Effective Bulimia Therapy Approaches

Traditional Therapies 

Typically this is combined with medication, and people can expect to see improvements in inhibition control and how to handle mood fluctuations (4). There is no set limit on how many sessions or for how long it takes for DBT to be effective. Some institutions encourage a 24-week program, but note that some people require regular, ongoing therapy, as relapse can be common.

Other Effective Therapies 

Art Therapy

In recent years, art therapy has gained traction as a treatment modality, especially for teens, as some tend not to respond positively to verbal therapy. Clinical trials evaluating the efficacy of art therapy are frequently criticized for having too small of a study population, or following a faulty design. More studies are definitely needed before making blanket recommendations, but people who have undergone art therapy report great improvements in quality of life and mental health. 

Art therapy supports expression, awareness, new perspectives, pride, and distraction, which can be helpful tools for healing from BN (12). Types of art therapy include drawing, painting, sculpting, listening to music, playing musical instruments, and dancing, to name a few (13). 

Equine Therapy

Equine-assisted therapy (EAT) and equine-assisted learning (EAL) aim for the person to develop a therapeutic relationship with a horse, as opposed to simply with a therapist. This type of therapy typically occurs on a farm, or equine-related environment, as opposed to a doctor’s office. Many find this much more approachable and comforting.

Equine therapy can be used for physical, occupational, and speech-language pathology, which is especially effective for those with autism spectrum disorders, as well as those that struggle with disordered eating. Therapeutic riding is an excellent way to use horses to sharpen mindful body skills and accomplish emotional goals. (14,15,16).

Nutritional Therapy 

Nutritional therapy involves working with dieticians to establish a healthy relationship with food again. Those who struggle with bulimia nervosa often eat in restricted patterns, engage in puring or other compensatory behaviors, and develop a fear of gaining weight. Nutrition therapy helps rededucate about food and nutrition, since bulimia can engrain inaccurate beliefs about food and nutrition. A dietician can help develop meal plans, and teaches the Health At Every Size (HAES) curriculum.

Dieticians almost always work on a multidisciplinary team to teach people about the psycho-socio-cultural aspects of eating. Some specialize in certain illnesses, like diabetes, dementia, or kidney failure. If possible, try to locate someone who specializes in eating disorders and has undergone trauma-sensitization training. They can provide skills that promote behavior change and teach about the physiology behind disordered eating (18).

How Do I Know Which Treatment Is Best for Me?

This is an incredibly important question that has no one-size-fits-all answer. Clinically, the best treatments for bulimia nervosa entail medication and cognitive behavioral therapy. Some, however, may not enjoy talk therapy at all, and prefer more intimate expressions of emotions that can be found in art and music therapy. If someone has suffered significant trauma, working with a horse in equine therapy can feel much safer. Studies do show that having a strong, supportive friend or family group is invaluable to recover from disordered eating. 

It’s important to also consider the goodness of fit with each therapist. Someone may find that DBT feels helpful, for example, but they do not mesh well with a particular therapist. It is perfectly acceptable and common to ask for a different therapist, or change practices. Many people feel more comfortable seeing a therapist, who reflects one of all of their intersecting identities. For example gender, sexuality, race, ethnicity and religion. 

Some find that augmenting therapy with practices like light therapy, acupuncture, meditation, hydrotherapy (floating), and relaxation therapy can help. These should not be practiced alone however, only in conjunction with formal therapy and medication (17).