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When attending adolescent-dedicated bulimia nervosa treatment centers, a structured leveling system is crucial to long-term recovery. This type of treatment for anorexia and bulimia nervosa program helps individuals progressively set recovery goals and achieve them level by level. With the structured level system, the recovery professionals can keep the focus on setting goals, recognizing accomplishments, gaining privileges, and most importantly, taking personal responsibility for their actions.

This approach helps teens and adolescents at bulimia nervosa treatment centers near them or further away learn health-appropriate coping skills that can replace disordered thoughts and behaviors. Parents can explore the purpose and benefits of treatment programs with structured level systems to see if this option would work best for their teens and adolescents in need of care.

Treatment for Anorexia and Bulimia Nervosa Begins With Adolescents

Bulimia nervosa inpatient treatment is an extreme step to be sure. However, early intervention has been proven time and time again to be the most effective way to stem the development of eating disorders in general. With increasing levels of stress, peer pressure and media influence at that early age, eating disorders like anorexia and bulimia nervosa normally begins in late adolescence, with disordered behaviors manifesting on average at age 18. These behaviors can lead to the development of anorexia nervosa and bulimia, necessitating bulimia nervosa inpatient or outpatient treatment.

Over time, the disordered eating habits associated with binge eating disorder, bulimia nervosa or anorexia nervosa can start to result in substantial weight loss, growth restrictions and nutritional deficiencies. This can result in not only short term physical issues, but lifelong growth deficiencies and health consequences.

What Holds People With Bulimia Nervosa and Other Eating Disorders Back From Recovery

Eating disorders in adolescence and the teenage years can erect unique barriers to recovery. Because adolescents are still developing both in terms of their body and their personality and emotional growth, undergoing bulimia nervosa treatment, nearby or far away, can have long-lasting effects. Without a direct involvement in bulimia nervosa eating disorder treatment, for example, teens and adolescents may substitute disordered behaviors for healthy coping skills in reaction to poor self-image or anxiety.

Improper anorexia or bulimia nervosa eating disorder treatment practices can also act as a barrier to recovery. For the maximum level of efficacy, the care process needs to focus on a multidimensional approach that allows for emotional, spiritual, physical and mental recovery. Coexisting disorders (such as anxiety or OCD) and other underlying factors must also be addressed to facilitate a lifetime of being recovered from eating disorders.

What Is a Structured Recovery Model?

In a structured leveling system like the one we employ at Clementine, every individual in the program starts at the entry level to get used to the day to day reality of the program. This initial level introduces the treatment program and its expectations. Each level has clear goals to attempt, and when they are achieved, the individual can move on to the next level, which has increased responsibility and greater rewards.

At each level, teens and adolescents can utilize solo and group activities to improve their relationships with both their bodies and with food and eating. These cornerstones of inpatient bulimia nervosa treatment make their disorder a problem that can be overcome step by step instead of an insurmountable mountain they can never overcome.

Every week, adolescents and teens complete their contracts that track their objectives and accomplishments as they navigate the program. Beyond establishing great nutrition and eating habits, the objectives might revolve around addressing problems with mood and cognition, family relationships and education. As individuals in bulimia nervosa treatment near them begin to achieve entry level goals and come to grips with their unique issues, they will gain new privileges and responsibilities which inform their return to life after treatment.

Upon reaching the fourth, and final, level, teens and adolescents should have a strong understanding of eating disorders, including their risk factors and causes. Individuals at this level are prepared to transfer to a lower level of care for continued recovery from eating disorders in teens and adolescents.

What Are the Levels?

Clementine’s inpatient bulimia nervosa treatment and other eating disorder programs include five levels. These were each developed over time to instill a pattern of sustained growth and mindfulness in each of our clients.

Entry Level

At the entry level, teens and adolescents learn about the daily schedule and programs at the center. They’ll meet the professional therapists, doctors, psychiatrists, and nurses that make up their care team. A close working relationship with the team and the client helps to promote great treatment outcomes, as we’ve observed over and over again. During the entry level period, several assessments will be performed to lay out the unique needs of each client and to design an individual bulimia eating disorder treatment program. The assessments look at the specific individual and family needs of the teens and adolescents enrolled in the treatment program.


The first priority when the leveling system is stabilization. Individuals in care will first have their physical and medical safety ensured, especially in severe cases where self-harm or malnutrition is a risk. Caregivers will help teens and adolescents meet their daily nutritional need with carefully portioned meals and snacks. At this point in cases of anorexia and bulimia nervosa treatment, they’ll be required to eat their entire meal or snack and not engage in compensatory behaviors like purging. Individuals who cannot abide by this rule will receive additional nutritional support until they can. Normally, exercise will be restricted at this level as it is a form of compensatory behavior in many cases.


The second level consists of reinforcing the adolescent individual’s commitment to recovery and continuing meal and nutrition training. At this level, portioning challenges are introduced by dieticians to encourage flexible eating habits. When meeting the goals they’ve worked out with the staff, teens in our care also begin to earn some new rewards like increased movie time as positive reinforcement of their achievement. Treatment professionals closely monitor treatment engagement and compliance to assess individual progress and determine how privileges are granted.


AS the client and the staff begin to feel more comfortable with each other and are beginning to trust each other, they can move on to the third level. Here, teenage clients begin to structure their own meal and snack times and portions. The care team will continue to monitor food intake and eating habits to promote healthy choices and, under the supervision of the professional staff. Light exercise, including walks and yoga, will now be part of the program, though more intense activities might still be a no-go.


At the final level in Clementine’s structured inpatient bulimia nervosa treatment system, individuals are fully aware of their disordered patterns of behavior and have shown that are capable of managing them without constant supervision. Teens and adolescents should show that they have and use healthy coping skills to overcome disordered thoughts and behaviors. The clients will normally take complete control of their meal-planning duties during this level and will attend restaurants, grocery stores, and other potentially stressful but commonplace arenas. Individual autonomy is increased at this level, the better to prepare the client to return to an unstructured daily life.

Upon making it through the fourth level in this system, teens and adolescents can move onto a less structured treatment program for continued support. The knowledge and skills developed with the structured level system will support these individuals’ progress in other treatment programs.

The Benefits of a Structured System in Bulimia Nervosa Recovery

By allowing individuals to take charge of their journey to a healthier, non-disordered life, a structured system allows for greater self-reliance and coping ability for adolescents who’ve completed the process and returned to “normal” life. This helps to boost mutual trust between caregiver, their clients, and their families, which helps promote better outcomes in most cases.

The structured level system introduces challenges and privileges to offer teens and adolescents the guidance and support they need to overcome their eating disorders. The level system promotes the eventual self-guided involvement of teens and adolescents in their treatment program, which spurs the development of healthy life skills.

With the regular and controlled implementations of challenges, individuals can work at a pace that meets their ability to achieve. The privileges granted at each level help to promote self-sufficiency in practicing healthy meal prep and eating habits. At their own pace, yet with the support and comfort of a structured plan, they can improve their self-image, eating habits, and thought processes.

Why Measuring Progress and Rewarding Achievement Is so Important

Two very important aspects of the structured level system for eating disorder recovery are the measurement of progress and award of privileges. By setting clear goals at the beginning of treatment and working in a structured environment towards them, individuals in treatment can effectively measure their progress and receive well-earned rewards. This improves motivation to continue on the way to a full recovery and instills the self-confidence that makes recovery more likely.

Awarding privileges as individuals make it through each level helps maintain adequate motivation levels through rewards for accomplishments. In addition, it helps to reinforce the commitment teens and adolescents have to make a full recovery from eating disorders.

The return to daily life is also a key goal that teens in treatment should be aiming for; the confidence borne from achievement at each level or recovery makes this final goal attainable. The increase in activity can help promote a seamless transition back home after completing the fourth level of treatment. The life skills coping skills and eating disorder-specific lessons learned in treatment make a continuation of healthy thoughts and behaviors more possible when they return home.

By facing these triggers while in the structured level system, teens and adolescents can receive the support they need to resist the urge to return to prior behaviors. They also receive the help they need to challenge unhealthy thought patterns that typically contribute to the development of eating disorders.

Bulimia Nervosa, Anorexia Nervosa, and Binge Eating Disorder Recovery at Clementine

Teens and adolescents with diagnosed eating disorders or disordered eating habits can benefit from enrollment in a treatment program that utilizes a structured level system. The system will promote the development of healthy thought patterns, behaviors and life skills for complete recovery from eating disorders. With a focus on collaboration with the care team and family members through the structured level treatment program, teens and adolescents will receive the support they need to overcome their eating disorders.

Adolescents and teens, along with their family members, can receive compassionate care from the team at Clementine by calling 855-900-2221. With our focus on education, skill-building, and empathy, our patients can achieve their goals and replace disordered eating thought patterns and behaviors with healthier alternatives for life.

Areas We Serve:

Houston, TX | South Miami, FL | Malibu Lake, CA | Naperville, IL | Portland, OR | Briarcliff Manor, NY | Twin Lakes, VA


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.