Bulimia Treatment

Bulimia is a serious, potentially life-threatening eating disorder. If you or a loved one show signs or symptoms of bulimia, it’s important to seek professional treatment. Treatment can take a number of forms, but typically includes counseling or therapy and nutritional rehabilitation.

Bulimia treatment usually utilizes a team approach. The team may include doctors, nutritionists, and psychologists or other mental health professionals. There may also be a case manager to supervise your overall care.

Getting help for bulimia may seem intimidating, but there is help available. You can start by reaching out to a supportive friend or family member or by talking with a medical professional.

Psychotherapy

Psychotherapy, also known as counseling or talk therapy, is the backbone of bulimia treatment. In psychotherapy, you discuss your disorder and find ways to effectively cope with the disorder itself as well as its underlying causes. There are different approaches to psychotherapy, and your counselor may use one or a combination of different approaches.

Cognitive Behavioral Therapy (CBT)

Cognitive behavioral therapy, or CBT, teaches you to challenge unhealthy thoughts and beliefs and replace them with positive behaviors. CBT may include nutritional counseling to help you develop healthy eating patterns. It can also help you identify and better respond to triggers that lead you to binge and purge.

CBT can help you develop healthier thoughts and behaviors around your appearance and weight. As a part of CBT, you may also examine your relationships and how you respond to the people in your life. You may also develop a plan to respond to potential relapses as you recover.

Typically, CBT will have two phases. The first phase helps you stop the cycle of binging and purging and develop healthy eating patterns. You learn to recognize situations that provoke the urge to binge and purge and how to cope with stress in healthy ways. The second phase focuses on your beliefs around your body image and weight. You learn to challenge your negative, perfectionist thinking and develop a healthy attitude toward your body.

Interpersonal Psychotherapy

Interpersonal psychotherapy focuses on your close relationships. You discuss the challenges you have with your interpersonal relationships and work with your therapist to develop new patterns of communication.

During interpersonal psychotherapy, you work to identify which relationships in your life influence your bulimia, and develop strategies for interacting within those relationships. You also learn about the emotions that these relationships bring up and how to cope with those emotions in a healthy way.

Interpersonal therapy can help you learn how past experiences influence your present relationships. With that knowledge, you can make changes in how you interact with the people in your life.

Family Based Treatment (FBT)

Family based treatment, or FBT, is particularly effective with adolescents. In FBT, the family is actively involved in supporting and guiding young people with bulimia. FBT actively involves the family in the adolescent’s food choices and behaviors until the adolescent can make good choices on his or her own. The family learns, together, how to cope with bulimia and recover.

FBT consists of three phases. During the first phase, the parents help re-establish healthy eating patterns for their child. They prepare healthy meals, and then after meals may do activities such as playing games or going for a walk to help distract their child from purging.

During the second phase, the parents gradually release responsibility for eating back to their child. They are still supportive but encourage the child to make healthy food choices and help them through any desire to purge.

The third phase addresses any lingering or underlying issues that are still present. The focus of the first two phases is on ending the cycle of binging and purging; the third phase is used to address other issues such as depression, distorted body image, or anxiety.

Dialectical Behavior Therapy (DBT)

Dialectical behavior therapy, or DBT, is a modified form of CBT. DBT helps you cope more effectively with painful emotions. There are four skills that are learned as a part of DBT. The first is mindfulness, which is being aware of your thinking in a neutral, non-judgmental way. The second is interpersonal effectiveness, which is improving how you interact in the relationships in your life. The third is emotional regulation, which helps provide you with tools to cope with challenging emotions in a healthy way. The fourth is distress tolerance, which teaches you to deal with distressing and challenging situations.

DBT typically involves both individual and group therapy. In DBT, the therapist strives to be an ally in recovery and provide an environment of acceptance and loving-kindness.

Eye Movement Desensitization and Reprocessing (EMDR)

Eye movement desensitization and reprocessing (EMDR) is designed to help patients cope with trauma. Many people with bulimia have experienced significant trauma, so this treatment helps to lower the overwhelming feelings associated with traumatic memories.

EMDR involves recalling traumatic memories while receiving bilateral sensory input, such as tapping each hand or moving an object back and forth within your field of vision. The goal is to reduce the stress associated with those memories so you are able to cope without returning to binging and purging behaviors.

Medication

Medication is also used to treat bulimia. The medications prescribed are typically antidepressants and fall into the selective serotonin reuptake inhibitor (SSRI) category. The only drug approved specifically for the treatment of bulimia by the FDA is fluoxetine, also known as Prozac. Fluoxetine has been shown to help those with bulimia, even if they aren’t experiencing depression. Medication is typically used in conjunction with, rather than instead of, therapy.

Nutrition Education

Nutritional education is an essential component to recovering from bulimia. During treatment, you work with a dietician who specializes in working with people with eating disorders. Together, you develop a healthy food plan that’s nutritious and has the appropriate amount of calories.

With your dietician, you learn to recognize hunger cues and develop a healthy attitude toward your weight and your body.

Beginning Treatment

Since bulimia is complex, a team approach is typically used to help you recover. You may begin treatment by meeting with your doctor, or you may work with a specialized facility. Regardless of the path you take, your treatment will typically begin with an assessment.

During assessment, your doctor will ask questions and perform tests to assess your current health. You may need to provide blood and urine samples in order for the doctor to assess your current nutritional and other health needs.

During assessment, you will also meet with a therapist or other mental health professional. The therapist will ask questions and may also ask you to fill out standardized surveys. This helps to get a sense of your specific treatment needs and formulate a plan to help you recover.

Treatment Settings

Bulimia can be treated in both inpatient and outpatient settings. Which setting is best for you depends on your situation, the severity of your illness, and whether other disorders, substance abuse, or medical issues are present.

Inpatient Treatment

Inpatient treatment for bulimia means that you live full-time at the treatment center where you are receiving care. Inpatient care may be best if you’re experiencing medical trauma as a result of bulimia or if you have other underlying issues affecting your recovery, such as borderline personality disorder or other mental illness. Inpatient treatment may also be best if you struggle with substance abuse in addition to bulimia.

Inpatient treatment may take place at a hospital or at a residential treatment program. Residential treatment programs provide a more home-like environment. During treatment, you may live alone or with other residents, and you participate in individual and group therapy.

Residential treatment allows you to avoid the temptations and struggles of your day-to-day life and focus fully on your recovery. Meals are provided, so you don’t need to worry about making decisions surrounding food.

Partial Hospitalization Treatment

Partial hospitalization treatment combines the intensity of an inpatient program with allowing you to return home at the end of the day. Some may transition from full inpatient treatment to partial hospitalization as part of their treatment plan, while others may begin with a partial hospitalization program.

Partial hospitalization programs are daily programs that run five days per week or more. You spend most of each day at the program. Your day consists of individual and group therapy, meals, and educational programs.

Intensive Outpatient Treatment

Intensive outpatient treatment allows you to live at home and maintain more of your daily routine. You typically go to treatment two to three days per week for most of the day. During your treatment, you’ll typically have a meal along with group and individual therapy. Intensive outpatient treatment may be during the day or in the evening, which allows you to maintain other commitments, such as taking care of children or other family members. During intensive outpatient treatment, you’re encouraged to continue your hobbies, work, and other relationships, and put what you learn into practice.

Outpatient Treatment

Outpatient treatment allows you to maintain your daily routine while you recover from bulimia. Outpatient care may be best if you have supportive family and friends, a job that you find fulfilling and that supports your recovery.

Outpatient care typically includes therapy sessions. These may be individual and group therapy sessions, and depending on the program may take place once or twice per week or more. Family counseling may also be a part of your program, particularly if you are an adolescent.

Outpatient care will typically include medical appointments to monitor your overall health along with any medications you’re taking.

Support After Treatment

Recovery from bulimia doesn’t stop when a treatment program is completed. You need continued support to prevent relapses and to continue to develop the tools you learned during treatment. There are resources available to help you in your recovery.

Support Groups

Support groups are a powerful tool to help you continue your recovery from bulimia. Support groups can be run through treatment centers, by therapists, or by other people recovering from bulimia. Support groups give you the opportunity to discuss the challenges and struggles you face and receive advice and help. They may also have educational opportunities for you to learn new coping skills.

Individual Counseling

After you’ve completed treatment, it can be helpful to continue individual counseling. This gives you a safe space to work on your individual needs. You can discuss your day-to-day experiences and learn strategies for dealing with stressors.

Individual counseling can be with a social worker or psychologist. Your treatment program may have a counselor they recommend. You can also reach out to eating disorder support organizations for recommendations.

Nutritional Support

You may find it helpful to continue to meet periodically with a dietician for support, even after you’ve completed a treatment program. A dietician can help you examine your food choices and develop strategies for eating healthier while maintaining a healthy weight. They can help provide accountability for making healthy food choices.

Self-Help Strategies

Developing a healthy relationship with food. You’ll need to commit to eating regular, healthy meals, while maintaining some flexibility. This means moving away from the all-or-nothing thinking that often comes with bulimia, and instead allowing yourself to occasionally indulge.
Accepting and loving yourself. Rather than basing your self-image on your appearance, focus on your inner qualities.
Self-care. Take time for things you enjoy. This may include a healthy exercise routine, hobbies, or taking in a movie or a good book.

Reach out for support. If you’re having a difficult time, talk to someone. This can be a trusted family member or friend, a mentor from a support group, or a health professional.
Maintain your treatment routine. Even though it can seem tedious, it’s vital to keep up your medical and therapy appointments. These provide accountability and support so that your recovery can continue.