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Bulimia Nervosa - Treatment Overview

Treatment for bulimia involves psychological counseling and sometimes medicines such as antidepressants. Treatment does not usually require staying in the hospital, although this is sometimes needed. Both professional counseling and antidepressant medicine can help reduce episodes of binging and purging and help you recover from bulimia. Both are long-term treatments that may require weeks or months before you notice significant results. You may need treatment with counseling and possibly medicines for more than a year.

Bulimia that occurs with another condition may take longer to treat. And you may need more than one type of treatment. If you have another condition that commonly occurs with bulimia, such as depression or substance abuse, your doctor may want to treat that condition first.

People who seek treatment for bulimia or another eating disorder may have other health problems caused by the disorder. If you have had bulimia for a long time without treatment, or if you have used substances such as laxatives, diuretics, or ipecac syrup to purge, then you may have a health problem such as dehydration that needs treatment first. In serious cases, these conditions related to bulimia may require you to spend time in the hospital.

Initial treatment

Initial treatment depends how severe the bulimia is and how long you have had it.

If you have no other conditions that need treatment first, then treatment for bulimia usually consists of:

  • Medicines. Antidepressants, such as fluoxetine (Prozac, for example), are sometimes used to reduce binge-purge cycles and relieve symptoms of depression that often occur along with eating disorders. They work best when combined with counseling.
  • Psychological counseling. Two types of counseling are useful in treating bulimia. They are cognitive-behavioral therapy (CBT) and interpersonal psychotherapy (IPT). In CBT you learn how to change negative thoughts that you may have about food, your weight, your body, or beliefs about yourself. In IPT you learn how relationships—and feelings about those relationships—affect binge eating and purging.

The goals of CBT are:

  • To use nutritional counseling to help you learn how to eat three meals and two snacks a day and avoid unhealthy diets.
  • To reduce concern about your body weight and shape.
  • To understand and reduce triggers of binge eating by examining your relationships and emotions.
  • To develop a plan to learn proper coping skills to prevent future relapses.

The goals of IPT are:

  • To identify relationships that are connected to binge eating and purging.
  • To learn how emotions that come up from these relationships are related to binge eating and purging.
  • To help correct these relationship patterns, so that you won't binge eat or purge in response to bad feelings.
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