As in anorexia nervosa treatment, a supportive and trusting therapeutic relationship and good rapport must be established before any serious therapy gains can be made. Many of the same issues of a distorted self-esteem and self-perception that are relevant to anorexia treatment are similar to bulimia treatment. A complete medical examination is usually warranted to evaluate the patient’s health and medical status. Underweight or overweight individuals often suffer from medical complications, especially if the person is using laxatives or vomiting as a method of controlling their over-eating behaviors. Therapy is most effective when it doesn’t so much focus on the actual eating behaviors, although they are important, but instead examines the causes of those behaviors, such as poor self-perception.
If the individual is not in immediate crisis or suffering from medical complications from the disorder, individual psychotherapy is usually a good starting basis of treatment. Cognitive-oriented therapies, focusing on issues of self-image and self-evaluation, are likely to be the most beneficial to the client. Distorted self-body images are most common amongst people who suffer from this disorder and should be the initial focus of treatment. The client should be instructed on how to recognize appropriate weight and body fat proportions of a normal body and relate that to theirs. Psychoeducational materials and approaches may be helpful in some cases.
Often negative self-image is created by specific traumatic events or memories within the individual’s developmental stages of childhood. Parents may play an important role in helping to inadvertently nurture a negative self-image in the individual. These are appropriate and important issues in which to touch upon in therapy. Family therapy is therefore sometimes beneficial in uncovering the reinforcers the individual is receiving from significant others in their lives to remain thin. Family therapy can also be very helpful in educating the family about the child’s disorder and how to ensure the patient’s compliance with treatment recommendations. An individual’s prognosis for recovery from an eating disorder is increased if the person does not binge or purge and they have only had the disorder for less than 6 months. A good support system is essential to quick recovery.
Group therapy is not only an appropriate modality, but often a chosen modality for its cost-savings as well as its powerful effects. In groups specifically devoted to issues of eating disorders, a patient can gain not only support for the gradual gains they accomplish, but also be confronted on issues more easily than in individual therapy.
Some medications can be extremely helpful in treatment a person who suffers from bulimia. As always, the medication should be carefully monitored, especially since the patient may be vomiting or taking large amounts of laxatives, which may impact on the medication’s use and effectiveness. A trusting and honest relationship must be established between the physician and the individual or mediation compliance will almost certainly become an issue.
Antidepressants (such as imipramine, desipramine, or phenelzine) are the usual drug treatment and may speed up the recovery process. Phenytoin and carbamazepine may also help reduce the frequency of the binging behaviors.
Self-help methods for the treatment of this disorder are often overlooked by the medical profession because very few professionals are involved in them. Self-help support groups are an especially powerful and effective means of ensuring long-term treatment compliance and decrease the relapse rate. Individuals find they can bounce ideas off of one another, get objective feedback about body image, and just gain increased social support. Many support groups exist within communities throughout the world which are devoted to helping individuals with this disorder share their commons experiences and feelings.
Psych Central. (2013). Bulimia Nervosa Treatment. Psych Central. Retrieved on March 8, 2014, from http://psychcentral.com/disorders/bulimia-nervosa-treatment/
Symptom criteria summarized from:
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders, fifth edition. Washington, DC: American Psychiatric Association.
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders, fourth edition. Washington, DC: American Psychiatric Association.
Last reviewed: By John M. Grohol, Psy.D. on 26 May 2013
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