Bulimia - Treating bulimia

You can recover from bulimia, but it may be a long and difficult process. The first step towards getting better is to recognise the problem and have a genuine desire to get well. This may involve a big change in lifestyle and circumstances.

If you are concerned about a friend or family member, it can be difficult to know what to do. It is common for someone with an eating disorder to be secretive and defensive about their eating and their weight, and they will probably deny being unwell.

Read more about talking to your child about eating disorders and supporting someone with an eating disorder.

You can talk in confidence to an adviser from eating disorders charity Beat by calling their helpline on 0845 634 1414. They also have a designated youth helpline, on 0845 634 7650.

Treatment usually begins with psychological therapy, which aims to help re-establish healthy attitudes towards eating. People with bulimia need to explore and understand the underlying issues and feelings that are contributing to their eating disorder, and change their attitudes to food and weight. 

Your GP may suggest medication, usually in addition to psychological treatment.

Psychological treatment

Cognitive behavioural therapy

Cognitive behavioural therapy (CBT) is the most common type of psychological treatment for bulimia. It involves talking to a therapist and looking at your emotions in detail to work out new ways of thinking about situations, feelings and food. It may also involve keeping a food diary, which will help determine what triggers your binge eating.

Interpersonal therapy

As with CBT, interpersonal therapy (IPT) involves meeting with a therapist to discuss your condition. However, the focus is more on your personal relationships than your problems with food.

You are more likely to be referred for this type of psychological treatment if you have recently lost a loved one or have experienced a big change in your life. The aim of IPT is to help you establish supportive relationships, which can draw your focus away from eating.

Medication

Antidepressants known as selective serotonin reuptake inhibitors (SSRIs) may be used to treat bulimia. The SSRI usually recommended to treat bulimia is called fluoxetine (brand name Prozac).

SSRIs are mainly used to treat depression, but are also used to treat:

• eating disorders
• obsessive compulsive disorder (OCD)
• anxiety
• social phobia

As with any antidepressant, an SSRI will usually take several weeks before it starts to work. You will usually be started on a low dose, which is then gradually increased as your body adjusts to the medicine.

When you start taking an SSRI, see your GP after two, four, six and twelve weeks to check your progress and to see if you are responding to the medicine. Not everyone responds well to antidepressant medicines, so it's important that your progress is carefully monitored.

Very few drugs are recommended for children and young people below the age of 18. It is also best not to take SSRIs if you have epilepsy or a family history of heart, liver or kidney disease.

Hospital treatment

Bulimia is not usually treated in hospital. However, if you have serious health complications and your life is at risk, you may be admitted to hospital. Hospital treatment is also considered if you are at risk of suicide or self-harm.

The recovery process

Once diagnosed, people with bulimia can recover, but it may take a long time. It can be very difficult, both for the person affected and their family and friends.

To recover, someone with bulimia needs to:

• change their eating habits
• change the way they think about food
• gain weight safely, if necessary

The longer someone has had bulimia, the harder it is to re-learn healthy eating habits and gain weight. It is important to start treatment as early as possible, so the person has the best chance of recovery.

For most people, recovery goes through several stages, with progress seeming to go backwards and forwards.