Treatment of bulimia, as with all eating disorders, can be challenging. Effective treatment addresses the underlying emotional and mental health issues — issues that can often date back to childhood and a person’s self-perception and self-image. Many of the treatment approaches described below help a person with bulimia break their unhealthy pattern of eating — the binging and purging cycle. Treatment will also help a person with bulimia understand how their own negative self-image impacts their eating behavior.
Some people with bulimia can be in what psychologists call “denial.” Part of the challenge of treatment with bulimia, as with many eating disorders, may be just helping the person with bulimia understand they do have a serious mental health concern that needs professional treatment (see family therapy below).
While there are many different routes to treatment, virtually all of them begin with seeing an eating disorder specialist. Usually this individual is a psychologist who has deep experience and training in helping a person with bulimia. A physical examination and workup by a medical doctor is also an initial part of the standard treatment of bulimia, to understand and begin addressing the physical problems that may have occurred as a result of the disorder.
Psychotherapy for Bulimia
Psychotherapy is the most common treatment for bulimia and has the greatest research support. Psychotherapy can involve a significant time and financial commitment, particularly if you are struggling with other issues (sexual abuse, depression, substance use, or relationship problems). Psychotherapy can be very helpful in addressing not only your disordered eating, but also your overall emotional health and happiness. The focus of psychotherapy treatment will be to address the underlying emotional and cognitive issues that result in the disordered eating.
People with bulimia often “binge” — that is, they consume a large amount of food in a very short time — and then they’ll “purge” — inducing vomiting of the food they’ve just eaten (often times in the very same bathroom at the restaurant they’re eating at, or shortly late in the safety of their home). Some bulimic behaviors may be more subtle, such as taking large amounts of laxatives, or drinking pots of coffee each day to ensure their body gets rid of food as quickly as it takes it in.
Cognitive behavioral therapy (CBT) is considered the treatment of choice for people with bulimia. With the support of decades’ worth of research, CBT is a time-limited and focused approach that helps a person understand how their thinking and negative self-talk and self-image can directly impact their eating and negative behaviors.
Cognitive-behavioral therapy will often focus on identifying and altering dysfunctional thought patterns, attitudes and beliefs, which may trigger and perpetuate the person’s pattern of harmful eating behaviors. Cognitive-behavioral therapy used in the treatment of bulimia focuses on the traditional foundations of CBT therapy — helping a person understand, identify and change their irrational thoughts (the “cognitive” part), and helping a person make the changes real through specific behavioral interventions (such as promoting health eating behaviors through goal setting, rewards, etc.).
Cognitive behavioral therapy is the gold standard treatment for bulimia.
Cognitive-behavioral therapy is time-limited, meaning that a person with bulimia will go into treatment for a specific period of time with specific goals in mind. Like all psychotherapy, it can be conducted in either an outpatient (once weekly) or inpatient setting. If done in an inpatient setting, eating disorders are often treated at residential treatment facilities (see below), since eating is such an integral and necessary part of our lives.
The first part of CBT for binge eating will focus on helping the person with bulimia break their pattern of unhealthy eating — the binging and purging cycle. This cycle is something that can be challenging to break, as the person has inadvertently setup a reward system for themselves. CBT will help the individual with bulimia monitor their eating habits and avoid situations that make them want to binge. The treatment will also help them cope with stress in ways that don’t involve food, eat regularly to reduce food cravings, and fight the “urge to purge.”
The second part of CBT will help the person with bulimia better understand their dysfunctional and broken beliefs about their own self-image, weight, body shape and dieting. They will do this through traditional cognitive-behavioral techniques such as challenging black-or-white, all-or-nothing thinking, and the other irrational beliefs commonly held by people with bulimia. CBT also helps a person to better understand the connection between their emotional state and eating — especially eating or turning to food when feeling bad.
According to an article published in 2008 from the U.S. National Guideline Clearinghouse that looked at the treatment research for bulimia, “Cognitive behavioral therapy administered individually or in groups reduced core symptoms of binge eating, purging, and psychological features in both the short and the long term.
“The [medication research] supported fluoxetine (60 mg/day) administered for 6 to 18 weeks in terms of short-term reductions in binge eating, purging, and psychological features. The 60 mg dose performed better than lower doses and was associated with prevention of relapse at 1 year.
“Generally, more than one-half of patients no longer suffered from this diagnosis at the end of various studies. A substantial percentage continued to suffer from other eating disorders; depression was related to worse outcomes. Bulimia nervosa was not associated with increased mortality.
Another form of psychotherapy is known as family therapy. Family therapy helps a person with bulimia see and understand the often-times dysfunctional role they play within the family, and how their eating behaviors maintain that role.
Family therapy is usually conducted with the person who has bulimia and their family. However, in some instances, a few family therapy sessions may involve therapy without the person who has bulimia present. This may help the family understand the roles they are playing in supporting the disordered eating, and suggest ways the family can help the person with bulimia acknowledge the problem and seek out treatment.