Bulimia Nervosa (BN) is an eating disorder in which an individual recurrently eats an abnormally large amount of food within a 2-hour period while experiencing a lack of control over their eating, followed by behaviors used to attempt to prevent weight gain (self-induced vomiting, laxatives, diuretics, medications, fasting, excessive exercise). Those with BN are often preoccupied with weight and bodily shape, and overemphasize this part of themselves in evaluating their self-worth.
Factors Associated with Bulimia Nervosa
- Occurs in those considered “normal” or “overweight” weight range according to BMI
- Restriction of food/calorie intake in between binges and avoidance of “trigger” foods
- Irregular or absent menstrual periods
- Fluid and electrolyte imbalances
- Esophageal tears, gastric rupture, and cardiac arrhythmias in more acute cases
- Laxative dependence
- Gastrointestinal issues
- Typically develops after engaging in dieting practices as opposed to before
- Comorbidity with depressive symptoms/disorders, bipolar disorders, anxiety symptoms/disorders, substance use disorders, and personality disorders
Treatment of Bulimia Nervosa
Outpatient treatment is appropriate for those who are medically and psychologically stable, have adequate control in managing symptoms such that they can function in their daily lives, and are generally progressing in treatment. The outpatient team typically consists of a mental health therapist, a nutritionist, and an eating disorder-informed physician. A psychiatrist may also be included in the treatment team if indicated.
Therapists help address thoughts and emotions associated with disordered eating behaviors, related/other psychological symptoms such as anxiety or depression, body image issues, and coping with stressors such as family relationships or unresolved trauma. Different forms of therapy include individual therapy, group therapy, or family therapy. Common therapy modalities used to treat BN include CBT, DBT, ACT, Psychodynamic therapy, Emotion-Focused Family Therapy, and Family-Based Treatment.
Nutritionists assist clients in creating a meal plan and developing a positive relationship with food. Nutritional counseling for eating disorders often include principles from Intuitive Eating and/or Health At Every Size (HAES) approaches.
Physicians monitor weight and other vital symptoms and levels to ensure one is medically stable and nourished.
Family-Based Treatment (FBT)
FBT is a form of outpatient eating disorder treatment for children and teens. Unlike other forms of outpatient care, clients do not need to be able to feed themselves in order to participate in FBT. Click here to learn more about FBT.
Intensive Outpatient Program (IOP)
IOP provides more structured and frequent care for those stepping down from higher levels of care, are medically stable, and at least fairly motivated to address their eating disorder. IOP generally offers services 3 to 5 days per week for up to a few hours per day.
Partial Hospitalization Program (PHP)
PHP offers treatment for the majority of every day, but not overnight. PHP is well-suited for those who are medically stable but only partly effective in managing their symptoms such that their functioning is impaired and could benefit from daily physiological and mental monitoring. PHP is also well-suited for those who are mentally stabilized but experiencing impaired functioning and engaging in daily binging and purging behaviors.
Residential treatment provides medically stable clients with 24/7 treatment including medical care, intensive mental health support, and supervision. Residential care is appropriate for those who are not responsive to IOP/PHP treatment and could use more mental health support.
Inpatient treatment is recommended for acute, medically unstable cases that could require daily intensive medical monitoring and treatment, mental health support, and nutritional services in a hospital setting. This level of care is recommended for those with acute issues with vital signs and laboratory results, coexisting medical issues, significant regression in recovery, or suicidal clients who are unable to maintain safety.
If you or someone you know shows signs of Bulimia Nervosa, please contact today for a free consultation.