Bulimia Nervosa Treatment: Therapy, Medications, & Support

How Is Bulimia Diagnosed?

Qualified healthcare professionals can diagnose bulimia. These professionals include psychologists, therapists, psychiatrists, pediatricians, and primary care physicians. Most providers will assess for bulimia using self-reports and asking individuals questions about their past and present eating habits. They may also administer assessment tools like ESP, SCOFF, EDE-Q, EAT-26, or CET to review the frequency and intensity of current symptoms.¹

Bulimia may also be diagnosed via other tests, and a doctor may want to run tests to determine how much damage has been done. A doctor may conduct a physical exam to assess height, weight, vital signs, and overall health. They may order lab tests to check protein, liver, kidney, and thyroid functions in addition to electrolytes. In some cases, they might recommend X-rays to assess stress fractures to measure bone density.¹

What Is Bulimia?

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.

Is There a Cure for Bulimia?

While bulimia cannot necessarily be “cured,” certain interventions can help people 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.

Where to Start When Getting Help for Bulimia

The type of intervention for bulimia will depend on the severity and intensity of current symptoms. In the most serious cases, people may need brief hospitalization and/or residential care to stabilize their physical health. In mild or moderate cases, people may start with intensive outpatient or outpatient mental health services. If you’re not sure what you need, you can always start by talking to your doctor or therapist.

Levels of Treatment for Bulimia

Eating disorder treatment consists of many levels of care, ranging from fairly infrequent therapy to 24/7 monitoring and support. The right treatment is based on numerous factors including your current symptoms, mental health, physical health, past recovery efforts, and current support system. Although there isn’t a cure for eating disorders, treatment can help reduce or eliminate symptoms. 

• Intensive outpatient treatment (IOP): IOP generally consists of attending treatment for a few hours for 2-5 days per week. Most people work or school and live at home while receiving IOP.
• Partial hospitalization (PHP): PHP treatment consists of 5 days of treatment for several hours a day. However, some people also continue to work or attend school when receiving this treatment.
• Residential programs: Residential treatment consists of full days living at a residential facility (also known as a rehab).
• Inpatient care: Inpatient care for eating disorders may take place at a hospital or rehab and is often necessary for acute medical stabilization.

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, acid reflux, diarrhea, and dehydration. Hospitalization for bulimia involves managing vitals, regulating food intake to ensure someone is getting enough calories, and seeing 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.

Residential Treatment for Bulimia

In some cases, receiving help for bulimia means going to a residential program. People interested in residential treatment must be stable enough to live independently in dormitories (contrary to hospitalization under constant watch). However, their condition is severe enough that it 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. People 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.²

Bulimia Therapy

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. 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.^2,5

Cognitive Behavioral Therapy (CBT)

CBT for eating disorders is one of the few evidence-based approaches to bulimia treatment. This short-term regimen has a 50% success rate for people with bulimia (success being the cessation of binging and purging). The idea is to uncover the irrational, repressed thoughts that trigger the unwanted behaviors of binging and purging. The individual will meet with a CBT-certified therapist to complete logs, workbooks, and worksheets (often referred to as “homework”).^2,3,4,5

Dialectical Behavior Therapy (DBT)

DBT for eating disorders may also be used to treat bulimia, as DBT is rooted in the essential skills of mindfulness, interpersonal effectiveness, and distress tolerance. Strengthening these skills can help people build a better relationship with themselves, their bodies, and food. DBT promotes a sense of self-empowerment, which can be particularly helpful for people with eating disorders.

Acceptance and Commitment Therapy (ACT)

ACT is a specific type of therapy that entails accepting negative thoughts rather than attempting to block or reframe them. In this therapy, you will learn to externalize your thoughts and separate yourself from them. You’ll also identify some of your core values and learn how to live in a way that’s more congruent with those values.

Cognitive Remediation Therapy

Cognitive remediation therapy (CRT) refers to a specific set of techniques intended to provide people with ‘thinking skills.’ This process mimics that of typical rehabilitation, and it can improve overall social functioning, attention, problem-solving, organizational capacity, and cognitive abilities. This can enhance cognitive flexibility, which may inherently reduce bulimic behavior.

Interpersonal Therapy

Interpersonal therapy can be used to treat bulimia because it helps people learn how to strengthen their relationships. It does not directly focus on food or eating behaviors. Because many people with eating disorders struggle in their relationships, improving their confidence, intimacy, and vulnerability with others may decrease the stuckness they feel with food.⁶

Psychoeducation

Psychoeducation includes teaching people 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, and parroting are helpful tools in psychoeducation:²

• Delay means allowing oneself to engage in unwanted binge and purge behaviors but waiting before taking action. With time and practice, episodes can become more sporadic.
• Distraction encourages people to use coping tools and engage in activities rather than unwanted episodes.
• Parroting means repeating helpful mantras, like, “Food will not hurt me,” “Food is part of recovery,” and “Purging now will only continue the cycle.”

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. Eating disorder 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.²
In some groups, bulimic individuals review meal plans and food journals with a sponsor or trusted peer.²

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 it can be helpful to explore how someone’s family dynamics affect their behavior. Family therapy for bulimia, like the Maudsley approach, can help people express their emotions while confronting and communicating with family, providing relief and resolution.^3,7

Brief Strategic Treatment (BST)

Brief strategic treatment (BST) is a short-term and effective treatment for bulimia. BST focuses 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?”⁸

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.

Bulimia Nervosa Medication

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 routine physical and psychiatric evaluations, and a prescription to receive bulimia nervosa medications.

Common medications used in the treatment of bulimia include:

• Prozac for bulimia: 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.^5,9
• Wellbutrin: Wellbutrin (buproprion) 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.⁵
• 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.⁵
• 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%.⁵
• MAOIs: MAOIs, like phenelzine and isocarboxazid, are more effective than placebo in reducing binge eating.⁵
• Topimax: Topimax (topiramate) is a seizure and headache medication that helps elevate mood, relieve anxiety, and control appetite.⁵

Nutrition Education

Nutrition education may be a component of bulimia treatment. It’s important to work with a registered dietitian who specializes in eating disorders. These professionals have both the education and clinical expertise to help people with bulimia. Many will focus on integrating concepts of mindful and intuitive eating with their clients.

It’s important for people with eating disorders to understand that there are no “good” or “bad” foods. Recovery requires learning how to eat regularly and nourish the body adequately. A dietitian often works closely with the client’s therapist, psychiatrist, and other members of their treatment team. They will also provide specific nutritional guidelines for people with other comorbid health conditions.

Support Groups & 12-Step Programs

Support groups and 12-step programs often supplement other treatment options. Groups focus on prioritizing a sense of peer camaraderie. Being around others can show people that they’re not alone in their shame or struggles. 12-Step programs embody the original principles of Alcoholics Anonymous (AA). These groups include Anorexics and Bulimics Anonymous (ABA), Eating Disorders Anonymous (EDA), and Overeaters Anonymous (OA).

Support groups vary in type and focus. For example, some groups are facilitated by licensed therapists certified in eating disorders. They may structure their groups based on specific topics like self-esteem, body image, and healthy coping skills. Other groups may be peer-led and rooted more in providing organic support to one another.

How Long Will Bulimia Treatment Take?

Recovering from bulimia generally takes time, and this process may include several ups and downs along the way. The length of treatment will depend on numerous factors, including the severity of the bulimia, one’s physical and mental health, and the presence of co-occurring conditions. Hospitalization tends to be the briefest treatment phase and may just last a few days or weeks.

Residential treatment tends to be at least a month, but it can range from anywhere from 1-6 months. IOP may last longer (about 3-6 months). Finally, people often work with outpatient therapists and/or registered dietitians for several months or years into their recovery process. This is because it simply takes time for people to understand and redirect themselves from their disordered patterns and thoughts.

How Are Bulimia Relapses Treated?

Relapses are common in every stage of bulimia treatment. They do not mean that you are failing at recovery. They simply mean that you are engaging in a trial-and-error process and learning more about your triggers and emotional regulation. That said, relapses can certainly be frightening, frustrating, and discouraging for both you and your loved ones.

In general, if a relapse occurs, it’s important to discern what happened. Which triggers were present, and which behaviors were used? In addition, what did you take away from this relapse? What will you attempt to do differently next time? Relapses can be dangerous, and it may be necessary to review treatment options or move to a higher level of care if they are persistent.

Bulimia Nervosa Self-Care for Support 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, coping skills specific to your eating disorder, a healthy relationship with food and your body, and an encouraging 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:

• Stick to your treatment plan: Remember your overarching goals for recovery and try to stay on track as much as possible.
• Understand your triggers: Identify the various emotional states, people, or situations that trigger you to binge and/or purge.
• Focus on nutrition: Prioritize eating regularly and nourishing your body. This may reduce binge urges.
• Grow your support system: Try to prioritize spending time with people who care about your emotional well-being. They can be there for you if you’re struggling.
• Practicing intuitive eating: Mindful eating starts with eating when hungry and stopping when full. Consider this approach over tracking and counting calories.
• Develop several different 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 that body dysmorphia and self-loathing are at the core of most eating disorders.²
• 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 before exercising: 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.¹⁰
• Get proper sleep: Consider a device that tracks sleeping patterns and learn about sleep hygiene techniques, such as reducing caffeine and screen time.¹¹