Bulimia Nervosa Treatment

Treatment

Treatment approaches to bulimia nervosa are outlined in Table 26-4.

Multiple studies have been published describing the efficacy of both psychotherapy and psychopharmacology in the treatment of bulimia nervosa.

Dynamically based psychotherapies, particularly those that focus on interpersonal conflicts, eg, assertiveness, negotiation of needs, intimacy fears, etc, are effective, but cognitive-behavioral therapies are by far the most studied. Such therapies focus on the thought patterns and feeling states that lead to episodes of binge eating and purging with special emphasis on attitudes pertaining to body weight and shape. Coping strategies for handling the feelings associated with these attitudes, such as maintaining a food journal that includes both "what you are eating, and what's eating you," are suggested to the patient. Patients are expected to eat structured meals and their irrational fears regarding weight gain are addressed. Obsessive preoccupation with body shape and size is challenged, as patients are helped to better tolerate painful affect, and to be more direct in interpersonal problem solving.

Psychoeducational approaches are also helpful. For example, advising patients to not fast during the day, because fasting leads to binge eating (the normal tendency to purchase more groceries, including more "junk foods," if shopping while hungry is an easily recognized example of this phenomenon), usually results in symptom reduction. Patient education and cognitive-behavioral approaches can be easily implemented in primary care settings.

Group therapies, including psychodynamic, cognitive-behavioral, and self-help formats, are usually recommended.