In Brokering Authenticity, Rebecca Lester describes how Caroline, a patient in their clinic, struggled for many years with a Binge Eating Disorder and later they found out BPD behaviors. Caroline would binge for 3-4 hours at a time and would then purge all the food she ate, and start the whole process again. Caroline’s body was slowly shutting down, and she was soon hospitalized, but she still found ways to purge without the staff noticing, vomiting in plastic Ziploc bags. She was then recommended to admit herself to an eating disorder clinic. It took several months, but the staff began to notice improvement; a significant decline in self-harm behaviors and purging (she made it two weeks without vomiting her food up). Often, when insurance companies begin to see this progress and that the patient is at a healthy weight, they will remove her from the facility, because it is no longer considered “medically necessary” for Caroline to stay there. However, if clinicians were to say that it is necessary for her to remain in the facility due to her emotional instability and inability to cope without significant help, insurance companies may deem her “treatment refractory” and terminate the rest of her coverage. It is a catch-22 situation–she has to be “sick enough” to receive treatment but also motivated enough to want to recover.