Bulimia nervosa responds better to treatment than anorexia nervosa. For bulimia treatment to succeed, therapy must alter the bulimic's unrealistic idea of body image and ideal weight. Healthy eating habits must be learned, and the patient must break free from the "addiction" of binge eating and purging.

Bulimia treatment may include psychotherapy, antidepressants, or a combination of the two. Cognitive behavioral therapy has better long-term results than antidepressants. A combined treatment regimen of both antidepressants and therapy is thought to yield better results than either treatment alone.

Bulimia Therapy: Changing Body Image and Teaching Healthy Eating Habits

Bulimia nervosa therapy is best performed by a specialist in treating eating disorders. For best results, the patient should undergo weekly therapy sessions for at least five months.

Cognitive-behavioral therapy is most often used to treat bulimia nervosa. The goals of cognitive-behavioral therapy are to change the patient's eating habits and his or her perception of the ideal body and weight.

During bulimia therapy, patients are educated on the health risks associated with the disease and how the cycle of binge eating and purging is affected by self-esteem and body image. Craving-control techniques and methods of developing healthy eating habits are taught during therapy.

Bulimia therapy also helps patients identify triggers of their binge eating, and develop more positive solutions to stress and emotions. As part of the process of reevaluating body image and ideal weight, therapy also attempts to improve self-esteem and replace body image with healthier methods of self-evaluation.

Antidepressants and Bulimia Nervosa Treatment

Treating bulimia with antidepressants has shown some success. Antidepressants can lessen bulimia symptoms and support therapy in restoring healthy eating patterns. While antidepressants are used to treat depression in anorexics, the medication does not seem to affect anorexia symptoms. In contrast, bulimics often benefit from antidepressants even if they aren't depressed.

SSRI (selective serotonin reuptake inhibitors) are the family of antidepressants most commonly used to treat bulimia nervosa. SSRI antidepressants reduce the severity of obsessive behavior, anxiety, impulsivity and depression often associated with bulimia. Reducing such symptoms may help bulimia patients overcome concerns about ideal weight and return to healthy eating habits.

Fluoxetine is the only SSRI specifically approved by the U.S. Food and Drug Administration (FDA) for the treatment of bulimia. Clinical trials have shown other SSRI antidepressants have benefits for bulimia patients, including sertraline, paroxetine, and citalopram.

Clinical trials also suggest certain tricyclic antidepressants (imipramine, nortryptyline, and desipramine) and monoamine oxidase inhibitors may be useful in bulimia nervosa treatment. Treating bulimia with antidepressants containing bupropion is not recommended, as the medication can causes seizures in purging patients.

Additional Bulimia Treatments

In addition to bulimia therapy and antidepressants, a number of other treatments may help bulimics during recovery, to help reevaluate body image and develop healthy eating habits.

• Dental Care: While undergoing bulimia treatment, patients who induce vomiting may be able to slow the progress of dental erosion by using a soft toothbrush and rinsing with a fluoride rinse.
• Family Therapy: If distorted body image and eating habits are rooted in family dynamics, family therapy may help resolve issues contributing to bulimia and preventing healthy eating.
• Group Therapy: Group therapy, support groups, and 12-step programs for eating disorders provide environments in which recovering bulimics can share experiences and discuss body image and ideal weight freely with other patients. Group therapy may help reduce relapse rates.
• Laxative Dependency Treatment: Treating laxative dependency in bulimia is difficult. Attempts should be made to educate the patient about the dangers of laxative abuse and how little laxatives actually contribute to weight loss. Restoring normal bowel function after laxative abuse may take weeks. Bowel function may return faster with a regimen of healthy eating, high fiber diet, rehydration and moderate exercise (however, exercise as treatment is not recommended when excessive exercise is part of the bulimic's purging strategy).
• Marital or Couple's Therapy: Couple's therapy helps resolve interpersonal conflicts that may otherwise hinder successful treatment.
• Nutritional Therapy: Consulting a qualified dietician or nutritional specialist may help bulimia patients learn healthy eating habits and devise menus geared towards proper nutrition and healthy eating.

Bulimia Treatment and Relapse

Overall, bulimia nervosa responds better to treatment than anorexia, and patients are often able to alter both body image and develop healthy eating habits. Elements of bulimia persist after treatment however — a recovered bulimic's sense of body image and ideal weight may always be a little distorted.

While prognosis for bulimia patients is generally positive, some factors reduce the chances of successful treatment. These include:

• denial of health problems
• frequent and persistent vomiting
• high levels of impulsivity
• history of obesity
• history of substance abuse
• hospitalization due to bulimia complications
• no motivation for recovery
• poor socialization skills
• severe depression
• severely distorted body image.

Short-term success for bulimia treatment ranges from fifty to seventy percent of cases, although relapse rates after six months can be as high as thirty to fifty percent. Few long-term studies on bulimia treatment outcomes have been pursued, so information on long-term relapse rates is unavailable.

Resources

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Deshmukh, R. & Franco, K. (nd). Eating disorders.

Gowers, S. & Bryant-Waugh, R. (2004). Management of child and adolescent eating disorders: The current evidence base and future directions. Journal of Child Psychology and Psychiatry 45, 63-83.

MedicineNet. (updated 2002). Bulimia nervosa.

Mehler, P.S. (2003, August 28). Bulimia nervosa. The New England Journal of Medicine 349(9), 875-881.

Rome, E.S. & Ammerman, S. (2003, December). Medical complications of eating disorders: An update. Journal of Adolescent Health 33(6), 418-426.