Treatment for Bulimia

Bingeing is triggered by both physiological factors (hunger) and emotional factors, such as stress, depression or anxiety. Effective treatment for bulimia nervosa needs to target both the physiological and the emotional triggers as well as the underlying causes. Psychological or ‘talking’ therapy is the most common treatment for bulimia and is known to be the most effective way of breaking unhealthy eating cycles. Cognitive behavioural therapy is known to be the most effective treatment for bulimia nervosa and so is most commonly recommended by our clinicians.

Cognitive Behavioural Therapy

CBT is the current leading treatment for bulimia nervosa (NICE Guidelines, 2004 / 2017). CBT focuses on your thinking (cognitions), your behaviours (what you do in response to certain thoughts), and your emotions (how you feel in response to certain thoughts). People can often recognise patterns in their thinking (e.g. “I am not good enough”, “People don’t like me”, “I need to be thinner to be successful”). These thoughts result in familiar emotions and behaviours that often involve manipulation of food or eating. CBT helps individuals to recognise their unhelpful or negative thinking, see the patterns in their behaviours and develop healthy strategies and skills to challenge or cope with their unhelpful thoughts. CBT is a structured skills based therapy that is most suitable for people who want to be guided by their therapist to find new ways of coping.

Family Based Treatment (FBT)

Family based treatment is usually offered to younger people with bulimia nervosa. Involving the family in treatment of young people is known to increase the likelihood that an adolescent will recover quickly from their eating disorder. FBT has three specific phases. The first phase focuses on empowering the parents to assist in implementing a healthy eating plan that will reduce the likelihood of bingeing. The second phase focuses on gradually supporting the adolescent to take more control over their own eating. Additionally, relationships that exist between family members are explored in order to help the family negotiate new, more adaptive way of relating to each other. In the third phase the focus is on maintaining healthy adult or adolescent relationships between family members in which the eating disorder does not form the basis of the relationship.

Dialectical Behaviour Therapy (DBT)

DBT is an emotional skills based treatment that combines eastern approaches (Buddhist theory, Eastern psychological and spiritual philosophies) and western therapies (including aspects of CBT and psychodynamic therapy). DBT sees bingeing and purging as having developed as a way of coping with or surviving difficult emotions. DBT focuses on healthy ways of responding to emotions in the here and now. DBT is comprised of 4 modules: mindfulness, distress tolerance, emotional regulation and interpersonal effectiveness.

Other therapy approaches

Although the therapies above are typically recommended for treating bulimia, they will not suit everyone. You may have tried these approaches before and not found them helpful, or they might not feel like the right “fit” for you because of how you think or talk about things. There are lots of other therapeutic approaches which people have found helpful in over coming an eating disorder which have been more recently developed, or less well researched. These include schema therapy, cognitive analytic therapy, and compassion focused therapy. Other people prefer a less structured approach, and may benefit from a more integrative approach with a counselling psychologist. For other people, comorbid difficulties (such as depression, anxiety or trauma) may be preventing them from making full use of eating disorder treatment, and therapy might need to address these issues too. Our clinicians are trained in a range of therapies, so we can help you find the treatment that suits you.

We are happy to discuss these treatments and what might be most helpful for you in more detail at your assessment.