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Bulimia nervosa - Treatment

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Treatment of bulimia nervosaEdit

Treatment is most effective when it is implemented early on in the development of the disorder. Unfortunately, since this disorder is often easier to hide and less physically noticeable, diagnosis and treatment often come when the disorder has already become a static part of the patient’s life. Historically, those with bulimia were often hospitalized to end the pattern and then released as soon as the symptoms had been relieved. However, this is now infrequently used, as this only addresses the surface of the problem, and soon after discharge the symptoms would often reappear as severe, if not worse, than when they had originally been.

There are several residential treatment centers across the country, which offer long term support, counseling, and symptom interruption. The most popular form of treatment for the disorder involves some form of therapy, often times group psychotherapy or cognitive behavioral therapy. Anorexics and bulimics typically go through the same types of treatments and are members of these same treatment groups. This is because anoreixa and bulimia often go hand in hand, and it is not unlikely that one has at some point participated in both. Some refer to this as "symptom swapping". These forms of therapy address both the underlying issues which cause the patient to engage in these behaviors, as well as the actual food symptoms as well. In combination with therapy, many psychiatrists will prescribe anti-depressants or anti-psychotics. Anti-depressants come in different forms, and the most promising drug to respond to bulimia has been an SSRI called fluoxetine, its shelf name being Prozac. In a study done with 382 bulimia patients those who took between 20-60 mg of the drug reduced their symptoms from 45% to 67%, respectively. However, Prozac is the only drug that has been tested for bulimia, so it is quite possible that several others could be more effective. Often insurance companies will not pay for other drugs for the patient until he or she has tried Prozac, because it has some positive outcome results.

Anti-psychotics are also used; they're known more politically correct as neuroleptics. Anti-psychotics are also used in schizophrenia, but in smaller doses for eating disorders. With an eating disorder, the patient perceives reality different as well and cannot grasp what it is like to eat normally because he/she is so far removed from that. This author has referred to anti-psychotics being "the brain's glue." They help you to think clearer and reorganize the chaos. Some brand name anti-psychotics are Seroquel, Risperdol, Geodon and Abilify from personal experience and through personal consultation with a representative at Lilly, the drug representative for Geodon- they were hesitant to put Geodon on the market because of its low outcome rates and dangerous side effects (this however is just heresay, but from personal experience, it did cause this author to experience some very dangerous side effects). Unfortunately, since this disorder has only recently been recognized by the DSM, long-term outcomes of people with the disorder are unknown. Current research indicates that up to 30% of patients rapidly relapse, while 40% are chronically symptomatic.

The most related factor to one’s prognosis with this disorder is the rate at which they received treatment. Those who receive treatment early on for the disorder have the highest and most permanent recovery rates. The bottom line is: getting treatment early will give the best chances of a permanent recovery from bulimia nervosa.

Unfortunately some patients are hesitant to seek treatment because they feel that they "are not sick enough" or will be "the fattest one there". This is a common concern among patients when they initially seek help. It is important to remember that everyone thinks that and most people are too concerned with their own appearance to be judging you in treatment. Also, many people are at different stages in recovery in their treatment, so while you are just entering someone may just be leaving, hence, fully weight restored. If you are suffering from bulimia nervosa, it is not okay to play the waiting game and seek treatment when you feel that you are thin enough to deserve it. Bulimia nervosa is one of the deadliest known psychological disorders in the world. This author has personally known girls who "looked" perfectally healthy and dropped dead from heart attacks and ruptured esophuguses. The medical community can be very uneducated about bulimia nervosa and eating disorders in general. If a practitioner turns you away because they think you are not sick enough, it's time to see a specialist. Men and women severely underweight can be looked at and dismissed by a practitioner thinking "it's just a phase".

Further readingEdit

  • Cooper, M., Todd, G. & Wells, A. (2000). Bulimia Nervosa: A self-help cognitive therapy programme. Chichester, UK: Wiley.
  • Cooper, M.J., Wells, A. & Todd, G. (2004). A cognitive model of bulimia nervosa. British Journal of Clinical Psychology, 43, 1-16.
  • Cooper, M., Todd, G. & Wells, A. (2007). Cognitive Therapy for Bulimia Nervisa: An A-B Replication Series. Clinical Psychology and Psychotherapy, 14, 402-411.
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