Treatment for Bulimia

Generally, bulimia nervosa patients are not as secretive about their symptoms as are patients with anorexia, and are typically more receptive to treatment. Treatment of bulimia may consist of individual psychotherapy, group therapy, family therapy and/or pharmacotherapy. Since bulimia nervosa often coexists with mood disorders, anxiety disorders and personality disorders, the doctor should factor these considerations into the patient's treatment plan.

Hospitalization
Patients with bulimia are not as secretive about their symptoms as anorexia patients, outpatient treatment is usually sufficient. However, when eating binges are extreme, if patients exhibit other psychiatric symptoms such as suicidal ideation and substance abuse, or if purging is so severe it causes electrolyte and metabolic disturbances, hospitalization may be warranted. As symptoms are brought under control and both eating behaviors and weight are stabilized, control is gradually and slowly return to the patient. At all levels of care, the treatment usually involves high levels of structure and a behavioral treatment plan based on the patient's weight and eating behaviors. Long-term psychotherapy and medical follow-up with an internist are usually necessary.

Psychotherapy
The goal of therapy is to help patients develop or improve self-control and judgment. Cognitive-behavioral psychotherapy has been shown to be useful in addressing the specific behaviors that lead to binging episodes. However, many patients have coexisting disorders (i.e., mood disorders and substance-related disorders) that go beyond the behavior surrounding binge eating. Therefore, additional psychotherapeutic approaches (such as psychodynamic, interpersonal and family therapies) can be useful.

Group therapy is also an appropriate treatment for patients with bulimia. Three major models of outpatient group therapy for bulimics have been developed: psychodynamically oriented psychotherapy, cognitive-behavioral therapy and self-help (support group) therapy (Nicholi, ed. The New Harvard Guide to Psychiatry, 1988).

Pharmacotherapy
Antidepressants have been successfully used in patients who are not responsive to psychotherapy alone. (The FDA recently approved Prozac® for the treatment of bulimia nervosa.) Tofranil® (imipramine), Norpramin® (desipramine), Desyrel® (trazodone), selective serotonin reuptake inhibitors (SSRIs) and monoamine oxidase inhibitors (MAOIs) have all suggested efficacy in small trials.

Self-Management

  • To make the fullest possible recovery, a person with bulimia must: 
  • Participate actively in the treatment plan. 
  • Complete the inpatient program when necessary. 
  • Maintain weight independently within 5 pounds of assigned target weight. 
  • Function independently in activities of daily living. 
  • Regularly attend individual, group and/or family psychotherapy. 
  • Regularly visit your internist to safeguard your physical health. 
  • Demonstrate effective coping skills. 
  • Ask for assistance when needed. 
  • Be honest with your therapist and internist. No withholding of information.