The treatment of bulimia nervosa usually involves a multidisciplinary team that provides several different types of therapy in the overall treatment plan.
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Psychotherapy
Psychotherapy is the first-line treatment approach for bulimia nervosa, as there is often an underlying psychological cause that is associated with the negative body image and unhealthy eating behaviors associated with the disorder.
This treatment approach involves psychological counseling and the discussion of struggles and progress related to the disorder with a mental health professional. There are several different types of psychotherapy that can be utilized, including:
- Cognitive-behavioral therapy (CBT) to identify unhealthy beliefs and behaviors, as well as create strategies to replace them with more positive ones.
- Family-based therapy allows for the parents and/or other family members of the patient to be involved in the treatment plan and help in the reinforcement of positive behaviors in the home environment, particularly for adolescent patients.
- Interpersonal psychotherapy addresses difficulties in close relationships that may have caused the disorder and helps improve communication and conflict resolution skills.
- Dialectical behavioral therapy (DBT) can be used to assist the patient in developing healthier methods to regulate and manage emotional stress, which may have caused the disorder.
- Intensive short-term dynamic psychotherapy (ISTDP) can allow the patient to identify and replace unhelpful emotional triggers and defenses that may have caused the disorder.
- Mindfulness therapy supports the patient in accepting and disengaging from negative thoughts, rather than challenging them, which is comparable to other therapies like CBT.
The type of psychotherapy that is best suited for the individual patient will depend on the characteristics of the disorder and the individual, such as age and likely causative factors.
Pharmacotherapy
In some cases, medications may be indicated to help manage particular symptoms of bulimia nervosa. It is worth noting that psychotherapy is more effective than medications for most patients; however, pharmacotherapy can also be beneficial, particularly if depression or anxiety is a major contributing causative factor.
Fluoxetine is a type of antidepressant called a selective serotonin reuptake inhibitor (SSRI) that is indicated for use alongside psychotherapy. There is also some evidence to suggest that it may be beneficial for patients who do not suffer from depression. Other antidepressants are also used in the treatment plan for some patients.
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Nutritional recommendations
A nutritious eating plan is useful to help patients achieve and maintain a healthy weight. A nutritionist or dietitian may be involved in the process to devise the diet plan and help the patient create strategies to stick to the plan.
A medically supervised program designed for weight loss can often be beneficial to help the individual lost weight and feel in control of their body image without causing feelings of guilt for failing to adhere to strict self-enforced diets.
Acute treatment
In most cases, the treatment of bulimia involves long-term strategies to maintain healthy eating habits and body weight, but in severe cases, acute treatment and hospitalization may be required.
This is particularly evident in the case of electrolyte imbalances following vomiting or the use of laxatives, which can cause potentially fatal cardiovascular complications. An echocardiogram can be used to identify heart arrhythmias and help guide the appropriate treatment decisions to prevent severe outcomes.
Long-term prevention
It is important for patients who are recovering from bulimia nervosa to have access to a strong support network that is able to assist them in maintaining healthy eating habits.
Although most patients make a full recovery, some patients always experience periods of bingeing and purging that may recur in highly stressful or emotional periods of life. For this reason, continued support should be available, particularly during these times, to help patients cope and manage stress levels in a healthier way. An eating disorder support group may be useful for this purpose.
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