Bulimia Nervosa is an eating disorder where the person binge eats and then uses a variety of compensatory behaviors to limit weight gain. A binge is defined as a larger than normal amount of food than most people would consume in a similar time period. The bulimic person usually binges alone, due to significant shame that is associated with their binging behavior. The bulimic individual often binges on high calorie and sweet foods.While bulimia often includes purging behaviors (vomiting after a binging episode), this is only one of several possible “compensatory behaviors”. The individual suffering from bulimia often begins with attempts to diet and lose weight. The attempts result in extreme hunger and obsessions with food. The person then binges after a significant period of struggle to avoid consumption of food. The binging behavior results in significant shame and distress. The purging behavior often creates a significant relief from the distress. Other compensatory behaviors include use of laxatives, diuretics, enemas, or excessive exercise.
The theoretical approaches applied with this disorder are cognitive-behavioral (including dietary management) and interpersonal psychotherapy. Cognitive behavioral therapy is effective in addressing perfectionistic thinking that is characteristic of bulimic patients. They often strive for perfection and feel like complete failures if unable to achieve perfection. Psychodynamic group, psychoeducation, and family therapies are also included.
As with all eating disorders, a multimodal approach seems most effective. This might include nutritional counseling, psychotherapy and pharmacotherapy.
You want to establish normal eating habits with the patient. A meeting with a nutritionist is often helpful to work out healthy dietary plans. Cognitive-behavioral treatment can be useful in modifying binging and compensatory cycle. It is important to modify the patient’s thinking patterns so he or she can learn more realistic coping skills. If the individual purges, learning control over this impulse is important. This may be the first step in breaking the cycle and dealing with the underlying emotional issues.
Conduct an assessment of the patient and address any safety issues. You will also need to establish a therapeutic relationship with the patient so you can motivate him or her for treatment. A thorough clinical history, psychosocial, and medical workup is imperative. Make yourself aware of the signs of low self-esteem as well as deficits in self-regulation. A personality assessment may be useful. It is quite important to assess the individual’s social environment to understand how others may be maintaining or encouraging the bulimic behavior.
Finally, have the patients self monitor their eating habits as well as their feelings about weight and self-image. Emphasize goal setting at the very start of treatment. Set specific goals - such as resisting the impulse to purge for a specific period of time. Each week this period may be extended. Expect that the individual will slip- be patient. Work on small goals and focus on health. Since bulimia is usually less life threatening than anorexia, the clinician can be patient with slipping into old patterns. However, always monitor dangerous or unhealthy behaviors.
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