I'm 17, and I have been battling with bulimia for five years now. I want to stop, but I can't seem to do it on my own. I am ready and willing to go into the hospital for treatment, but the problem is the money. We do not have $2,000 to spare. All these things have been happening to my family -- my mom lost her job, my dad had surgery, my sister is in college, I'm soon going to college -- so we don't have the money. Is there any way I can get financial help to get treatment? I am very desperate.

Karin

I've heard of some residential or intensive outpatient eating disorders programs offering services at a reduced fee for those in great need with no ability to pay. Obviously they wouldn't be able to do that too often, because patients' fees pay the costs of running the programs. But it probably wouldn't hurt to ask, in case such reduced fees are available and your family would qualify.

Before you do that, though, I'd check first to see whether hospitalization is actually the best choice for you. The Renfrew Center, for instance, has some intensive outpatient eating disorders programs available in several cities (as well as excellent inpatient facilities in Philadelphia, PA and Coconut Creek, FL). You can get information on these programs by calling 1-800-RENFREW. There may be other outpatient programs available in your area, too. The Something Fishy website on eating disorders has a list of eating disorders programs and therapists across the country, as well as a lot of other resources you might find helpful.

But even an intensive outpatient program may be more than you need. If you're truly motivated to change, you might do well in outpatient psychotherapy with a psychologist or other therapist experienced in treating eating disorders. I've seen many people with bulimia recover in individual therapy outside of a hospital setting. If their physical health is in question, a periodic evaluation by an internist or family medicine practitioner can be conducted as part of the overall treatment process.

You mentioned the cost. I'm not up on current costs for psychiatric hospitalization, but a few years ago such hospitalization ran about $1,000 a day. Let's say someone spent two weeks in a psychiatric program, at a cost of about $14,000 to them or their insurance company. Compare that to the cost of seeing a licensed psychologist or other therapist experienced in treating eating disorders at $100 per hour-long session. (Some charge less, others charge more.) At $100 a session, you could see a therapist for 140 sessions for the same amount of money. At a session a week, with breaks for vacations and holidays, those 140 sessions would probably stretch three years or more. Even with twice-a-week sessions ... well, you can do the math. (And I'm not even factoring in here the fact that most inpatient treatment is followed by outpatient therapy in the patient's hometown or college setting, since inpatient treatment alone is rarely sufficient.) Some insurance companies can be convinced to transfer benefits from inpatient to outpatient services by having these equations spelled out for them by therapists or patients.

I'd recommend your making an appointment with a psychologist or other therapist experienced in treating eating disorders before you jump into a hospital or residential program. Get his or her feedback and opinion regarding your options and recommendations. If you decide to go ahead and pursue residential treatment -- or if there are no qualified therapists within driving distance of where you live -- then call around to different programs and see if financial aid is available. (Your parents, of course, might need to make those calls, since they're financially responsible for you.) Good luck.