.S. Dr. Spann is a Certified Eating Disorder Specialist and clinical supervisor as well as an accomplished presenter and passionate clinician who has spent her career working in the eating disorder field in higher levels of care. She is a member of the Academy for Eating Disorders and the International Association of Eating Disorder Professionals where she serves on the national certification committee, supervision faculty, and is on the board of her local chapter. She received her doctoral degree from Drexel University, master’s degree from the University of Miami, and bachelor’s degree from the University of Florida.