Bulimia Treatment Options - OmniMedicalSearch.com

Bulimia is a complex disorder that requires a comprehensive and multidisciplinary treatment with different types of approaches from the medical care, psychological counseling, nutritional interventions to medication. However, although there is lot of interest in finding the most effective form of therapy with the best results, there is no universally accepted standard treatment used for individuals suffering from bulimia.

According to clinical experience, treatment is more successful when the disorder is being diagnosed in the initial stages. If the disorder is present for a longer period the time, it is harder to overcome its symptoms and effects on the body and the person is less likely to accept that they are sick and need help.

The primary goal of bulimia treatment is to reduce and completely eliminate the binge eating and purging behaviors and replace them with healthy eating habits while reducing the negative effects of the condition as it affects the overall health. The long term goal of the treatment is to alter the distorted body image of the bulimic and change their unhealthy and unrealistic ideal weight goals.

The most used treatment approaches used for individuals with bulimia that accept to be treated are:

Psychotherapy is an umbrella concept used to include all those treatment approaches where the individual is addressing aspects of the disorder under the direct guidance and support of a psychotherapist or counselor. Some of the most common psychotherapeutic approaches used with individuals suffering from bulimia are:

1). Cognitive behavioral therapy: Cognitive behavioral therapy is a form of psychotherapy that offers the most benefit in treating bulimics. It is estimated that in 30 to 50 percent of the bulimics treated with this form of therapy, the binging and purging symptoms disappear.

This form of psychotherapy addresses psychological disturbances based on the notion that they are stemming from "specific, habitual errors in thinking," therefore the treatment focuses on reducing and replacing the bulimic's dominant dysfunctional and harmful beliefs and behaviors with those that are more adaptive and functional. The main goal of cognitive behavior therapy (CBT) in individuals with bulimia is to help them gain control over their eating habits, and to develop a healthy attitude towards food, eating, as well as body weight and shape. Although both aspects of the conditions are addressed, the cognitive and behavioral dimensions, studies suggest that "the cognitive component of CBT appears to be the active ingredient for change, as behavioral interventions alone are not as effective." (11)

CBT has proven to be effective in perfectionist individuals with bulimia when addressing their unrealistic expectations and all-or-nothing type of thinking (binge-purging). Bulimics strive "for unattainable goals motivated by fear of failure and which repeatedly results in frustration due to the inability to attain the goal."(13) The therapy is trying to teach the patients to acknowledge and challenge their fears and change their way of thinking from an all-or-nothing to a more a balance manner.

2). Interpersonal psychotherapy (IPT): Interpersonal psychotherapy is a short-term, non-interpretative, and non-directive psychotherapy that helps patients identify and understand the relationship between the onset and fluctuation of their symptoms in connection to their current life dynamic (interpersonal problems) and to find ways to modify them. The therapy is guided by three goals: (1) engaging the person in treatment, (2) evaluating the interpersonal context in which the eating disorder developed by assessing "the quality of the patient's current interpersonal functioning" and examining the interpersonal context of the bulimic episodes, and (3) focusing on resolving the problems identified by the patient with the counselors help. There are several studies which suggest that interpersonal psychotherapy seems to be as effective as cognitive behavioral therapy in the treatment of bulimia. (12)

3). Psychodynamic/psychoanalytic psychotherapy. Psychodynamic psychotherapy is a form of therapy that attempts to modify behavior using psychoanalytical approaches such as "uncovering of abreaction to traumatic events (purging of emotional tensions); emotional responses to real, imagined, and anticipated losses; realizations regarding the existence of conflictual attitudes and self-deceptions; analysis of typical maladaptive emotional reactions and defensive styles; examination of negative transference reactions when they present clear resistance's to therapeutic advance; and the development of new perspectives in relation to these discoveries. (Yager, 1992)" (13) When addressing bulimia psychological issues, the attention is focused on the developmental issues related to dependency and separation (or individuation - spelled correctly). The disorder is seen as the result of developmental struggles for autonomy, competence, self-esteem, and self-control.

4). Family therapy: Although there is no direct evidence that bulimia is caused by dysfunctional family communication and relationship patterns, the need for family therapy in the treatment of bulimia is undoubtable. The role of this approach is to explore the family dynamic and dysfunctional relationships by identifying those factors that precipitate and trigger dysfunctional eating behaviors and to facilitate a therapeutic process of change by eliminating the life threatening symptoms of the disorder.

According to a study conducted by Dr. Daniel le Grange of the University of Chicago, family therapy seems to be more effective then "traditional solo psychotherapies in helping teens with bulimia to abstain from binging and purging." (14) The family based therapy evaluated during the study was structured on three phases: (1) phase one: the sessions focus on teaching parents how to stop their children from engaging in dysfunctional and harmful eating habits, (2) phase two: the sessions focus on helping adolescents learn to take control over their eating habits without the direct control of their parents, and (3) phase three: the sessions focus on addressing how bulimia affects the developmental process.

5). Couples therapy: For bulimic patients engaged in a relationship, there are supportive services that address marital or couple issues caused by the negative impact of the disorder in the couple's dynamic. However, the studies that focus on the efficiency of this form of treatment are limited and the information not sufficient in order to formulate a conclusion.

In general, individuals with bulimia know a lot about food, but their knowledge is distorted and used in a self-destructive manner, therefore nutritional counseling is recommended in order to reintroduce the bulimic to normal and healthy eating habits. Based on clinical experience and studies, the use of nutritional rehabilitation in addition to psychotherapy and medication "produces a rate of clinical improvement not seen in single modality treatments."(15)

Nutritional rehabilitation is a specialized approach focused on correcting disordered behaviors and beliefs about food and exercise by replacing unhealthy and harmful eating patterns with organized and healthy eating behaviors, and restoring and maintaining a healthy weight. Under the guidance of a nutritional counselor, bulimics learn to set achievable goals and use various ways to maintain them throughout their life without returning to the active stages of the disorder.

Through nutritional counseling, bulimics learn to regulate their appetite and engage in and maintain normal eating habits. Bulimics engage in behaviors that restrict the intake of calories for a period of time, but when an overwhelming sense of hunger takes over, they start binging. Under the guidance of a nutritional counselor, bulimics learn how to eat normal meals and snacks in order to regulate their appetite and how to recognize feelings of fullness and hunger.

Due to their constant concern with gaining weight, it is common for bulimics to avoid certain foods and nutrients. Through nutritional counseling the patient is educated about the nutritional value of different food groups and avoid fad diets, how to shop for food and prepare it in order to offer the body the nutrients required to function properly, and even how to safely eat at restaurants avoiding triggers that can lead to binge and purging.

In addition to psychotherapy and nutritional rehabilitation counseling, there are cases when the use of medication can be beneficial for certain patients. However, when medication is administered the patient is carefully monitored especially when they engage in frequent purging behaviors or are taking increased amounts of laxatives. Psychotropic medication, primarily antidepressants have been found to be helpful in treating bulimia symptoms. The use of antidepressants prove to be efficient in reducing bulimia symptoms and supporting psychotherapy in restoring a healthy eating lifestyle.

One of the most common groups of antidepressants used in the treatment of bulimia is SSRI (selective serotonin reuptake inhibitors). SSRI reduce the severity of obsessive behaviors, anxiety, impulsivity, and depression. Bulimics benefit from the use of antidepressants even if they are not depressed. The only approved antidepressant drug by the U.S. Food and Drug Administration for the treatment for bulimia is Fluoxetine. Other SSRIs that seem to work in individuals with bulimia include sertraline, paroxetine, and citalopram.

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