Bulimia, or bulimia nervosa, is a serious and potentially life-threatening eating disorder characterized by the practice of eating large amounts of food in secretive binges followed by compensatory behaviors, such as purging that food via vomiting and/or laxative use to prevent weight gain. Unlike patients with anorexia nervosa, patients with bulimia nervosa rarely lose much weight or develop nutritional deficiencies.
Individuals who struggle with bulimia may feel a sense of lack of control over their binge eating episodes and an intense sense of guilt or shame afterward. Patients with bulimia nervosa can develop serious physical and mental health consequences if left untreated and typically requires professional treatment, such as therapy and/or medication, to overcome.
SIGNS AND SYMPTOMS OF BULIMIA NERVOSA
It can be hard to tell if a child, teen, or adult has bulimia, as people with this disorder are often at a healthy weight and only binge and purge when their family and friends are not around. So, recognizing the signs and symptoms of bulimia nervosa is important.
Symptoms of bulimia nervosa include:
- Being preoccupied with your body shape and size
- Having an intense fear of gaining weight
- Frequent episodes of binge eating large amounts of food in one sitting
- Feeling a loss of control while bingeing
- Forcing yourself to vomit or exercise rigorously to maintain the perceived goal weight
- Using dietary supplements or herbal products excessively to lose weight
- Abuse of laxatives, diuretics, or enemas after eating when they’re not needed
You may also notice physical symptoms such as:
- A sore throat from being sick
- Abdominal pain
- Acid reflux
- A puffy face
According to a study published by the National Eating Disorders Association (NEDA), bulimia nervosa has a mortality rate of 3.9%.
The frequency of your binge eating and purging episodes determines the severity of your eating disorder. Consult with a healthcare provider if you suspect bulimia in you or a loved one.
What Are the Mental Health Disorders Associated With Bulimia?
Studies have shown that individuals with bulimia nervosa are more likely to experience one or more mental health disorders, including anxiety disorders (such as obsessive-compulsive disorder, generalized anxiety disorder, and social anxiety disorder), mood disorders (such as depression), and substance use disorders. In some cases, the eating disorder may develop as a way to cope with these other psychiatric disorders or as a result of the symptoms associated with them. It is not uncommon for individuals with bulimia to have a history of traumatic experiences, such as abuse or neglect, or to experience symptoms of post-traumatic stress disorder (PTSD). It’s important for individuals with bulimia nervosa to receive comprehensive treatment that addresses both the eating disorder and any co-occurring mental health conditions they may be experiencing.
TREATMENT OPTIONS FOR BULIMIA NERVOSA
It is important to seek treatment for bulimia nervosa because this eating disorder can have serious physical and mental health consequences if left untreated. Complications of bulimia can include electrolyte imbalances, dehydration, gastrointestinal problems, and damage to internal organs, among other health concerns. In addition to the physical health risks, bulimia can also have significant impacts on an individual’s mental health, including increased risk for major depression, anxiety disorders, and other mental health disorders.
Treatment of bulimia nervosa typically involves a combination of medical, nutritional, and psychological interventions. Medical treatment of bulimia may be necessary to address any physical complications resulting from the eating disorder, such as malnutrition or electrolyte imbalances. Nutritional treatment may involve working with a registered dietitian to develop a meal plan that meets the individual’s nutritional needs and supports recovery. Psychological treatment may include a combination of therapies, such as cognitive behavior therapy (CBT) and interpersonal therapy (IPT), or family-based treatment. This treatment approach may focus on addressing the underlying psychological factors contributing to the eating disorder, such as low self-esteem, anxiety, or depression.
Antidepressant medications may also be used to help reduce the symptoms of bulimia when used along with psychotherapy. The only antidepressant medication 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 the patients with bulimia nervosa don’t have symptoms of depression.
Your treatment team may include your primary care provider, a mental health professional, and a dietician with expertise in treating eating disorders. You may also be assigned a case manager to ensure that you receive the necessary treatments and services to address the condition effectively.
Here is a brief look at some of the psychotherapy options for bulimia:
Also known as talk therapy, psychotherapy is a treatment approach that involves discussing your eating disorder and related issues, such as distorted body image, with a mental health specialist. Evidence suggests that the below types of psychotherapy help improve physical and psychological symptoms of bulimia :
- Cognitive-behavioral therapy (CBT) – This helps you re-establish healthy eating patterns and identify and change maladaptive thought processes, beliefs, and behaviors. The goal is to help individuals learn to self-monitor, recognize distorted thought patterns, and reframe negative beliefs or attitudes.
Enhanced Cognitive Behavioral Therapy (CBT-E) – This therapy evolved from traditional CBT 12, with the inclusion of several additional techniques. Specifically, it incorporates techniques designed to address problems with self-esteem, perfectionism, and interpersonal interactions.
- Family-based treatment or family therapy – This helps parents intervene and stop their children’s unhealthy eating behaviors, help them regain control over their eating, and resolve misunderstandings and issues that may have been caused due to the eating disorder.
- Interpersonal psychotherapy – This psychological treatment addresses issues in your relationships and helps you develop communication and problem-solving skills.
Dialectical Behavior Therapy (DBT) – This is a form of therapy that combines elements of CBT with other techniques, including mindfulness and emotion regulation skills. In addition to addressing the eating disorder directly, it aims to help individuals improve their ability to tolerate distress and better regulate their emotions.
Will You Need to Be Hospitalized for Bulimia Treatment?
Treatment for patients with bulimia can be done outside of a hospital setting. However, hospitalization may be necessary for individuals with more severe or life-threatening symptoms, such as extremely low body weight or electrolyte imbalances. Hospitalization can help to stabilize the individual’s condition and provide medical care, nutritional support, and psychological treatment as needed. Additionally, some specialized residential or inpatient treatment programs may be available for individuals with bulimia who require intensive support and monitoring to manage their symptoms and achieve a sustained recovery. However, it’s important to note that hospitalization is typically reserved for individuals with the most severe symptoms, and most individuals with bulimia can be treated effectively on an outpatient basis.
GOALS OF BULIMIA TREATMENT
The goals for treatment will be tailored to meet the needs of the individual, but in general, the top four goals of treatment when bulimia nervosa is the primary disorder include:
- Identifying distorted perceptions about food. Often, those struggling with eating disorders believe that whole food groups are fattening or unhealthy. They develop rituals in eating, grouping foods or eating large amounts of specific foods in the hopes of avoiding caloric absorption while still allowing them to binge. Recognizing which beliefs are false – and dangerous – is an important part of bulimia treatment.
- Addressing issues of body image. Often people with bulimia nervosa are of average weight but perceive themselves as overweight. Learning how to more healthfully and accurately define “normal weight” can aid those in recovery in adjusting their self-perceptions.
- Learning how to eat healthfully. Nutritional counseling that teaches patients how to plan meals, shop, cook, and order at restaurants can increase their ability to manage their eating habits and maintain healthy body weight without resorting to disordered eating habits.
- Managing compulsive behaviors. Compulsive binge eating may be triggered by a number of different factors. Identifying the trigger issues in each patient and learning how to better handle those problems without resorting to episodes of binge eating is another main goal of treatment for bulimia.
PERSONALIZE CARE IN EATING DISORDER TREATMENT PROGRAMS
Everyone who lives with an eating disorder like bulimia develops these disordered eating behaviors for a number of different reasons, often including one or more of the following:
- Lack of control in life
- Body image issues and lack of self-esteem
If any of these issues are problematic for the patient, they should be addressed during the treatment program. Individual therapy, group therapy, and a wide range of holistic and alternative treatments can help patients with bulimia nervosa to progress as they process through the mental and emotional obstacles to developing positive eating habits.
It is not uncommon for those with an eating disorder to struggle with other mental disorders, such as major depression, obsessive-compulsive disorder, anxiety disorders, personality disorders, and substance use disorders. For such people, successful treatment entails a treatment plan that includes both the treatment of bulimia and other co-occurring psychiatric disorders.
If you would like to learn more about how we help patients heal through eating disorder treatment and improve mental and physical health here at Futures, contact us today.