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Pt 4 of our Bulimia review looks at treatment options and offers support tips for the family circle trying to assist recovery

Posted by Eamonn Brady on

Bulimia Nervosa (Part 4)

Tips for family members

Recovery takes years rather than weeks or months. Psychological treatment is core to treatment as patients must be convinced that they need to attain a normal weight. Progress should be monitored by weighing; monitoring needs to be managed skilfully so it does not become a battleground. Substance misuse (including alcohol, deliberate overdoses, use of laxatives or misuse of prescribed insulin) greatly increases risk. Weight fluctuations and binge-purge methods rather than pure starvation alone increases risk. Depression, anxiety, and family arguments are usually caused by the disorder (rather than these factors causing the eating disorder); therefore, the eating disorder must be treated before tackling other issues. Medication has little benefit in anorexia and the risk of dangerous side effects is higher in malnourished patients (Medication has more success in helping bulimia). Involving the family in treatment and care encourages calm firmness and assertive care. Family involvement increases the chances of recovery.




Individual therapy


Structured individual treatments are usually offered as a weekly one hour session with a therapist trained in the management of eating disorders and in the therapy model used. Therapies available include:


Cognitive analytic therapy

This psychotherapy uses letters and diagrams to examine habitual patterns of behaviour around other people and to experiment with more flexible responses.


Cognitive behaviour therapy (CBT)

A form of therapy that emphasises the important role of thinking in how we feel and what we do. CBT challenges the automatic thoughts and assumptions behind behaviour in bulimia.


Interpersonal psychotherapy

A talking therapy that focuses on relationship based issues and aims to provide new techniques in dealing with distress.


Motivational enhancement therapy

This psychotherapy uses interviewing techniques derived from work with substance misuse to reframe “resistance” to change as “ambivalence” about change, and to nurture and amplify healthy impulses.


Dynamically informed therapies

These therapies will only provide weight gain if the patient can be convinced of the risk of irreversible physical damage or death and acknowledges that certain boundaries (for example, that they must be weighed weekly, examined regularly by a doctor, and admitted to hospital if weight continues downwards) are observed. Therapies involved include talking, art, music, and movement.


Group therapy


Group therapy is not recognised as an effective therapy type for anorexia and bulimia.


To be continued…next week.

Disclaimer: Information given is general; please ensure you consult with your healthcare professional before making any changes recommended

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