Psychotherapy

Psychotherapy can involve a significant time and financial commitment, but you are worth it! Particularly if you are struggling with other issues (e.g., sexual abuse, depression, substance use, relationship problems), psychotherapy can be very helpful in addressing not only your disordered eating, but also your overall emotional health and happiness.

• Cognitive-behavioral therapy includes standard elements of behavioral treatment with a focus on identifying and altering dysfunctional thought patterns, attitudes and beliefs that may trigger and perpetuate binge behavior or restrictive eating. Monitoring your intake of food is an important component, along with identifying triggers and developing alternative reactions to them
• Interpersonal psychotherapy focuses on relationship difficulties, self-esteem, assertiveness, social skills and coping strategies.
• Family therapy comes in many forms. The goal of the family therapist is to help members of the family change behaviors that may have contributed to the development of some of the person with bulimia’s pathologic thoughts and activities. Blame is not placed on one individual.
• When a person with bulimia is recovering, group therapy can be very helpful. The group format allows people the opportunity for sharing information, survival skills and feedback about how one interacts with others. It is also a chance to enhance a person’s self-esteem by helping others. A trained leader directs the group.

Medications

Many people with bulimia also have depression and their symptoms may respond to antidepressants. As of now, only Fluoxetine Prozac is approved by the Food and Drug Administration for the treatment of bulimia nervosa. This medication has been found to decrease the number of binges as well the desire to vomit in people with moderate to severe bulimia nervosa.

Medications such as Fluoxetine (Prozac), Sertraline (Zoloft), Paroxetine (Paxil), which are approved for depression and obsessive compulsive disorder may help the person with bulimia have less depressed feelings, as well as be less obsessed with food and their weight. At appropriate doses (similar to those used for OCD treatment), antidepressants, which act on the serotonin system in the brain (e.g., Prozac), have been found to decrease the strength of urges to binge for some individuals. Individuals with a positive response to these medications have reported a lessening of their carbohydrate cravings, which prevents bingeing. Others have experienced a less dramatic relief/pleasure associated with binge/purge behaviors. This response makes the binge/purge cycle less enticing as a means of stress release.

Naltrexone: Another family of medicines, which works on the opiate system in the pleasure center of the brain, has yielded some success with some people. This family of medication is also used to help recovering alcoholics.

Self-help programs and books:

There are a variety of materials available on bulimia. Some people are able to make significant gains in this way. Other people require the structure of groups or more supervised treatment in order to recover fully.

What's Related

• An Introduction to Bulimia Nervosa
• All About Eating Disorders
• Treatment and Management of Eating Disorders
• Gaining: The Truth About Life After Eating Disorders
• Behavioral Therapy, Medications and Anorexia
• A Brief Overview of Eating Disorders
• What Is Binge Eating Disorder?
• Which Antidepressants Cause the Least Sexual Side Effects?
• Being Teased and Taunted
• Fitness Magazines and Eating Disorders: Is There a Relationship?
• Other articles by Jim Haggerty, M.D.

 

Last reviewed:
  On February 17, 2006
  By John M. Grohol, Psy.D.