Treatment

Bulimia nervosa treatment

Treatments that are effective for bulimia include talk therapy, self-help, medication, and nutritional support.

Talk therapy

There are several different approaches to talk therapy. In the treatment of bulimia, research suggests that cognitive behavioral therapy (CBT) is effective in helping you change your thoughts and behaviors around body image. One study found that family-based therapy—which involves intense parental involvement and a therapist trained in this approach—was effective for treating teenagers still living with their parents.

There is another option, too, that research suggests is helpful in bulimia treatment. Self-help, such as research-based online information or books, can be effective. These sources of information and reference can be a useful complement to help from a therapist or doctor. It is important to understand the difference, however, between Web sites that offer valid, research-based information and the pro-mia sites that either overtly or covertly offer tips for “being a better bulimic.”

Medication

An antidepressant may be prescribed to treat bulimia. It’s important to note that Prozac (fluoxetine) is the only medication approved by the U.S. Food and Drug Administration (FDA) to treat bulimia. According to the National Institute of Mental Health, fluoxetine appears to help alleviate the binge eating/purging behavior and decreases the likelihood of relapse while also helping to improve your attitude toward eating. Medication should be used in combination with talk therapy, not in place of it.

Antidepressants are not a cure-all; in fact, they can pose their own risks. The FDA has issued a warning on the use of antidepressants for teens and young people under the age of 24 due to research suggesting possible increase in suicidal thinking and behavior.

Nutritional counseling

As with treatment for anorexia, a dietitian can provide much-needed help during initial treatment by working with you to create meal plans and reinforce healthy eating patterns. A nutritional counselor helps you learn how normal meals and snacks regulate appetite. While nutritional counseling teaches the patient about healthy eating patterns, it’s often not an effective treatment by itself. It is most powerful when combined with talk therapy.

Binge eating disorder treatment

Shame, poor self-image, and other unhelpful emotions tend to drive binge eating disorder, so treatment usually focuses on addressing psychological issues.

Talk therapy
Psychotherapy can help you let go of unhealthy behaviors in exchange for new, healthier ones. The types of talk therapy that have been shown to be specifically helpful in treating binge eating disorder are cognitive behavioral therapy (how to change your thinking and change certain identified behaviors), interpersonal therapy (examination of relationships and how distressing relationship patterns can trigger binge eating), or dialectical behavior therapy. This type of talk therapy aims to teach you new ways to better tolerate stress, control or regulate emotions, and improve relationships.

Medications
The U.S. Food and Drug Administration (FDA) has not approved any drug specifically to treat binge eating disorder. The study results on their effectiveness have been mixed; researchers tend to agree that more studies need to be done. That being said, however, certain antidepressants may be helpful.

• Serotonin reuptake inhibitors and tricyclic antidepressants may affect brain chemicals that control mood. And changing mood may alleviate the need to binge. Antidepressants pose their own risks. The FDA has issued a warning on the use of antidepressants for teens and young people under the age of 24 due to research suggesting possible increase in suicidal thinking and behavior.
• Topamax, an anticonvulsant used to control seizures, may also help reduce binge eating episodes, according to the results of some studies. But the drug has serious side effects, including vision changes, dizziness, drowsiness, jumbled thinking, and physical clumsiness.
• Meridia, an anti-obesity drug, is an antidepressant. The FDA has given its approval for long-term obesity treatment. This drug may be helpful for those who have a binge eating disorder and who are obese. One of its most serious side effects is significant change in blood pressure.

Weight loss programs
A weight loss program might be used in conjunction with talk therapy. These programs are usually supervised by a healthcare provider and focus specifically on reducing weight safely to a healthy level. The programs may touch on the issues that set off binge eating behavior but don’t delve as deeply into issues as psychotherapy does. Weight loss programs are not typically used until the binge eating disorder is successfully treated.