The best approach in the treatment of bulimia is actually a balanced combination of all the treatments that will match closely a particular patient’s profile and circumstances. In this multidisciplinary approach, the patient’s doctor, psychiatrist, and dietitian are involved. In some cases where complications from the eating disorder have arisen, a surgeon or endocrinologist may have to render their services. Lastly, the help of a dentist can also contribute in the detection and ongoing treatment of bulimia.This multidisciplinary bulimia treatment plan should have the following goals:
- Treatment of physical complications
- Treatment of psychiatric conditions, including changing of the patient’s thoughts, attitudes, and feelings related to and causing bulimia
- Elimination of binge eating and purging
- Providing of education on nutrition
- Motivating the patient to practice healthy eating patterns and attitudes
- Getting the family to support the treatment as well as also providing the family with counseling, and
- Preventing the patient from going to relapse
- Cognitive behavioral therapy
- Interpersonal therapy
- Nutritional rehabilitation and counseling
- Family therapy
- Couple therapy
- Support groups and guided self-help
- Psychodynamic psychotherapy
- Bright light therapy
The medical aspect of the treatment includes all or a combination of inpatient care, surgical care, and medication.Inpatient care is given in cases of medical complications and infections, incapacity of the patient to function in daily life, absence of a support structure, failure of outpatient bulimia treatment methods, or risk of suicide. Surgical care is required when patients develop gastric dilatation, which is severe and uncontrollable vomiting that happens right after food consumption. This condition is one major cause of bulimia-related deaths. Surgical treatment is also required if the patient develops esophageal tear.
Medication for the treatment of bulimia is often in the form of antidepressants. These are helpful for patients who have symptoms of depression and anxiety. Medication is used to complement ongoing psychological treatment. Antidepressants that have proven effectiveness in most cases and have fewer negative side effects are SSRIs or Selective Serotonin Reuptake Inhibitors.
Other medications that have been tried in treating mood disorders associated with bulimia are tricyclic antidepressants, topiramate, lithium, valproic acid, ondansetron, baclofen, and methylphenidate. In prescribing medication, doctors must present and discuss the benefits and risks related to antidepressant treatment with the patients and their families. The importance of making this decision can hardly be overemphasized for young patients such as children and adolescents.