Mental health articles

Care and management of bulimia nervosa

The person with bulimia is usually cared for as an outpatient. Hospital admissiononly tends to occur if the person has suicidal ideas or physical illnesses or symptoms.Although the person generally is of normal weight, they will require support and understanding by the health care practitioner in order to address their beliefs about eating and their episodes of bingeing.

NICE guidelines for eating disorders (NICE 2004) stipulate that a self-help programme may be the first step. However, instead of this, the person with bulimia nervosa may be prescribed antidepressant therapy, the drug of choice being fluoxetine(Prozac) 60 mg daily (usual dose to treat depression is 20 mg).This is because it can reduce the frequency of binge eating and purging. Long-termtreatment with medication may be necessary.

Psychological treatments consist of cognitive behavioural therapy (CBT) specifically developed for bulimia nervosa. The person receives between 16 and 20 sessions.CBT, according to Fairburn and Harrison, has been found to be the most effective treatment for people with bulimia nervosa.在CBT is often split into three phases. The first phase consists of learning to reduce bingeing and dieting. The person maintains a diary recording how often they eat, binge and exercise. They are also encouraged to eat small meals throughout the day. Information about bulimia nervosa is also provided by the therapist.During the second phase, they are encouraged to talk more about food, what foods they eat and their feelings about food and weight. During the third phase,Tonks suggests that the person should be feeling better and with fewerepisodes of bingeing and treatment will focus on improving their symptoms further and developing strategies to avoid their symptoms reoccurring. An alternativeform of psychological therapy to CBT is interpersonal psychotherapy (as describedin the section on anorexia nervosa).

The person experiencing bulimia nervosa will require an understanding and empathic approach to facilitate a discussion of their feelings and behaviour. They feel much shame and embarrassment regarding their binges and subsequent purging and exercise behaviour. Therefore, they will need to see that the health care practitioner will be understanding and supportive before they conceal these symptoms for fear of humiliation and rejection.

Tags: bulimia nervosa, treatment