How to Treat Bulimia: A Guide for Mental Health Professionals 

Bulimia is a severe mental health disorder, but it responds to treatment. The sooner you spot the signs and enroll a patient in care, the more likely it is that the person will make a full recovery.

Medical professional

How to treat bulimia depends on the person, the severity of the symptoms, and more. But most people benefit from the following:

While some people need years to fully recover and avoid relapse, many with bulimia get better. As a mental health professional, you make this possible. 

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Should Families Hold an Intervention?

All eating disorders are characterized by denial and secrecy. For example, people with bulimia may claim they don’t have eating problems. And they’ll do almost anything to keep symptoms hidden. 

It’s tempting to encourage families to hold a formal intervention. Conversations in the Johnson Model use surprise and conflict to force awareness, and they’re commonly used in addiction management.

In a Johnson Model intervention, families surprise a person with a collection of friends and family members. Each attendee talks with the person about the addiction and why treatment is required. 

These discussions are difficult, and up to 70% of families that prepare such a talk never hold it. [1] This approach could also backfire on someone with an eating disorder.

Counsel families to talk openly about the bulimia symptoms they’ve seen (both behavioral and physical symptoms). Encourage families to share what they know about treatment. But encourage them to be kind and careful with the person they love. Eating disorders are mental illnesses, not choices, and people need to trust their families. 

How is Bulimia Diagnosed?

Some people with bulimia walk into doctor’s offices prepared to discuss bulimia. Others discuss their eating disorders after a confrontation.

A dental exam, blood work, or physical exam could indicate the person isn’t eating healthfully. Armed with this data, you can talk with your patient about bulimia. 

To formally diagnose bulimia, your patient must demonstrate the following: [2]

  • Binges: The person eats more in one sitting than the person would eat in a comparable situation.
  • Compulsion: During the binge, the person can’t control the behavior. 
  • Purging: The person uses vomiting, laxatives, or exercise to remove calories consumed in the binge. 
  • Distress: The person’s self-worth is closely tied to weight or appearance. 
  • Repetition: The behavior must occur at least weekly for three months. 

Most mental health professionals interview their eating disorder patients to understand their eating habits and thoughts. Collaboration with the patient’s doctor or dentist could be helpful if you need to demonstrate your knowledge of the person’s health. You may need multiple appointments to build trust and encourage the person to speak openly.

Creating a Treatment Plan

Your patient has admitted to disordered eating and purging. What happens next? Multiple treatment modes exist; you can help your patient’s family determine the right setting. 

These are the four basic levels of bulimia care: [3]

  • Intensive outpatient: The person is medically stable but needs significant psychotherapy assistance. The person lives at home but heads to a therapy center almost every day.
  • Partial hospital: The person needs daily medical care and psychotherapy. The person lives at home but heads to a hospital center every day.
  • Residential: The person needs significant psychological help to avoid binges and purges but is medically stable. Moving out of the home and into the facility is best. 
  • Inpatient: The person is both physically and psychologically unstable and needs around-the-clock care. 

In general, it’s best to begin with the least invasive model possible. If your patient can live at home while improving, you’re offering the opportunity to practice critical lessons in real time. But a supervised environment is appropriate if your patient is both physically and mentally unstable.

How Does Bulimia Therapy Work?

Conventional talk therapy is the cornerstone of most bulimia treatment programs. People need to discuss their thoughts and feelings, learn to change their behaviors for the better, and engage in healthy eating habits.

About 25% of people with bulimia get therapy in a group setting. [4] But some do best with private sessions. 

People with bulimia obsess over body shape and size and can feel intimidated in rooms filled with bodies. They may compare themselves instead of listening to the therapist.

The National Eating Disorders Association recognizes seven types of therapy: [3]

  • Acceptance and commitment therapy
  • Cognitive behavioral therapy
  • Cognitive remediation therapy
  • Dialectical behavior therapy
  • Family-based treatment
  • Interpersonal psychotherapy
  • Psychodynamic psychotherapy

Each model works differently, but all are designed to help people with bulimia separate the urge to binge from the act of bingeing. Some patients benefit from just one form of treatment, while others need multiple models to understand their behaviors and improve.

In addition to therapy, nutritional counseling is also essential for long-term recovery. It will also help the patient understand the dangers and serious health complications that can arise from bulimia and binge eating disorder.

The Role of Medications in Treatment

Bulimia responds well to psychotherapy, but some people benefit from the addition of medications. Pharmacotherapy can ease the urge to binge, allowing the person to focus on therapy without feeling the constant pull of the eating disorder and obsessing over their food intake. 

Prozac

The U.S. Food and Drug Administration approved fluoxetine (Prozac) for bulimia treatment. In studies, people treated with 60 mg of Prozac per day had a 67% reduction in bingeing and a 56% reduction in purging. [5]

Some patients don’t respond to Prozac but do well on another form of antidepressant. Experts aren’t sure why medications help bulimia, but they suspect some people experience a disruption in serotonin pathways while on the medications. [6] 

Support group

What About Support Groups for Bulimia?

Some people with bulimia appreciate spending time in eating disorder support groups, including those based on the 12-step model of Alcoholics Anonymous. People who enjoy these meetings cite reductions in stigma and improved motivation. [7]

All support groups aim to help people feel connected to others. Through their participation, they learn to take responsibility for their eating habits while becoming role models for others.[8]

But some people don’t appreciate support groups and resent spending time with people they don’t connect with. So balancing a patient’s wishes is your primary job as a mental health professional. 

How Long Does Treatment for Bulimia Take?

Just as bulimia rarely develops overnight, people with bulimia often need months or even years of care to truly recover.

Typical Treatment Time Frame 

Researchers say more than half of people with bulimia are recovered within five years. [9] The longer they stay in therapy and are more committed to recovery, the faster their symptoms decrease. But it’s common for people to remain in treatment for extended periods. 

Eating Disorder Relapse

Everyone defines “recovery” differently, but typically, people with bulimia are considered recovered when they’ve had no binges or purges for an entire year. Unfortunately, this is a challenging benchmark to accomplish.

Eating disorders like bulimia are characterized by relapse. As people improve in therapy, they start to push the boundaries. For example, people who avoid holiday parties due to triggers may decide this is the year to go to a New Year’s Eve celebration. But the stress of that experiment pushes them to binge.

A relapse doesn’t indicate treatment failure. Instead, it provides a patient and the doctor with more opportunities. So what else should the patient learn? What gaps has the relapse exposed?

Does Eating Disorder Treatment Work?

Bulimia therapy can be time-consuming, but it’s overwhelmingly effective. In one 22-year study, researchers found that people who recovered from an eating disorder were 2.17 times more likely not to have a major depressive disorder. [10]

It’s important that when treating eating disorders, you also address any other co-occurring mental health disorders the patient has and any physical symptoms.

The work you do to help your patients understand and overcome their eating disorders makes a massive difference in their lives and overall well-being. You could change that person’s life dramatically for the better. 

Resources


  1. Johnson Intervention. (2011). American Psychological Association. Retrieved August 14, 2022.
  2. Bulimia Nervosa. (n.d.). National Eating Disorders Association. Retrieved August 14, 2022.
  3. Types of Treatment. (n.d.). National Eating Disorders Association. Retrieved August 14, 2022.
  4. Polnay A, James VAW, Hodges L, Murray GD, Munro C, Lawrie SM. (2013). Group Therapy for People with Bulimia Nervosa: Systematic Review and Meta-Analysis. Psychological Medicine; 44(11):2241-2254.
  5. Gorla K, Mathews M. (2005). Pharmacological Treatment of Eating Disorders. Psychiatry (Edgmont); 2(6):43-48.
  6. Crow SJ. (2021). Bulimia Nervosa in Adults: Pharmacotherapy. UpToDate.
  7. Waller A, Paganini C, Andrews K, Hutton V. (2020). The Experience of Adults Recovering From an Eating Disorder in Professionally Led Support Groups. Qualitative Research Journal.
  8. Murn LT. (2010). Group Therapies for the Treatment of Bulimia Nervosa. Inquiries Journal; 2(12):1-2.
  9. Smink FRE, van Hoeken D, Hoek HW. (2013). Epidemiology, Course, and Outcome of Eating Disorders. Current Opinion in Psychiatry; 26(6):543-548.
  10. Keshishian AC, Tabri N, Becker KR, Franko DL, Herzog DB, Thomas JJ, Eddy KT. (2019). Eating Disorder Recovery is Associated with Absence of Major Depressive Disorder and Substance Use Disorders at 22-Year Longitudinal Follow-Up. Comprehensive Psychiatry; 90:49-51.

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