As with anorexia, treatment for bulimia often involves a combination of options and depends on individual needs.
To reduce or eliminate binging and purging, a patient may undergo nutritional counseling and psychotherapy, especially cognitive behavioral therapy, and be prescribed medication. Some antidepressants, such as fluoxetine (brand name, Prozac)—the only medication approved by the FDA for treating bulimia—may help patients who also suffer from depression and anxiety. It also appears to help reduce binge-eating and purging as well as the chance of relapse, and it can improve eating attitudes.
Cognitive behavioral therapy tailored to treat bulimia also has shown to be effective in changing binging and purging behavior and improving attitudes towards eating. Therapy may be done one on one or in a group.
Note: Despite the relative safety and popularity of selective serotonin reuptake inhibitors (SSRIs) and other antidepressants, some studies have suggested that they may have unintentional effects, especially on adolescents and young adults. In 2004, after a thorough review of data, the FDA adopted a black box warning label on all antidepressant medications to alert the public about the potential increased risk of suicidal thinking and attempts in children and adolescents. In 2007, the FDA proposed that makers of all antidepressant medications extend the warning to include young adults up through age 24. A black box warning is the most serious type of warning on prescription drug labeling.
Current Research
Unlike a neurological disorder, which generally can be pinpointed to a specific lesion on the brain, an eating disorder likely involves abnormal activity distributed across brain systems. With increased recognition that mental disorders are brain disorders, more researchers are using tools from neuroscience, such as magnetic resonance imaging (MRI), to better understand eating disorders and how those with a disorder process information, whether they've recovered or are still in the throes of their illness.
Behavioral or psychological research on eating disorders is more complex and challenging. New studies are currently underway to remedy the lack of information about treatment. Researchers also are working to define the basic processes of the disorders, which should help identify better treatments.
These and other questions may be answered in the future as scientists and doctors think of eating disorders as medical illnesses with certain biological causes. Researchers are studying behavioral questions, along with genetic and brain systems information, to understand risk factors, identify biological markers and develop medications that can target specific pathways that affect eating behavior. Finally, neuroimaging and genetic studies may provide clues for individual responses to specific treatments.
Bulimia Nervosa. Last reviewed 03/13/2008
Sources:
- National Institute of Mental Health
- Diagnostic and Statistical Manual of Mental Disorders
- American Psychiatric Association Work Group on Eating Disorders
- American Journal of Psychiatry
- U.S. Department of Health and Human Services
