Bulimia nervosa (BN) is a serious mental health condition that can have dangerous and long-lasting impacts on physical, mental, and emotional well-being. It often manifests as cycles of binge eating and purging, which can lead to or support a number of other harmful symptoms.

Treating eating disorders like bulimia nervosa is possible through the right kind of support and care, along with patience and time. Many methods can help you or a loved one find recovery from bulimia nervosa.

Different Treatments for Bulimia

Like nearly all eating disorders, BN is a complex condition with a number of biological, psychological, and environmental factors working to develop and drive the eating disorder. A multi-faceted approach to treatment is often the best way to address these various issues.

Psychological Bulimia Treatments

Eating disorders like BN, anorexia nervosa (AN), and binge eating disorder (BED) manifest in very physical ways, but at their core, they’re mental health conditions. As such, psychological care is usually the primary method of bulimia treatment.

Some of the most common types of psychotherapy to help treat bulimia include:

Cognitive behavior therapy (CBT): Often considered the most effective treatment for bulimia nervosa, CBT helps people change unhelpful behavioral patterns by recognizing and changing the unhelpful thought patterns that drive them. Essentially, this structured course of treatment helps people “unlearn” harmful thoughts and learn new, healthier coping mechanisms.

Dialectical behavior therapy (DBT): Dialectical behavior therapy focuses on helping patients improve their emotional regulation, distress tolerance, and interpersonal relationships and cultivate a greater sense of mindfulness. It teaches that patients can simultaneously love and accept themselves while working to make helpful changes.

Acceptance and commitment therapy (ACT): Rather than focusing on thoughts that may be harmful, ACT teaches patients to let those thoughts go. The method uses mindfulness and other techniques that help encourage acceptance and encourages patients to direct their energy instead toward activities that align with their morals and make them feel good.

Physical Treatment for Bulimia

Since eating disorders like BN impact physical and mental health, treatment methods addressing physical ailments are also sometimes necessary.

This can be particularly true for people who utilize self-induced vomiting as a purging method, as this can have a major impact on oral health, causing tooth decay, dental erosion, and other issues that require medical attention.1

In severe cases, medical attention may also be necessary to help a patient in crisis reach medical stability. Most long-term treatments, including psychological care, are not administered until a patient is considered medically stable.

Nutritional Bulimia Treatments

Nutritional care is another keystone of bulimia nervosa treatment. Generally administered by a nutritional counselor, this type of treatment is largely educational, helping people learn more about nutrition and maintaining a healthy diet and eating habits.

Nutritional counseling aims to help patients learn how to maintain a healthy weight, get more in touch with their physical needs, and build a better overall relationship with their body. In some cases, counselors or other treatment team members may also provide meal support, eating with patients to help them feel more comfortable and safe during mealtimes, especially in early recovery.

Treating Bulimia Nervosa with Medication

Medications are generally not considered a first-line treatment for eating disorders, but some patients use them in tandem with psychotherapy. Medications can also be used as a way to help maintain recovery after treatment or help alleviate issues related to eating disorder behavior, such as anxiety or depression.

When treating bulimia nervosa in particular, selective serotonin reuptake inhibitors (SSRIs) can be helpful for some patients. This group of drugs generally helps with emotion regulation and has been found to help reduce binge eating behavior in some patients.2

What is the Most Effective Treatment for Bulimia Nervosa?

Every patient is different, with their own unique personal and medical history, psychological profile, and biological makeup, among other factors. That means that the most effective treatment for bulimia nervosa will look different for everyone.

Some patients may flourish with therapy, while others may do better with therapy and medication, and still others will rely more heavily on nutritional counseling and require other medical attention.

In general, however, cognitive behavioral therapy is considered the treatment of choice for BN. The method is also one of the most widely-researched treatment methods for bulimia nervosa, with a number of studies exploring its impact on healthy weight gain (when considered necessary), the reduction of binge eating behavior, and the improvement in important facets of mental health.3

Recently, an “enhanced” cognitive behavioral therapy method (CBT-E) has been developed, which incorporates the same techniques as CBT but addresses additional issues, such as low self-esteem, mood regulation, and perfectionism. Early studies show CBT-E may be an even more effective treatment for bulimia nervosa than cognitive behavioral therapy.4

Virtual Treatment for Bulimia

In an increasingly digital world, many of these treatments can now be administered online. Virtual eating disorder treatment is still relatively new, but studies have already shown it to be just as effective as in-person care, even in cases where patients require higher levels of care.5

Virtual treatment offers a number of benefits over in-person care, including the convenience of receiving care from home, greater flexibility when scheduling appointments, and the ability for patients who live in more remote or underserved areas to easily receive care. Remote programs are also generally less expensive than in-person programs, though this can vary from program to program.

Online care may not be the best choice for everyone, including patients with unstable home environments or little-to-no control over their disordered behaviors. But virtual eating disorder treatment can be helpful for most people who are struggling with eating disorders. Ask your healthcare provider if they think virtual treatment is a good choice for you.

Choosing the Best Treatment for You

When it comes to treating eating disorders, there is no “best” form of treatment, just the best treatment for you. The most effective bulimia nervosa treatment will depend on a number of very personal factors.

Speaking with a mental health professional is the best way to choose the best kind of care for you. These experts will be able to help issue an official diagnosis and determine a treatment plan that’s tailored to your personal history and needs.

Just remember to have patience. There are many ways to help someone recover from bulimia nervosa, and recovery is always possible.

Resources

Rosten A, Newton T. (2017). The Impact of Bulimia Nervosa on Oral Health: A Review of the Literature. British Dental Journal; 223:533–539. 

Sysko R, Sha N, Wang Y, Duan N, Walsh BT. (2010). Early Response to Antidepressant Treatment in Bulimia Nervosa. Psychological Medicine; 40(6):999–1005. 

Murphy R, Straebler S, Cooper Z, Fairburn CG. (2010). Cognitive Behavioral Therapy for Eating Disorders. The Psychiatric Clinics of North America; 33(3):611–627. 

Cooper Z, Fairburn CG. (2011). The Evolution of “Enhanced” Cognitive Behavior Therapy for Eating Disorders: Learning From Treatment Nonresponse. Cognitive and Behavioral Practice; 18(3):394–402. 

Van Huysse JL, Prohaska N, Miller C, Jary J, Sturza J, Etsell K, Bravender T. (2023). Adolescent Eating Disorder Treatment Outcomes of an In-Person Partial Hospital Program Versus a Virtual Intensive Outpatient Program. The International Journal of Eating Disorders; 56(1):192–202.

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