Bulimia nervosa treatment needs to address the complexity of this eating disorder. Noted for its cycle of binge eating which is then followed by some type of action designed to compensate for the overeating, research has found that between one and three women out of every 100 will experience this eating disorder during her lifetime. The rate of males who have the diagnosis of bulimia nervosa is much lower.
There are two general types of binge eating distinct from one another depending on the compensatory actions the individual takes. The most common type involves the individual taking measures to purge their body of the excess calories consumed during the binge eating phase. Some of the more popular ways of doing this include using laxatives, self-induced vomiting or the use of diuretics.
The other type is known as non-purging bulimia nervosa. Instead of engaging in one of the purging behaviors noted above, the individual uses other methods to ensure the excessive calories they consumed do not cause weight gain. Common methods of doing so include fasting for a day or more and obsessively exercising.
Binge eating is the common thread between the two types of compensatory methods seen in bulimia nervosa. Even though many people consume an excess of calories during the normal course of their day, binge eating goes beyond simply overeating. Instead, this eating disorder is focused on eating large quantities of food over a relatively short amount of time. Some examples of a binge eating episode might include when an individual consumes a gallon of ice cream or an entire pie instead of the serving size that is typical. This period of overeating usually takes place over a period of two hours.
Signs of Bulimia Nervosa
When a diagnosis of bulimia nervosa is given to a family member, friend or loved one, there is often confusion and fear. Much of this centers around the fact that there were few bulimia nervosa symptoms to alert loved ones to the fact there was an issue.
It is important for the loved ones of an individual who needs bulimia nervosa treatment to not be too hard on themselves. Because a person who is living with an eating disorder is often secretive about their actions, it is easy for even close family members and friends to be unaware of what is going on.
This is especially true when one considers the primary differences between bulimia nervosa and other eating disorders. Anorexia nervosa, for example, is often easier to recognize because the individual starts to lose noticeable amounts of weight. Binge eating, too, is recognizable because in many cases, the individual gains weight.
Because bulimia nervosa involves a compensatory behavior that is designed to rid the body of the excess calories consumed during the binge eating phase of this eating disorder, individuals are often within a normal weight range.
Bulimia Nervosa Treatment
Like any other eating disorder, bulimia nervosa treatment typically involves several approaches used together to address each facet of the disease. Because it involves both physical and psychological aspects, these must be identified and included within the treatment plan. An additional factor that must be considered is the presence of any medical conditions that occurred as the result of the eating disorder.
The Medical Aspect of Treatment
While a person with bulimia nervosa might appear to be at a healthy weight, this does not mean they are a healthy individual. Because of the repeated vomiting, for example, those individuals who purge by vomiting after binge eating could experience damage to their gums and teeth, experience gastrointestinal conditions and/or be dehydrated because of a reduction in their fluid intake. Heart arrhythmias could occur if an individual is experiencing electrolyte imbalances because they aren’t getting the nutrients they need. Having regular access to high-quality medical treatment focused on eating disorders is crucial for a full recovery.
Psychological Treatment for Bulimia Nervosa
A wealth of research has shown that cognitive behavioral therapy (CBT) is highly effective as a treatment option for adults who are coping with bulimia nervosa. Working with a highly-trained eating disorder counselor, the individual with bulimia nervosa learns to both identify and challenge those thoughts that are disordered and alter them to healthier thought patterns and behaviors. One of the ways of achieving this is to learn better ways of coping with the stressors in life.
In addition to CBT, interpersonal therapy is often a valuable bulimia nervosa treatment. Because conflicts within a family could contribute to an individual’s psychological distress and the development of an eating disorder such as bulimia nervosa, learning how to improve personal relationships could also support one in recovery.
Is Medication a Treatment Option?
Research has shown using CBT can help an individual break the bingeing and purging cycle quickly. By adding medication as a way of supporting the individual as they improve has been proven to help avoid relapse. In some cases, instead of adding a medication, another type of psychotherapy is used so a stepped approach to treatment is implemented.
Fluoxetine, a selective serotonin reuptake inhibitor (SSRI), has been approved by the Food and Drug Administration (FDA) for the treatment of eating disorders. Other SSRIs could also be used to treat bulimia nervosa. Though these medications are often used to treat depression, they have also been shown to have a positive effect on treating bulimia nervosa symptoms even if the individual is not depressed.
The doses of SSRIs used in individuals who have signs of bulimia nervosa are usually higher than those used to treat depression. Because not everyone responds in the same manner, it may be necessary to try different medications to find the one that is most effective. A general guideline suggests taking an antidepressant for at least nine to twelve months may help reduce the chances of relapse.
Topiramate, a medication used to control seizures, has also been shown to help curb bulimia nervosa. It can do this by helping individuals who have bulimia nervosa reduce the urge to binge eat. Using this medication may also lower preoccupation with weight and eating.
Levels of Care
Just as with other medical conditions, one person with bulimia nervosa may need a more intensive level of care while another may need treatment that is less structured. This is often determined — at least in part — by the bulimia nervosa symptoms the individual displays, By working closely with a staff trained in addressing eating disorders, the right treatment plan can be developed.
Residential treatment is the most structured and medically-involved option. The individual lives on-site and has access to care around the clock. Psychiatric treatment, medication management and nutritional counseling are just a few of the many options available with residential treatment.
Day treatment includes both intensive outpatient programs and partial hospitalization programs. These treatment options are considered to be a step down in intensity and structure compared to residential treatment.
Supervised Living
There is a third level of bulimia nervosa treatment an individual can access: supervised living. This is considered to be a midway option between residential treatment and outpatient (day) treatment that bridges the gap between the two.
Individuals enjoy living in an environment that is healthy, supportive and free of substances. During this time, participants learn to develop their life skills, self-care skills, to take responsibility and other important lifelong skills.
Connecting with their community is also an important aspect of healing while engaging in supervised living. Increasing their ability to cope with the stresses experienced in life including conflicts stemming from interpersonal relationships, disruptive thoughts regarding eating and anxiety is also a vital element of supervised living and can help prevent bulimia nervosa in the future.
One of the most important components of supervised living focuses on reshaping the participant’s relationship with food. While encounters with food were largely structured and designed to help participants relearn crucial elements about their relationship with it, supervised living allows for a more natural and spontaneous approach to unfold.
Even though supervised living is a more independent method of treatment than residential care, this does not mean that the participant does not have the assistance and support of highly-trained clinical staff. Throughout each aspect of their day during their stay in a supervised living arrangement, the treatment facility’s staff is always there to help them. The goal is for each individual to become their fully recovered self and to return a life of independence.
Using a gradual approach that allows each individual to proceed at their own pace and to facilitate their own recovery in a fuller manner, supervised living allows for deeper integration of the body and mind. This relaxed environment provides the participant with the ability to better accept themselves and improve their own body image.
One sign of bulimia nervosa that can surprise many people is the presence of downtime. This is because downtime can be a source of stress for many people. In many cases, a person might turn to food when boredom sets in which can lead to binge eating. Then the cycle of purging starts in an effort to maintain a fairly consistent weight level. Learning how to address downtime in a healthy and constructive manner provides an individual with valuable life skills that will serve them well into the future. Instead of turning to food as an outlet for their boredom during their downtime, for example, a participant in supervised living might be encouraged to engage in volunteer efforts, start a new hobby, exercise or attend a class.
Choosing the Right Facility
Choosing the right supervised living arrangement is a crucial component in the journey toward one’s recovered self. Having different options for bulimia nervosa treatment, such as residential treatment, outpatient treatment, supervised living and extended care ensures that the participant has a continuity of care that can help prevent relapse.
Oliver-Pyatt Centers provides unique opportunities for bulimia nervosa treatment that offer individuals the flexibility they crave as well as the support they need. Their supervised living program is for those participants who engage with the facility’s day treatment program. Living in luxurious apartments that are conveniently located and tastefully decorated, an individual has access to a relaxed, welcoming and engaging environment that has their recovery in mind.
Clinical assistance is never very far away when an individual is participating in the Oliver-Pyatt Center’s supervised living program. From evaluating their treatment plan on a regular basis to offering hands-on assistance with challenging food issues, the compassionate, warm and caring team at Oliver-Pyatt Centers is known for their ability to forge deep connections with those who are in the supervised living program.
A comprehensive evaluation is the first step in determining if supervised living at Oliver-Pyatt Centers would be a good fit for a particular individual. Contact the staff today for more information.
Sources
https://www.mayoclinic.org/diseases-conditions/bulimia/symptoms-causes/syc-20353615
https://anad.org/education-and-awareness/about-eating-disorders/eating-disorders-statistics/
https://www.nationaleatingdisorders.org/learn/by-eating-disorder/bulimia