Treatment of Bulimia Nervosa
Bulimia can have devastating personal and medical effects and deciding to seek treatment for bulimia is a huge and difficult step for most bulimics. The goal of bulimia nervosa treatment is to stop the binge eating and purging cycles while dealing with any complications brought about by the eating disorder. Other bulimia treatment goals include:
- Creating a healthy attitude towards food
- Gaining self-esteem
- Creating nutritional eating patterns
- Preventing relapse
A bulimia treatment plan, created by a doctor, addresses all these issues and may include medical, supervised self-help, nutritional, therapeutic and support group treatment recommendations. The most successful bulimia treatment plans contain a combination of approaches.
Medical Treatment for Bulimia
Visiting the doctor for a proper bulimia test and diagnosis is the first step in the treatment process. A doctor interviews the patient and run tests to ensure a correct diagnosis and to assess any physical and psychological damage done by the eating disorder. (See bulimia side effects.) The doctor will also try to assess any additional mental illness the bulimic may need treatment for - such as body dysmorphic disorder, substance abuse, depression or a personality disorder.
Next, the doctor will typically decide whether inpatient or outpatient treatment for bulimia is required. Inpatient bulimia treatment is uncommon but is used in severe cases, particularly where there are further medical complications (read about bulimia treatment centers). The doctor will also determine if a medication, typically an antidepressant, is required for the treatment for bulimia.
Drug treatment has been shown to decrease bulimic behaviors, such as binge eating and vomiting, by up to 60%, although relapses are common when medication is discontinued.1 Doctors can choose from several medications:2
- Selective serotonin reuptake inhibitors (SSRIs) - the preferred type of antidepressant; thought to help decrease the depressive symptoms often associated with bulimia, helping the bulimic develop a more positive body image. Eg. Fluoxetine (Prozac)
- Tricyclics (TCAs) - another type of antidepressant thought to help with depression and body image. TCAs are generally only used if SSRIs fail as a bulimia treatment. (eg. Desipramine Norpramin)
- Antiemetics - a drug specifically designed to suppress nausea or vomiting. Eg. Ondansetron (Zofran)
(More information on medications for eating disorders.)
Medical treatment for bulimia also typically involves dentistry to address the effects the illness has on teeth and gums.
Nutritional Treatment for Bulimia
Nutritional intervention, education and support are critical in bulimia treatment. By the time treatment has been sought, the person is often malnourished with deficiencies in vitamin C and D and imbalances in calcium and electrolytes. Therefore, a nutritionally balanced diet should be undertaken immediately. This may happen at an inpatient eating disorders facility or, more often, as an outpatient with the oversight of a nutritionist and family or friends of the bulimic.
Because a person may be bulimic for a long time before seeking bulimia treatment, they often lose the ability to gage what a healthy meal or a healthy diet is. Nutritional education can help with this problem. It focuses on reestablishing healthy eating patterns and choices as well as introducing food, in healthy amounts, on which the bulimic had previous binged.
Bulimia support of family and friends is also key in bulimia treatment. Those around the bulimic can encourage healthy choices and discourage the reemergence of old, bulimic behaviors. Family and friends of the bulimic may also need nutritional counseling in order to properly support their loved one.
Psychological Treatment for Bulimia
While the behaviors associated with bulimia are centered on eating and food, it's important that bulimia treatment address the underlying psychological reasons for the bulimia. Treatment for bulimia almost always includes some form of psychological counseling. This may be a specific type of individual counseling such as talk therapy or cognitive behavioral therapy or may be group counseling in the form of family therapy or support groups. Often, it involves a combination of therapies. It is always a best practice to get a therapist who specializes in eating disorders.
Talk therapy is beneficial to work out the psychological issues behind bulimia, particularly where severe family dysfunction or a history of abuse are involved. Talk therapy involves one-on-one counseling between a licensed therapist and the person suffering from bulimia.
Cognitive Behavioral Therapy
Cognitive behavioral therapy (CBT) is gaining in popularity and is the most studied form of psychotherapy in the treatment of bulimia. This therapy can be done one-on-one or in a group setting and focuses on monitoring and challenging the thoughts and beliefs the bulimic has around food, eating and body image. Other components of CBT include:
- CBT is short-term, typically 4 - 6 months
- Patients set treatment goals
- Patients may be asked to keep a food diary to record feelings to binge or purge along with consumed food
- Patients analyze binge and purge triggers
- Patients are challenged to not link their weight to their self-esteem
Eating disorders group therapy can be structured or unstructured. Some groups have the expressed goal of delivering CBT or another therapy in a group setting, while other groups are aimed at supporting the person going through the treatment for bulimia. Therapy groups are usually led by a therapy professional, while bulimia support groups may be run by bulimics trying to help other bulimics.
Group therapy for bulimia may also consist only of family members of the patient or include patients and family members. Bulimia treatment involving the family is often essential to create a positive and supportive home environment for the bulimic. (read: How to Help Someone with Bulimia) This type of therapy also addresses how bulimia has affected family members and allows family members to get support from others.
Last Updated: 14 May 2016
Reviewed by Harry Croft, MD