The treatment of bulimia nervosa usually involves a multidisciplinary team that provides several different types of therapy in the overall treatment plan.

Psychotherapy

Psychotherapy is the first-line treatment approach for bulimia nervosa, as there is often an underlying psychological cause that is associated with the negative body image and unhealthy eating behaviors associated with the disorder.

It involves psychological counseling and the discussion of struggles and progress related to the disorder with a mental health professional. There are several different types of psychotherapy, including:

• Cognitive behavioral therapy (CBT) to identify unhealthy beliefs and behaviors and create strategies to replace them with more positive ones.
• Family-based therapy to involve the parents or other family members in the treatment plan and help in the reinforcement of positive behaviors in the home environment, particularly for adolescent patients.
• Interpersonal psychotherapy to address difficulties in close relationships that may have caused the disorder and help to improve communication and conflict resolution skills.
• Dialectical behavioral therapy (DBT) to develop healthier methods to regulate and manage emotional stress, which may have caused the disorder.
• Intensive short-term dynamic psychotherapy (ISTDP) to identify and replace unhelpful emotional triggers and defenses that may have caused the disorder.
• Mindfulness therapy to accept and disengage from negative thoughts, rather than challenging them (as in other therapies such as CBT)

The type of psychotherapy that is best suited to the individual patient will depend on the characteristics of the disorder and the individual, such as age and likely causative factors.

Pharmacotherapy

In some cases, medications may be indicated to help manage particular symptoms of bulimia nervosa. It is worth noting that psychotherapy is more effective for most patients, but pharmacotherapy can also be beneficial, particularly if depression or anxiety is a major contributing causative factor.

Fluoxetine is a type of antidepressant called a selective serotonin reuptake inhibitor (SSRI) that is indicated for use alongside psychotherapy. There is also some evidence to suggest that it may be beneficial for patients that do not suffer from depression. Other antidepressants are also used in the treatment plan for some patients.

Nutritional Recommendations

A nutritious eating plan is useful to help patients achieve and maintain a healthy weight. A nutritionist or dietitian may be involved in the process to devise the diet plan and help the patient to create strategies to stick to the plan.

A medically supervised program designed for weight loss can often be beneficial to help the individual to lost weight and feel in control of their body image, without feelings of guilt for failing to adhere to strict self-enforced diets.

Acute Treatment

In most cases, the treatment of bulimia involves long-term strategies to maintain healthy eating habits and body weight, but in severe cases acute treatment and hospitalization may be required.

This is particularly evident in the case of electrolyte imbalances following vomiting or the use of laxatives, which can cause potentially fatal cardiovascular complications. An echocardiogram can be used to identify heart arrhythmias and help guide the appropriate treatment decisions to prevent severe outcomes.

Long-Term Prevention

It is important for patients that are recovering from bulimia nervosa to have access to a strong support network that is able to assist them in maintaining healthy eating habits.

Although most patients make a full recovery, some patients always experience periods of bingeing and purging that may recur in highly stressful or emotional periods of life. For this reason, continued support should be available in these times to help patients to cope and manage stress levels in a healthier way. An eating disorder support group may be useful for this purpose.

References

• http://www.nhs.uk/Conditions/Bulimia/Pages/Treatment.aspx
• http://www.helpguide.org/articles/eating-disorders/bulimia-nervosa.htm#treatment
• http://www.nytimes.com/health/guides/disease/bulimia/treatment-for-bulimia.html
• http://www.eatingdisorders.org.au/eating-disorders/treatment/types-of-treatment
• http://www.mayoclinic.org/diseases-conditions/bulimia/diagnosis-treatment/treatment/txc-20179842