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How Is Bulimia Nervosa Treated?
Because of the secrecy and shame around eating disorders, only about one in 10 people with bulimia nervosa receive treatment. Even with treatment, relapse is common. Although males account for only about 10-15% of people with bulimia, eating disorders among male athletes are the rise, especially in sports where weight is restricted.
Since many people with bulimia struggle with obsessive thoughts, therapy is vital to the process of recovery from eating disorders. Treatment for bulimia focuses on understanding the behavioral, psychological, cultural, and treatment needs of individual binge eaters and bulimics. Obese or overweight people often benefit from a medically supervised behavioral weight-loss program. Those with a substance abuse disorder may need counseling, medications, and self-help support groups.
Many people with bulimia work with an eating disorders team that includes a mental health clinician, nutritionist, and medical support. Antidepressants have been shown to improve symptoms of bulimia, especially in people who also suffer from depression.
A mental health clinician may coordinate care in an outpatient setting or an eating disorder treatment center. Since people with bulimia often struggle with perfectionism and low self-esteem, long-term therapy leads to better outcomes. Psychological treatment to tackle flawed thinking and poor self-image often integrates a number of different therapies:
- Acceptance and Commitment Therapy (ACT) is a type of psychotherapy that helps people accept things that are largely out of their control. ACT helps individuals give up harmful or self-destructive bulimic behaviors by encouraging flexibility and new ways of thinking.
- Individual, group, and family psychotherapy. The multifaceted approach focuses on thinking and behaviors. A psychotherapist works one-on-one to support the individual. Family therapy helps parents and adolescents work through relationship problems or interpersonal issues related to bulimia. Some therapists use additional treatment modalities for children or those with a history of trauma.
- Cognitive-behavioral therapy (CBT) is the leading evidence-based treatment for adults with eating disorders. CBT is considered the “gold standard” treatment for bulimia. The treatment addresses cognitive factors like negative body image, core beliefs about self-worth, and perfectionism. CBT also helps people with binge eating disorder. Mindfulness-Based Cognitive Behavior Therapy integrates concepts of mindfulness into the treatment approach.
- Dialectical behavioral therapy (DBT) combines mindfulness with techniques for healthy emotional regulation. The focus is on acceptance (rather than change) and learning to cope with difficult emotions.
- Pharmacotherapy. Antidepressant medication is prescribed for bulimia. Prozac® (fluoxetine) is the only medication approved by the Food and Drug Administration (FDA) to treat bulimia. The usual dose is 60 mg of Prozac to help control symptoms. Additional medications may be prescribed for co-occurring mental health problems, such as bipolar disorder or obsessive-compulsive disorder.
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