Treating Bulimia and Co-Occurring Mental Illness

It’s not uncommon for someone with bulimia to suffer from a co-occurring mental health disorder. Sometimes an eating disorder will develop after a different mental health condition, or the conditions may start simultaneously. In either instance, treatments are available to help individuals with bulimia and a co-occurring mental illness.

Mental illness

Is Bulimia a Mental Illness?

Bulimia nervosa (BN) is an eating disorder and a serious mental health illness. People with BN have uncontrollable episodes of binge eating. Binge eating is when an individual eats a larger than normal amount of food in a short period. In some people, an act of calorie restriction follows their binging. Purging by self-induced vomiting or laxative use is also a part of BN. People with BN might also engage in behaviors such as excessive exercise or fasting. (1)

Bulimia is a mental health disorder with serious psychological and physical consequences. l. People with bulimia commonly have co-occurring mental illnesses such as depression or anxiety. 

Co-Occurring Disorders Associated with Bulimia

There are a few common co-occurring conditions associated with bulimia including depression, generalized anxiety disorder, obsessive-compulsive disorder, and borderline personality disorder. (16)

Major depressive disorder (MDD) is a mood disorder that severely affects how someone feels and thinks. MDD n 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 dMDD 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)

The Effects of Mental Health on Bulimia Behaviors

Co-occurring mental illness can affect the intensity and frequency of the individual’s eating disorder behaviors, which can make it more challenging to regulate their eating disorder. 

Many co-occurring mental illnesses create a cycle that makes it difficult for people to change behaviors. For example, if individuals are depressed, they may turn to food to regulate their emotions. Once they eat, they may experience anxiety or guilt about how much they consumed and turn to purge or calorie restriction.

If the person is experiencing high stress or underwent a traumatic event, this cycle might occur more frequently, increasing the severity and frequency of their bulimia behaviors. The same ideas are valid for those living with a borderline personality disorder. And since borderline personality disorder affects someone’s ability to regulate emotions, they may trigger guilt or anxiety after eating and purging. 

Calling a hotline

Treatments for Bulimia and Co-Occurring Mental Illnesses

Treatment for bulimia and a co-occurring mental illness addresses both the eating disorder and the other mental health conditions. The most effective approaches include a team of medical professionals well-versed in eating disorders and their co-occurring mental health disorders and a combination of treatment methods, most notably different kinds of talk therapy. 

Who Treats Bulimia and Co-occurring Mental Illnesses?

The treatment of bulimia and a co-occurring mental health disorder is often approached by a team of medical professionals, including an individual’s primary health practitioner, mental health practitioner, and dietitian. It’s ideal for all medical professionals on the treatment team to have knowledge of bulimia and experience working with patients with an eating disorder. (3) Treatment may also include an individual’s family and close friends to help support their loved one through treatment. 

Types of treatments

Medical professionals use a combination of treatments to treat bulimia and any co-occurring mental health condition. 

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)

Resources


  1. Johns Hopkins Medicine. (2019, November 19). Bulimia nervosa. Johns Hopkins Medicine. Retrieved June 27, 2022, from https://www.hopkinsmedicine.org/health/conditions-and-diseases/eating-disorders/bulimia-nervosa
  2. Mental Health Foundation. (2021, May 25). Bulimia nervosa. Mental Health Foundation. Retrieved June 27, 2022, from https://www.mentalhealth.org.uk/a-to-z/b/bulimia-nervosa
  3. Hurley, K. (2018, February 13). Depression and Bulimia. Psycom.net. Retrieved June 27, 2022, from https://www.psycom.net/depression.central.bulimia.nervosa.html
  4. American Psychological Association. (2017, July). What is cognitive behavioral therapy? American Psychological Association. Retrieved June 27, 2022, from https://www.apa.org/ptsd-guideline/patients-and-families/cognitive-behavioral
  5. Nadeau, P.-O., & Leichner, P. (2009, February). Treating bulimia in adolescents: A family-based approach. Journal of the Canadian Academy of Child and Adolescent Psychiatry. Retrieved June 27, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2651218/
  6. Sussex Publishers. (n.d.). Interpersonal psychotherapy. Psychology Today. Retrieved June 27, 2022, from https://www.psychologytoday.com/us/therapy-types/interpersonal-psychotherapy
  7. Reiter, C. S., & Graves, L. (2010). Nutrition therapy for eating disorders. Nutrition in Clinical Practice, 25(2), 122–136. https://doi.org/10.1177/0884533610361606
  8. U.S. Department of Health and Human Services. (2018, February). Depression. National Institute of Mental Health. Retrieved June 27, 2022, from https://www.nimh.nih.gov/health/topics/depression
  9. Lebow, H. I. (2022, January 7). The link between depression and eating disorders. Psych Central. Retrieved June 27, 2022, from https://psychcentral.com/depression/depression-and-eating-disorders
  10. Eating Disorders | Anxiety and Depression Association of America, ADAA. (n.d.). Eating disorders. Eating Disorders | Anxiety and Depression Association of America, ADAA. Retrieved June 27, 2022, from https://adaa.org/understanding-anxiety/related-illnesses/eating-disorders
  11. U.S. Department of Health and Human Services. (2022, April). Anxiety disorders. National Institute of Mental Health. Retrieved June 27, 2022, from https://www.nimh.nih.gov/health/topics/anxiety-disorders
  12. U.S. Department of Health and Human Services. (2019, October). Obsessive-compulsive disorder. National Institute of Mental Health. Retrieved June 27, 2022, from https://www.nimh.nih.gov/health/topics/obsessive-compulsive-disorder-ocd
  13. Neziroglu, F., & Sandler, J. (2009). The relationship between eating disorders and OCD part of the spectrum. International OCD Foundation. Retrieved June 27, 2022, from https://iocdf.org/expert-opinions/expert-opinion-eating-disorders-and-ocd/
  14. U.S. Department of Health and Human Services. (2022, April). Borderline personality disorder. National Institute of Mental Health. Retrieved June 27, 2022, from https://www.nimh.nih.gov/health/topics/borderline-personality-disorder
  15. Borderline in the ACT. (2017, November 14). BPD and eating disorders. Borderline in the ACT. Retrieved June 27, 2022, from https://www.borderlineintheact.org.au/living-with-bpd/bpd-comorbidities/bpd-eating-disorders/0
  16. Dual diagnosis & co-occurring disorders. Eating Disorder Hope. (2022, May 5). Retrieved June 27, 2022, from https://www.eatingdisorderhope.com/treatment-for-eating-disorders/co-occurring-dual-diagnosis

Last Update | 11 - 15 - 2022

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