Bulimia Treatment Overview

When to see a provider

If you have bulimia, you should see a mental health provider to help you understand what’s causing it and give you strategies to help manage your be. Bulimia treatment often uses a combination of therapies that may include psychotherapy, medical care, medication, nutritional and dietary counseling, and family support.

Getting diagnosed

Your provider will use specific criteria to diagnose bulimia. They may also do a physical exam, bloodwork, and urine analysis to check for other medical conditions.

The main criteria include the following if they happen at least once a week for 3 months:

• Repeated episodes of binge eating is when you eat extremely large amounts of food and feel out of control—like you can’t stop.
• Repeated extreme behaviors to prevent weight gain like vomiting, use of laxatives, diuretics, fasting, or excessive exercise.

If your provider is concerned that you have bulimia, you will likely be referred to a mental health provider to be evaluated for bulimia and other mental health conditions.

What to expect from your visit

• The first step may be talking to a mental health provider about your feelings and attitudes about food, your eating and weight loss habits, and any possible causes and triggers for the behaviors.
• Psychotherapy can help you learn about and change any cognitive, emotional, and behavioral patterns that are contributing to bulimia. Therapy will also teach healthy coping and strategies and ways to regulate your emotions and eating behavior.
• The length of therapy varies depending on a person’s needs—it may be as short as 3 months to a year or longer. But most people see improvements within the first few weeks after trying new skills and strategies.
• You may be referred to a psychiatrist or psychopharmacologist to see if you would benefit from a medication, like antidepressants.
• You may also want to work with a registered dietician and nutritionist to help with weight management and to make sure you are getting the right nutrients.
• Mind-body therapies, like acupuncture, meditation, massage, and clinical hypnosis, may help you feel about your body, reduce stress, and help you manage your emotions.

Prescription medications for bulimia

Antidepressants

• Fluoxetine (Prozac)
• Escitalopram (Lexapro)
• Sertraline (Zoloft)
• Citalopram (Celexa)
• Paroxetine (Paxil)

Stimulant

• Lisdexamfetamine dimesylate (Vyvanse)

Types of bulimia providers

• A primary care provider can check your physical health and refer you to a behavioral health specialist (for mental health treatment) or a nutritionist.
• A mental health provider, like a psychologist or a clinical social worker, can offer therapy.
• A registered dietician and nutritionist can give you strategies and dietary recommendations for healthy weight management and a balanced diet.

How to manage bulimia at home

It’s important that you see a healthcare provider—sometimes a few different types of providers—to help you manage bulimia. But a big part of getting better is that you work on your thoughts and behaviors at home. A treatment plan often includes:

• Psychotherapy homework: Therapy will help you learn about your specific triggers and causes of bulimia symptoms. You will also get strategies for managing your thoughts and behaviors around your eating and your emotions.
• Good nutrition: Eating a balanced diet and mindful eating can help you regulate your eating and avoid nutritional issues from binging and purging.
• Regular meals. You need to eat regularly and avoid restricting and fasting behaviors.
• Healthy relationships: Maintain a healthy and positive social support system.
• Cautious exercise: Work closely with your care team to figure out the type and amount of physical activity that is right for you. Sometimes people with bulimia exercise too much as a way to burn calories.
• Resist purging and dietary aids: Do not use anything to help you purge, including appetite suppressants, laxatives, diuretics, and enemas.
• Support: Joining a support group can help you feel less isolated. It can also be helpful to hear from other people who have bulimia and how they manage it.
• Stress management. Doing stress-reducing activities like yoga, meditation, and mindfulness training can help you reduce your stress and manage your emotions.