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Treatments and drugs
By Mayo Clinic staffWhen you have bulimia, you may need several types of treatment, although combining psychotherapy with antidepressants may be the most effective for overcoming the disorder. Treatment generally involves a team approach that includes you, your family, your primary care doctor or other medical provider, as well as a mental health provider and a dietitian experienced in treating eating disorders. You may have a case manager to coordinate your care.
Here's a look at bulimia treatment options and considerations:
Psychotherapy
Psychotherapy involves talking about your bulimia and related issues with a mental health provider. Psychotherapy is also known as talk therapy, counseling or psychosocial therapy. There's evidence that these types of psychotherapy help improve symptoms of bulimia:
- Cognitive behavioral therapy to help you identify unhealthy, negative beliefs and behaviors and replace them with healthy, positive ones
- Interpersonal psychotherapy, which addresses difficulties in your close relationships, helping to improve your communication and problem-solving skills
- Dialectical behavior therapy to help you learn behavioral skills to tolerate stress, regulate your emotions and improve your relationships with others — all of which can reduce the desire to binge eat
- Family-based treatment to help parents intervene to stop their teenager's unhealthy eating behaviors, then to help the teen regain control over his or her own eating, and lastly to help the family deal with problems the bulimia can have on the teen's development and the family
Ask your mental health provider which psychotherapy he or she will use and what evidence exists that shows it's beneficial in treating bulimia.
Medications
Antidepressants may help reduce the symptoms of bulimia when used along with psychotherapy. The only antidepressant specifically approved by the Food and Drug Administration to treat bulimia is fluoxetine (Prozac), a type of selective serotonin reuptake inhibitor (SSRI), which may help even if you're not depressed.
Nutrition education and achieving healthy weight
If you're underweight due to bulimia, the first goal of treatment will be to start getting you back to a healthy weight. Dietitians and other health care providers can design an eating plan to help you achieve a healthy weight, normal eating habits and good nutrition. If you have binge-eating disorder, you may benefit from medically supervised weight-loss programs.
Hospitalization
Bulimia can usually be treated outside of the hospital. But if you have a severe form and serious health complications, you may need treatment in a hospital. Some eating disorder programs may offer day treatment, rather than inpatient hospitalization.
Treatment challenges in bulimia
Although most people with bulimia do recover, some find that symptoms don't go away entirely. Periods of bingeing and purging may come and go through the years, depending on your life circumstances, such as times of high stress. If you find yourself back in the binge-purge cycle, "booster" sessions with your health care providers may help you weather the crisis before your eating disorder spirals out of control again. Learning positive ways to cope, creating healthy relationships and managing stress can help prevent a relapse.
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