Treating Bulimia and Co-Occurring Mental Illness

Major depressive disorder (MDD) is a mood disorder that severely affects how someone feels and thinks. MDD also affects how a person performs daily activities, such as eating. Symptoms include persistent sadness or hopelessness, irritability, decreased energy, restlessness, difficulty concentrating, trouble sleeping, appetite changes, body aches, and digestive problems. For someone to receive a clinical diagnosis, they must have symptoms for at least two weeks. (8)

When someone has MDD co-occurring with bulimia, the person can experience significant changes in their eating behaviors. In some cases, MDD can make someone feel like eating less. These eating behaviors can progress to the binging and purging of bulimia. (9)

Anxiety disorders are a group of conditions that cause what feels like uncontrollable fear or anxiety. Some anxiety disorders can grow severe enough to affect someone’s daily activities, such as sleep and work. The symptoms of an anxiety disorder can vary depending on the type, but they generally include feelings of impending doom, feeling out of control, chronic stress, rapid heart rate, trouble sleeping, or a decreased appetite. (11)

A person with bulimia may experience anxiety outside of their eating disorder, but anxiety can also be related to eating disorder symptomatology itself. Often when an individual with bulimia binge eats, it’s followed by anxiety about what they’ve consumed and can trigger their compensatory behaviors such as purging, fasting, or excessive exercise. While many different anxiety disorders are linked to eating disorders, women who have posttraumatic stress disorder (PTSD) or social anxiety disorder are more likely to develop bulimia. (10)

Obsessive-compulsive disorder (OCD) is an anxiety disorder that commonly co-occurs with bulimia. It’s categorized as having uncontrollable obsessions and compulsions that an individual continues to repeat. (12) In bulimia, obsessive thoughts usually accompany guilt after a binging episode, triggering compulsive purges. OCD can also play a role in other calorie-restrictive activities, such as excessive exercise. Some people with bulimia excessively exercise to compensate for a binge. 

Borderline personality disorder is a mental illness that makes it challenging for someone to regulate their emotions, often leading to impulsivity. (14) Signs and symptoms of a borderline personality disorder include mood swings, feelings of emptiness, patterns of unstable relationships with friends or family, impulsive or dangerous actions, uncontrollable anger, or feelings of dissociation. 

In those with BN, borderline personality disorder can exacerbate symptoms of the eating disorder. The co-occurring mental health conditions can also increase the risk of self-harm, especially if the individual is also living with depression. (15)

A medical professional may prescribe medications such as an antidepressant to address a co-occurring mental illness. 

Cognitive behavioral therapy (CBT) is a psychological treatment for eating disorders, depression, anxiety, and other mental illnesses. (4) In the case of bulimia, CBT can help individuals understand their thoughts and change their behaviors. It can also help with a person’s way of coping with various emotions or intrusive thoughts often associated with depression or OCD. 

Some individuals may benefit from family therapy. Family therapy is talk therapy between a person and their relatives. By discussing various relatives’ actions and thoughts, therapists can help individuals build a healthier home environment. The sessions are moderated by a licensed therapist and discuss the family elements involved in various mental illnesses.

Family therapy is vital for adolescents with bulimia and co-occurring mental health conditions. (5) Many behaviors, such as eating behaviors or how one deals with their emotions, are learned at home. 

Interpersonal psychotherapy (ITP) focuses on building communication skills and strengthening relationships. It’s a standard treatment for eating disorders, depression, and other mood disorders. ITP is similar to CBT, but its focus is to address behaviors that apply to interpersonal relationships. (6) ITP treatments can occur individually or in a group session. 

Many people with bulimia undergo nutritional therapy with a registered dietitian. Nutritional therapy is an evidence-based process that goes beyond informing someone on basic nutrition facts and how food affects the body.

A registered dietician provides nutritional guidance, interventions, and monitoring to help those with bulimia change eating behaviors and stick with them. (7)