• Home

Home > Medical Reference > Patient Education

• Highlights
• Introduction
• Risk Factors
• Causes
• Complications of Bulimia
• Complications of Anorexia
• Symptoms
• Diagnosis
• Treatment
• Treatment for Bulimia
• Treatment for Anorexia
• Therapy
• Resources
• References

Eating disorders

Description

An in-depth report on the treatment and prevention of eating disorders.

Alternative Names

Anorexia; Bulimia; Binge eating

Treatment for Bulimia

Some experts recommend a stepped approach for patients with bulimia, which follow specific stages depending on the severity and response to initial treatments:

• Support groups. This is the least expensive approach and may be helpful for patients who have mild conditions with no health consequences.
• Cognitive-behavioral therapy (CBT) along with nutritional therapy is the preferred first treatment for bulimia that does not respond to support groups.
• Drugs. The drugs used for bulimia are typically antidepressants known as selective serotonin-reuptake inhibitors (SSRIs). A combination of CBT and SSRIs is very effective if CBT is not helpful.

Patients with bulimia rarely need hospitalization except under the following circumstances:

• Binge-purge cycles have led to anorexia
• Drugs are needed for withdrawal from purging
• Major depression is present

Psychotherapeutic Approaches and Medications for Bulimia

Psychologic Therapy. Cognitive-behavioral therapy (CBT) is the first-line of therapy for most patients with bulimia and is successful in about 60% of cases. In one study of bulimic patients, those who did not respond to CBT tended to be less committed to the treatment, were more preoccupied with their symptoms, and had ritualized eating behaviors. Interpersonal therapy may be tried if CBT fails, although in one study it was no more successful than antidepressants. Some studies have found that bulimic patients respond well to self-help CBT with a CD-ROM or manual. These methods, the research found, reduced the incidence of both binging and vomiting.

Antidepressants. Because of the high incidence of depression in patients with bulimia, antidepressant medication is often recommended for patients who have normal weight or for those who are overweight. They should be used in combination with CBT. (Some of these drugs can cause weight loss and should not be used in patients who are underweight.)

The most common antidepressants prescribed for bulimia are selective serotonin reuptake inhibitors (SSRIs) such as:

• Fluoxetine (Prozac)
• Sertraline (Zoloft)
• Paroxetine (Paxil)
• Fluvoxamine (Luvox)

Studies are mixed, however, on whether SSRIs offer an additional advantage in reducing binge-eating compared to CBT. Prozac has been approved for bulimia and is considered the drug of choice, although some studies suggest that other SSRIs, such as Luvox, may be even more effective.

Important note : Recent studies indicate that the use of Prozac and other antidepressants may cause children and teenagers to have suicidal thoughts. Children who are taking these drugs must be monitored very carefully for signs of potential suicidal behavior.

If the drugs are not effective, the doctor should be sure it is not because the patient is vomiting after taking the medication. Some experts believe that these drugs should be continued even after symptoms have improved in order to restore healthy brain chemical balances.

Other Drug Therapy for Bulimia Nervosa

Drugs to Prevent Vomiting. In one study, ondansetron (Zofran), a drug that prevents vomiting, reduced the binge-purge episodes by half. The drug may cause depression in people already on SSRI antidepressants. More studies are needed.

Sibutramine. Sibutramine (Meridia) is a drug used for weight loss . It does so by balancing two important brain chemicals, serotonin and norepinephrine, which helps to increase metabolism. Some evidence suggests that the actions of this drug may be useful for people who binge. However, this drug should be used only for patients with bulimia who have normal or above normal weight, and should never be used for those who are anorexic.

Inositol. Inositol is a B vitamin that is being investigated for bipolar disorder, anxiety, and depression. A 2001 study suggests that it may also have benefits for bulimic patients.

Topiramate . The antiepileptic drug topiramate (Topamax) has been shown in studies to reduce bingeing and purging episodes in bulimics, as well as to improve self-esteem, attitudes, and body image.

Alternative Approaches to Bulimia

Hypnosis. A study on women with bulimia showed that they had a high susceptibility to hypnosis, suggesting that it might be beneficial as part of their treatment. People with anorexia, on the other hand, seem to be very resistant to the state of vulnerability required in this process.

Light Therapy. Some researchers have noted an association between bulimia and seasonal affective disorder (depression that intensifies in the darker winter months). This suggests that therapy using intense directed light may be useful. Studies report, however, that while light therapy relieves depression, it has little effect on binge-purging behavior. Some experts suggest it may be more useful in combination with medication and psychotherapy.

Guided Imagery. A technique called guided imagery reduced frequency of binges and vomiting by almost 75% in one study. This method uses audiotapes to evoke images that will reduce stress and help achieve specific goals.

• Review Date: 12/13/2006
• Reviewed By: Harvey Simon, MD, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is the first of its kind, requiring compliance with 53 standards of quality and accountability, verified by independent audit. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial process . A.D.A.M. is also a founding member of Hi-Ethics (www.hiethics.com) and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997-2007 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.