Therapy for bulimia nervosa, as for anorexia nervosa, requires a team of experienced clinicians. These patients are less likely than those with anorexia to enter treatment in a state of semi starvation. However, if a bulimic patient has lost significant weight, this must be treated before psychological treatment begins. Although clinicians have yet to agree on the best therapy for bulimia nervosa, they generally agree that treatment should last at least 16 weeks. Hospitalization may be indicated in cases of extreme laxative abuse, regular vomiting, substance abuse, and depression, especially if physical harm is evident.
The first goal of treatment for bulimia nervosa is to decrease the amount of food consumed in a binge session in order to decrease the risk of esophageal tears from related purging by vomiting. A decrease in the number of this type of purges will also decrease damage to the teeth.
The primary aim of psychotherapy is to improve patients' self-acceptance and help them to be less concerned about body weight. Cognitive behavior therapy is generally used. Psychotherapy helps correct the all-or-none thinking typical of bulimic persons— "If I eat one cookie, I'm a failure and might as well binge." A patient may be asked to analyze the statement as a scientist would do when testing assumptions. In this way, patient and therapist together examine the validity of food and weight beliefs. The premise of this therapy is that, if abnormal attitudes and beliefs can be altered, normal eating will follow. In addition, the therapist guides the person in establishing food habits that will minimize bingeing: avoiding fasting, eating regular meals, and using alternative methods—other than eating—to cope with stressful situations. Group therapy is often useful to foster strong social support. One goal of therapy is to help bulimic persons accept as normal some depression and self-doubt.
Although pharmacological agents should not be used as the sole treatment for bulimia nervosa, studies indicate that some medications may be beneficial in conjunction with other therapies. Fluoxetine (Prozac) is the only antidepressant that has been approved by PDA for use in the treatment of bulimia nervosa, but physicians also may prescribe other forms of antidepressants and related medications.