Bulimia Treatment
Although specific treatment goals are tailored to individual patients, in general, the goals include:
- To re-establish healthy eating habits, weight and body image. This is done within the context of identifying and exploring psychosocial issues that influence sense of self and affect functioning.
- To address self esteem, school stress, friendships and family relationships. An emphasis is placed on building adaptive strategies and coping skills
- Treatment is provided for coexisting psychiatric diagnoses; Eating disorders commonly co-occur with other psychiatric disorders including depression, obsessive-compulsive disorder, substance abuse and anxiety disorders.
- Parents are seen as allies in the treatment of each child and adolescent
- Coordination of care with the primary care physician is also indicated.
- Referral for additional diagnostic testing including blood work, physical examination and nutritional evaluation may be indicated
Evidence-Based Treatment:
A small body of evidence indicates that CBT is more beneficial than pharmacotherapy, supportive therapies, behavioral therapy, and self-help CBT in improving some symptoms of bulimia, particularly in eliminating or reducing the frequency of vomiting episodes and associated symptoms of depression in the short-term.
However, the overall stability and strength of the evidence supporting these conclusions was considered low based on the size of the evidence base, internal validity of the studies, and lack of precision and robustness of the meta-analytic findings.
Most often, a stepped approach is used for patients with bulimia. The treatment approach depends on how severe the bulimia is, and the person’s response to treatments:
- Outpatient treatments, such as individual and family therapy, and support groups may be helpful for patients with mild conditions who are early in their illness and who do not have any health problems.
- Cognitive-behavioral therapy (CBT) and nutritional therapy, as well as family therapy, are the preferred first treatments for bulimia that does not respond to support groups.
- Antidepressants known as selective serotonin-reuptake inhibitors (SSRIs) are often used for bulimia. A combination of CBT and SSRIs is very effective if CBT is not effective alone.
- For children and adolescents, residential treatment can be pivotal to breaking the cycle and producing recovery-oriented thinking, behaviors, and goals
- Day treatment or Intensive Outpatient treatment can be an important part of the transition from residential treatment to adapting back into one’s family, school, and social life.
Family involvement is a key to successful interventions in the treatment of eating disorders including bulimia
- Families are important in establishing healthy eating habits to break the restrict-binge-purge cycle
- Family dynamics have often played a role in sustaining the disorder and recovery is easier to maintain as family interactions become less dysfunctional
- Families can be a support for a person with bulimia who is experiencing thoughts or urges and needs support to avoid a full relapse
Patients and families may become disheartened and drop out of programs if they have unrealistic hopes of being “cured” by therapy alone. Before a program begins, the following should be made clear:
- A number of therapies are likely to be tried until the patient can overcome this difficult disorder.
- It is common for bulimia to return (relapse), and this is no cause for despair.
- The process is painful, and the patient and family need to work hard.