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.
While many medications may be prescribed for symptoms related to bulimia, only Fluoxetine (brand name: Prozac) has approved by the Food and Drug Administration for the treatment of bulimia nervosa. This medication has been found to decrease the number of episodes of binging, as well the desire to vomit, in people with moderate to severe bulimia.
As of now, 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 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 appears to help prevent binging. Others have experienced a less dramatic relief or pleasure associated with their binge/purge behaviors. This response makes the binge/purge cycle less enticing as a means of stress release.
Naltrexone, which works on the opiate system in the pleasure center of the brain, has yielded some initial positive research results in some people with bulimia as well.
Residential Treatment Facilities for Bulimia
Residential treatment facilities offer a complete array of treatment services in one place.
One place where all of the above treatment options are available is called a residential treatment center. Such treatment centers are located throughout the United States and in many other countries as well, and focus on the treatment of all the different types of eating disorders (including bulimia). Such facilities usually include a wide range of specialists — psychologists, medical doctors, nutritionists, meditation and relaxation professionals, and fitness experts. They help a person learn all of the skills necessary (through the cognitive-behavioral techniques outlined above), and put them into daily practice in a safe, relaxed setting.
Often these kinds of treatments may be paid for by an individual’s private health insurance, for up to a certain period of time (often 30 days). Check with your health insurance provide to see if such coverage is available for you.
Hospitalization for Bulimia
In cases where a person with bulimia is severely ill or the individual has other serious medical problems, inpatient hospitalization may be necessary. 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. Hospitalization may be necessary in order to immediately address the most pressing medical problems. Group and individual therapy supplement dietary and medical therapies.
At one time inpatient treatment lasted many weeks, if not months, but in today’s climate the goals of hospitalization are weight gain and medical stabilization. The person with bulimia is moved to outpatient therapy when it is considered safe to do so.
Self-Help for Bulimia
There are a variety of self-help methods available for eating disorders, including bulimia. Self-help support groups are a great way of getting emotional support while trying to make changes in one’s life to support a healthier self-image and eating behaviors. Self-help books on bulimia can be a great place to start to gain some insights and tips on changing one’s self-image and disordered eating.
Since many people with bulimia use food as a coping skill for dealing with negative emotions, finding other, healthier coping skills may be a good place to start.
Our positive self-image and eating issues blog Weightless is a great place to find more tips on improving your coping skills and self-image. However, you can also start with these tips about how to improve your body image from the Something Fishy website:
- Wear clothes you feel comfortable in – Dress to express yourself, not to impress others. You should feel good in what you wear.
- Stay away from the scale – If your weight needs to be monitored, leave that up to the doctors. How much you weigh should never affect your self-esteem.
- Stay away from fashion magazines – Unless you can look through these magazines knowing they are purely fantasy, it’s just better to stay away from them.
- Do nice things for your body – Get a massage, a manicure, or a facial. Pamper yourself with a candlelight bath, scented lotion, or a new perfume.
- Stay active – Movement therapy helps improve your sense of wellbeing. Take up Yoga or Tai’ Chi, play volleyball with the kids, or bike ride with friends. Make angels in the snow or sandcastles at the beach. Be active and enjoy life!