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Treating Bulimia Nervosa
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Bulimia, or bulimia nervosa (BN), is an eating disorder characterized by bingeing and purging. 

Bulimia is more prevalent than anorexia nervosa. Data suggests this disease affects approximately 1 percent to 3 percent of adolescents in the United States, with onset usually beginning in late adolescence or early adult life. There is evidence that the incidence of bulimia is growing, but estimates vary. 

Medical complications of bulimia can be serious and can be fatal. When a parent suspects that a loved one has BN, it is important to seek treatment immediately, beginning with a comprehensive medical examination. Ideally, parents should seek out a physician who is experienced in the treatment of eating disorders, to support their loved one’s ongoing care.

The symptoms of bulimia include an overwhelming and addictive compulsion to binge and then purge food. Unlike anorexia, the condition usually causes intense embarrassment and shame and can be concealed even from close family members indefinitely.  Contrary to popular ideas about the illness, patients are generally of normal weight. Despite the lack of outward signs of the illness, bulimic patients are often suffering from nutritional deficiencies and internal damage. Emotionally, the experience of being bulimic is painful and chaotic. 

The bulimic cycle is generally initiated, like anorexia, with restrictive eating. This is followed by an intense psychological (and physical) compulsion to eat – often highly palatable carbohydrate foods in rapid and intense binges. Following the brief relief from hunger, there is often intense regret and a compulsion to rid the body of food. The act of purging offers a short and intense physiological and emotional “high” and relief from the discomfort of feeling full. As the patient resists eating again, the cycle continues.

Purging is achieved in several different ways: generally through vomiting but also through other means such as laxative abuse and exercise.

Both binging and purging can cause permanent damage or injury without warning even in patients new to the illness. Psychologically, this is a devastating and frightening illness to experience and often frightening to loved ones surrounding the patient.

Caregivers should avoid shame, blame, and anger and remember that the patient is not weak or willful. Bulimia is a real illness, not a choice, and recovery is painful and difficult. It takes courage and support and expert care to face this illness. Parents and caregivers play a key role in creating a home environment conducive to recovery by participating in evidence-based care with well-trained clinicians, reducing stress and conflict in the home, and creating a well-ordered plan around food and monitoring after meals. The key to successful treatment is early, long-term, well-informed intervention.

Family-Based Maudsley Therapy

Research into Family-Based Maudsley therapy to help patients recover from bulimia is currently under way. A treatment manual for clinicians is available: “Treating Bulimia in Adolescents.” (see this entry on our Book Review page)

 

Cognitive Behavioral Therapy

The US NIH reports: “For many patients, cognitive behavioral therapy combined with high doses of Prozac, can help them in recovery from BN” Serotonin regulation is considered an important aspect of managing BN, and may help reduce the risk of relapse of behaviors."

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