The two main treatments that have been found to be helpful to people with bulimia nervosa are: (1) psychological treatment and (2) treatment with medications. The psychological treatment that has been most clearly shown to be helpful is cognitive behaviour therapy, known as CBT for short. Some other psychological treatment approaches have been used, but they have not yet been demonstrated to be as effective as CBT. A number of medications have been found to help diminish the symptoms of bulimia nervosa.
How is cognitive behaviour therapy applied to help people with bulimia nervosa?
In cognitive behaviour therapy, treatment focuses on cognitive aspects (thoughts) and behaviours. In the cognitive component, the person with bulimia nervosa is helped to examine thoughts that are connected to the disorder, to challenge irrational thoughts and thinking styles, and to develop new ways of thinking about topics such as body shape and weight, and self-esteem. The behavioural component addresses the person's day to day behaviour and helps to make gradual adjustments in eating and other relevant areas. CBT has been found to be an effective treatment for most people with bulimia nervosa, and studies have shown that its positive effects continue for years after treatment.
How are medications used to help people with bulimia nervosa?
A number of antidepressant medications have been shown to help some people with bulimia nervosa. Such treatment should occur under the management of a doctor who is familiar with the prescription of antidepressant medications. Only some of the antidepressant medications have been shown to be effective. The medications do not appear to work by changing mood, but appear to have a specific effect on the symptoms of bulimia nervosa (in particular, they appear to help decrease the urge to binge-eat). The antidepressant medications used for the treatment of bulimia nervosa may have an "anti-compulsive effect" (they may help to decrease repetitive thoughts and behaviours).
Is bulimia nervosa related to other "compulsive" disorders?
Bulimia nervosa has some elements in common with a number of other problems that are thought to be "compulsive" in nature. The word "compulsive" denotes a series of repetitive behaviour that a person finds difficult to resist. Examples of other compulsive behaviours are: repetitive counting, cleaning, rearranging objects and putting things in a specific order, repeatedly pulling out one's hair (trichotillomania), and shoplifting (kleptomania). Some people with bulimia nervosa find that they have these or other compulsive behaviours in addition to the symptoms of bulimia nervosa. It has been determined that some of the other compulsive behaviours also improve with antidepressant medications.
How can family and friends help?
Family and friends can sometimes feel confused regarding the best way to help people who are struggling with bulimia nervosa. At times, a person with bulimia nervosa may push away family or friends and may resist efforts to help. Family and friends can usually help by being understanding and persistent. It is important for family and friends to be fully open and honest with the person who is struggling with bulimia nervosa and to clearly communicate the wish to help. As much as possible, family and friends should ask the person who is struggling with bulimia nervosa to identify what would and would not be helpful actions. Offers to accompany the person to receive some support can be valued. In some instances, it may be very helpful to provide support with meals and other aspects of treatment. This is best done in collaboration with health professionals who are providing treatment.
What can be done if someone doesn't want help?
In some circumstances, people with bulimia nervosa will refuse to accept help. Often, this is because the illness causes them to panic at the thought of increasing their weight or changing their eating behaviour. Most often, the best thing to do is to be persistent and respectful in approaching the person with bulimia nervosa in this situation. At times, it is necessary to insist on treatment in order to prevent serious medical disaster or death. This should be done in conjunction with doctors and other health professionals who are experienced in dealing with this situation.
Elliot Goldner, MD,
in association with the MediResource Clinical Team