Treatment:

People with bulimia rarely have to go to the hospital, unless:

• Binge-purge cycles have led to anorexia
• Drugs are needed to help them stop purging
• Major depression is present

Most often, a stepped approach is used for patients with bulimia. The treatment approach depends on how severe the bulimia is, and the person's response to treatments:

• Support groups may be helpful for patients with mild conditions who do not have any health problems.
• Cognitive-behavioral therapy (CBT) and nutritional therapy are the preferred first treatments for bulimia that does not respond to support groups.
• Antidepressants known as selective serotonin-reuptake inhibitors (SSRIs) are often used for bulimia. A combination of CBT and SSRIs is very effective if CBT is not effective alone.

Patients may drop out of programs if they have unrealistic hopes of being "cured" by therapy alone. Before a program begins, the following should be made clear:

• A number of therapies are likely to be tried until the patient can overcome this difficult disorder.
• It is common for bulimia to return (relapse), and this is no cause for despair.
• The process is painful, and the patient and family need to work hard.

Support Groups:

Self-help groups like Overeaters Anonymous may help some people with bulimia. The American Anorexia/Bulimia Association is a source of information about this disorder.

See: Eating disorders - support group

Expectations (prognosis):

Bulimia is a long-term illness. Many people will still have some symptoms, even with treatment.

People with fewer medical complications of bulimia, and those who are willing and able to take part in therapy have a better chance of recovery.

Complications:

Bulimia can be dangerous. It may lead to serious medical complications over time. For example, vomiting over and over again puts stomach acid in the esophagus (the tube from the mouth to the stomach), which can permanently damage this area.

Possible complications include:

• Constipation
• Dehydration
• Dental cavities
• Electrolyte imbalances
• Hemorrhoids
• Pancreatitis
• Swelling of the throat
• Tears of the esophagus from too much vomiting

Calling your health care provider:

Call for an appointment with your health care provider if you (or your child) have symptoms of an eating disorder.