How Bulimia Nervosa Is Treated

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Bulimia is an eating disorder marked by a consistent pattern of binge eating and purging through the form of vomiting, overexercising, fasting, and laxative abuse.

Bulimia Diagnosis

To receive an official diagnosis of bulimia, the episodes of binging and purging must occur weekly for at least three months. This disorder typically begins to present itself in the pre-teen years and is most commonly diagnosed in females. However, males can also develop bulimia, and it is crucial to check for symptoms regardless of gender.

Symptoms of bulimia are often somatic-based and result from the bodily trauma resulting from constant binging and purging. The most common symptoms include sore throat, sensitive teeth, worn tooth enamel, intestinal irritation, and severe dehydration. 

The most studied and recommended treatments include psychotherapy and medication. Mental health professionals can offer these two treatments in tandem in residential inpatient programs.

However, other treatment options, including brain stimulation techniques and complementary treatment modalities, may not be discussed as often. This article will review each of these treatments in detail.

Psychotherapy

Below discusses the types of therapy that can help treat bulimia.

Cognitive-Behavioral Therapy

Cognitive-behavioral therapy (CBT) is the preferred psychotherapy modality for those experiencing bulimia due to its strong evidence-based background.

CBT is a form of talk therapy that supports patients in identifying negative thinking patterns and challenging these thought patterns to ultimately break maladaptive behavior and beliefs. CBT can curb the triggers associated with episodes of binging and purging, leading to a decreased likelihood of relapsing.

Interpersonal Psychotherapy

Interpersonal psychotherapy (IPT) is another recommended form of talk therapy. This brief evidence-based treatment explores social and interpersonal factors that prevent recovery from eating disorders.

IPT will focus on the interpersonal stressors impacting the client that, in turn, lead to episodes of binging and purging. The aim of IPT is to encourage the individual to create lifestyle changes that are supportive of their recovery.

Medication

Medication may be prescribed to treat bulimia. Selective serotonin reuptake inhibitors (SSRIs) are the most effective in reducing symptoms.

Common SSRIs include:

FDA-Approved Medication

Fluoxetine, however, is the only bulimia medication that has received FDA approval.

Topiramate is an anti-epileptic medication used off-label to treat bulimia. It has shown some success in minimizing binge episodes. Despite this success, it is important to note the side effects. For example, cognitive functioning impairment and weight loss can outweigh the benefits that taking this medication can bring.

Treating Medical Complications

Due to the nature of this disorder, medical complications tend to arise when treating bulimia. Dehydration is a common concern for those experiencing bulimia, for which saline in an IV drip is administered.

Constipation can also result from excessive binging and purging or detoxing from laxatives. More holistic support like staying hydrated, getting some physical movement in, and eating dietary fiber will be suggested to maintain bowel regularity. 

Surgery and Invasive Procedures

While surgery and invasive procedures to treat bulimia are rare, they still exist. Below include the types of procedures that can be helpful.

Bariatric Surgery

Bariatric surgery, often referred to as weight loss surgery, is a type of procedure that limits the body’s ability to ingest a high volume of food and decreases hunger signals (i.e., your brain won't get as many messages saying that you're hungry).

While bulimia is often associated with those having a low body weight, those who are experiencing obesity may also have bulimia. In these cases, and typically after all other treatment options have been exhausted, professionals may suggest bariatric surgery. 

Deep Brain Stimulation

Deep brain stimulation, a treatment that utilizes a surgically placed device to stimulate the brain, has been considered for treating bulimia. However, this therapy is still in its early stages, and while there is hope for this being a beneficial treatment, the clinical trials still leave much to be desired.

Complementary Alternative Medicine (CAM) and Over-the-Counter (OTC)

Some complementary alternative medicines can be quite supportive in treating bulimia. However, they must be used in addition to, not in place of, other forms of clinically-proven treatment.

Yoga

For example, a recent study shows that yoga can be quite helpful in treating some of the disturbances that trigger eating disorder episodes, like symptoms of anxiety, depression, and body image disturbance.

In this study, no significant changes to body mass index were indicated, making yoga safe for those who need to gain weight.

Other CAM Therapies

The following CAM therapies require further research to prove efficacy, but they have potential:

  • Massages and Bright Light Therapy: Often, depression can co-occur with bulimia, or some symptoms of depression may even trigger bulimic episodes. Tending to the depressive symptoms with massage and bright light therapy can help decrease the frequency of episodes.
  • Acupuncture and Relaxation Therapy: For those who experience symptoms of anxiety alongside bulimia, acupuncture and relaxation therapy can be helpful. Similar to depression and bulimia, symptoms of anxiety can exacerbate bulimia. Soothing anxiety can, in turn, alleviate symptoms of bulimia.

You Cannot Rely on CAM Therapies Alone

Again, it is imperative to remember that these protocols will not work independently. A treatment plan including psychotherapy, medication, and lifestyle options will be needed in addition to complementary alternative medicine therapies to treat bulimia. 

How to Make Your Treatment Most Effective

The most effective treatments include lifestyle changes, a robust support system, and a well-rounded treatment team. Moving through treatment for bulimia can be challenging, but recovery is possible. Here are some tips:

  • Identify triggers and stressors: First, with the help of a licensed therapist, you'll consider the triggers you have in your life and assess how you can begin to shift them. Perhaps you have a negative relationship with a family member or find that a particular aspect of your life is incredibly stressful.
  • Make lifestyle changes: Consider what changes can be implemented to minimize the harm to your mental and physical health. Exercising, and making a habit of journaling daily can help manage any intense emotions you might experience as you recover.
  • Reach out to your support system: Allow yourself to lean on your friends and family. Also, ensure that medical professionals around you account for your mind-body-spirit wellness. 

Even though healing is hard, it can and will change the trajectory of your life. Your well-being is worth it.

9 Sources
Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Jain A, Yilanli M. Bulimia nervosa. Treasure Island, FL. StatPearls Publishing; 2022.

  2. National Institute of Mental Health (NIMH). Eating disorders.

  3. Murphy R, Straebler S, Cooper Z, Fairburn CG. Cognitive behavioral therapy for eating disorders. Psychiatr Clin North Am. 2010;33(3):611-627. doi: 10.1016/j.psc.2010.04.004

  4. Karam AM, Fitzsimmons-Craft EE, Tanofsky-Kraff M, Wilfley DE. Interpersonal psychotherapy and the treatment of eating disorders. Psychiatr Clin North Am. 2019;42(2):205-218. doi: 10.1016/j.psc.2019.01.003

  5. Cleveland Clinic. Bariatric Surgery.

  6. Sekuła M, Boniecka I, Paśnik K. Bulimia nervosa in obese patients qualified for bariatric surgery – clinical picture, background and treatment. VSJ. 2019;14(3):408-414. doi: 10.5114/wiitm.2019.81312

  7. Duriez P, Bou Khalil R, Chamoun Y, et al. Brain stimulation in eating disorders: state of the art and future perspectives. J Clin Med. 2020;9(8):2358. doi: 10.3390/jcm9082358

  8. Fogarty, S, Smith, CA, Hay P. The role of complementary and alternative medicine in the treatment of eating disorders: A systematic review. Eating Behaviors. 2016;21:179-188. doi: 10.1016/j.eatbeh.2016.03.002

  9. Hall A, Ofei-Tenkorang NA, Machan JT, Gordon CM. Use of yoga in outpatient eating disorder treatment: a pilot study. J. Eat. Disord. 2016;4(1):38. doi: 10.1186/s40337-016-0130-2