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Table 26-4. Treatment approaches to bulimia nervosa. |
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1. Evaluate and treat the medical complications associated with bulimia nervosa. Replace fluid and electrolytes as necessary. Monitor electrolytes on regular basis. Refer for dental evaluation. |
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2. Ascertain the mechanism of purging. Educate patients regarding the medical dangers of chemical purgatives such as ipecac and baking soda as well as of diuretic and laxative abuse. |
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3. Hospitalize when necessary. If fluid and electrolyte balance cannot be maintained, if episodes of fainting occur, if concentration impairment makes employment or schoolwork impossible to perform, or if binge eating and purging behavior are the dominant activities in one's life, then a brief hospitalization to break the cycle and initiate treatment is necessary. |
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4. Diagnose and treat comorbidity. The presence of an affective disorder is an indication for treatment with an antidepressant medication if such treatment has not already been initiated on the basis of bulimic symptoms alone. Indeed, a trial of antidepressant medication is generally indicated for bulimia nervosa and is often effective even in the absence of concurrent affective disorder. Issues pertaining to personality disorders, when present, should be addressed in psychotherapy. |
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5. Identify and address psychological and cognitive underpinnings of bulimic behavior. Psychodynamically oriented and cognitive-behavioral treatments that address attitudes and feelings related to self and body images are effective treatment modalities. Such treatments may be particularly effective for many patients when combined with antidepressant medications. Support groups are also often helpful in the treatment of bulimia nervosa. |
