Bulimia Nervosa Treatment: Therapy, Medications, & Support

How Is Bulimia Treated?

Bulimia nervosa is an eating disorder marked by episodes of binging and purging. This condition can lead to long-term mental and health impacts, such as tooth decay and acid reflux. While bulimia cannot necessarily be “cured,” certain interventions can help individuals overcome uncomfortable thoughts and beliefs that fuel their disorder. Determining how to treat bulimia varies by person but can include therapy, medications, and healthy lifestyle changes. With effort and time, bulimia recovery is possible.

Therapy for Bulimia

Therapy for bulimia ranges from weekly talk therapy to intensive outpatient programs (IOP). These options encourage patients to gain perspective into their disorders through self-reflection. The client-therapist relationship provides an unbiased, open-minded space to explore anything impacting recovery. Therapy is not always easy and comfortable, but it offers the environment to work through challenging and uncomfortable feelings.

Cognitive Behavioral Therapy (CBT)

Cognitive behavioral therapy (CBT) is one of the few evidence-based approaches to bulimia treatment. This short-term regimen has a 50% success rate for individuals with bulimia (success being the cessation of binging and purging).

The idea is to uncover the irrational, repressed thoughts that trigger unwanted behaviors (binging and purging). The individual will meet with a CBT (or CBT-E) certified therapist to complete logs, workbooks, and worksheets (often referred to as “homework”).^1,2,3,4

Psychoanalysis

Psychoanalysis is a long-term treatment with sessions typically occurring once or twice weekly. While there is qualitative and anecdotal evidence of success, psychoanalysis is not considered an evidence-based practice. The goal is to uncover the root of the bulimia through delicate and gradual probing of the subconscious psyche.

This treatment for bulimia is valuable because those with the disorder are especially prone to experience deep insecurities and self-loathing. Ideally, Certified Eating Disorder Specialists (CEDS) with extensive training provide this treatment.^1,4

Psychoeducation

Psychoeducation includes teaching individuals about bulimia, nutritional information, and the causes and effects of purging. For some, the idea of tooth decay and acid reflux can be enough to alter their behavior. Additional techniques, like delay, distraction, or parroting, are helpful tools in psychoeducation.¹

Delay means allowing oneself to engage in unwanted binge and purge behaviors but delay their initiation. With time and practice, episodes become more sporadic.¹ Distraction encourages individuals to use coping tools and engage in activities rather than unwanted episodes.¹ Finally, parroting means repeating helpful mantras like, “Food will not hurt me,” “Food is part of recovery,” and “Purging now will only continue the cycle.”.¹

Group Therapy

Bulimia nervosa treatment plans can also benefit from group therapy. Individuals with bulimia often struggle with socializing, relating to others, and asserting themselves in conflict. Group therapy led by a trained facilitator can be helpful because it adds a social component to treatment.

Members benefit from knowing they are not alone through feeling seen and genuinely understood by others.¹ In some groups, bulimic individuals can review meal plans and food journals with a sponsor or trusted peer.¹

Family Therapy

Bulimia has a strong genetic component and higher incidence in those with a parent exhibiting disordered eating. Environmental stressors at home can also contribute to an eating disorder, so individuals should explore how their family dynamics affect their behavior. Family therapy for bulimia can help individuals express their emotions while confronting and communicating with family, providing relief and resolution.^2,5

Brief Strategic Treatment (BST)

Brief strategic treatment (BST) is a short-term and effective treatment for bulimia. BST uses the dysfunctional perceptive-reactive system to focus on “un-doing” dysfunctional approaches to learn new solutions to problems. The therapist may use a miracle question like, “What would need to happen in your life for you to feel resolved?”⁶

Residential Treatment for Bulimia

In some cases, receiving help for bulimia means seeking residential programs. Interested individuals must be stable enough to live independently in dormitories (contrary to hospitalization under constant watch). However, their condition warrants putting their life on hold for weeks away from friends, family, and work to focus solely on recovery.

Once admitted, patients spend their days in various educational and recovery groups. These may include psychoeducation and eating groups to review meals from the previous day. Individuals may also engage in individual, family, and group therapy. In general, the intensity of a residential program shows a good prognosis for recovery. After treatment, outpatient therapy may be necessary for sustaining recovery efforts.¹

Hospitalization for Bulimia

The most acute and severe cases may warrant hospitalization. These stays can help address medical problems from bulimia, such as aspiration of food, respiratory distress, GERD, acid reflux, diarrhea, and dehydration.

Hospitalization bulimia nervosa treatment includes managing vitals, regulating food intake (proper caloric intake), and a specialist to prevent self-harming and purging behaviors. Patients will also engage in group and family therapy. The goal is not to cure the patient but to stabilize them for ongoing treatment in an outpatient setting.

Medication for Bulimia

Medication for bulimia is not always necessary. However, professionals may recommend an antidepressant to address underlying mood issues or an appetite suppressant to control binges. Patients need a routine physical, psychiatric evaluation, and a prescription to receive bulimia nervosa medications.

Common medications used in the treatment of bulimia include:

• Selective serotonin reuptake inhibitors (SSRIs): One study shows that Prozac for bulimia reduced binge eating episodes by 45% and purging by 29%. Prozac is often a first line of defense in treating bulimia. The FDA has also approved fluoxetine for bulimia.^4,7
• Buproprion/Wellbutrin: This antidepressant can help with addictive behaviors, including smoking and alcohol use. In bulimia treatment, bupropion can improve mood and energy levels and reduce binge eating episodes.⁴
• Trazodone: Trazodone is a tetracyclic antidepressant used to treat depression and anxiety. In one study, this medication reduced binge eating by 31% in patients taking a daily 400 to 650 mg dose.⁴
• Tricyclic antidepressants: One study showed that desipramine, imipramine, and amitriptyline reduced binge eating by 72% and vomiting by 78%. Overall, short-term placebo-controlled trials in patients with bulimia nervosa report that tricyclic antidepressants reduce binge eating by 47 to 91% and vomiting by 45 to 78%.⁴
• MAOIs: MAOIs, like phenelzine and isocarboxazid, are more effective than placebo in reducing binge eating.⁴
• Topiramate/Topimax: Topimax is a seizure and headache medication that helps elevate mood, relieve anxiety, and control appetite.⁴

How to Cope With Bulimia During Treatment

Bulimia is a chronic condition requiring ongoing monitoring and support. Relapse is common, and some days will feel like a struggle, even in prolonged recovery. Be proactive about developing positive lifestyle routines, a healthy relationship with food and your body, and a support system. Recognize that feeding your body and taking pleasure in food is okay and healthy.

Avoid deprivation when learning how to overcome bulimia. Depriving yourself of food means you are more likely to engage in binge and purge sessions. If you do binge and purge, keep track of what led to an episode to identify any emotional triggers and foods. Educate yourself on body positivity to approach recovery from a compassionate place of self-love and gratification.

Below are bulimia self-care activities to help you in recovery:

• Practicing intuitive eating: Mindful eating starts with eating when hungry and stopping when full. Consider this approach over tracking and counting calories.
• Develop coping skills: Easing into hobbies and enjoyable activities again can be a welcome distraction and method of coping when overwhelmed.
• Join a self-help group: Food Addicts Anonymous and Overeaters Anonymous are long-standing, reputable support groups for sufferers of all eating disorders.
• Learn body positivity: Learning to accept and love your body will reduce episodes of bulimia. Studies show body dysmorphia and self-loathing are at the core of most eating disorders.¹
• Be honest about your experience: Be honest with doctors and other care providers about your food, purging, and exercise habits.
• Limit environmental stress: Your health and wellness should take priority over any other career, financial, or aspirational stressors during bulimia recovery.
• Explore your social media habits: Re-evaluate the role of social media in your life. Are the influences on social media negatively or positively impacting you in your recovery?
• Talk to professionals: Consult with a registered dietician, nutritionist, and other professionals involved in your treatment prior to engaging in diets or exercise routines aimed at weight loss.
• Engage in mindfulness: Practice a meditation routine to work on distancing yourself from unhelpful thoughts that feed into your desire to binge, purge, or restrict.
• Stay positive: Research shows that an excessive negative attitude strongly correlates with disordered eating behavior.⁸
• Get proper sleep: Consider a device that tracks sleeping patterns and learn about sleep hygiene techniques, such as reducing caffeine and screen time.⁹

Final Thoughts

Being concerned or even skeptical about treatment for bulimia is natural. Sometimes fear and vulnerability keep individuals who desperately need help from reaching out. Trust that your providers are there to help you. Our judgment and decision-making abilities can feel all out of sorts when in the midst of a mental health crisis, so consider pursuing professional guidance. Overcoming bulimia is possible–you just have to take the first step.