Treatment of Bulimia Nervosa
Nutritional counseling has two main goals: correcting misconceptions about food and re-establishing regular eating habits. Patients are given information about bulimia nervosa and its consequences. Avoiding binge foods and not constantly stepping on a scale may be recommended early in treatment. The primary goal, however, is to develop a normal eating pattern. To achieve this goal, some specialists encourage patients to develop daily meal plans and keep a food diary in which they record food intake, internal sensations of hunger, environmental factors that precipitate binges, and thoughts and feelings that accompany binge-purge cycles. Keeping a food diary not only is an accurate way to monitor food intake but also may help identify situations that seem to trigger binge episodes. With the help of a therapist, patients can develop alternative coping strategies.
In general, the focus is not on stopping bingeing and purging per se but on developing regular eating habits. Once this is achieved, the binge-purge cycle should stop by itself. Patients are discouraged from following strict rules about healthy food choices, because this simply mimics the typical obsessive attitudes associated with bulimia nervosa. Rather, encouraging a mature perspective on nutrient intake—that is, regular consumption of moderate amounts of a variety of foods balanced among the food groups—helps patients overcome this disorder.
Setting time limits for the completion of meals and snacks is important for people with eating disorders. Many bulimic persons eat very quickly, reflecting their difficulties with satiety. Suggesting that the patient put his or her utensil down after each bite is a behavioral technique that a therapist might try with a recovering bulimic person. (In comparison, many anorexic persons eat in an excessively slow manner—for example, taking 1 hour to eat a muffin because it was cut into tiny, bite-size pieces.)
People with bulimia nervosa must recognize that it is a serious disorder that can
have grave medical complications if not treated. Because relapse is likely, therapy
should be long term. Note that those with bulimia nervosa need professional help be
cause they can be very depressed and are at a high risk for suicide. About 50% of people with bulimia nervosa recover completely from the disorder. Others continue to
struggle with it to varying degrees for the rest of their lives. This fact underscores the
need for prevention because treatment is difficult.