Patient information from BMJ

Bulimia: what treatments work?

Last published:Jan 17, 2022

Bulimia is a serious medical condition that can damage your health. Many people find it difficult to talk about this illness, which can make it hard to get help.

But getting help is the most important thing you can do. Treatment can help you feel better about yourself and stop bulimia taking over your life.

You can use our information to talk with your doctor and decide which treatments are right for you.

What treatments work?

There are several good treatments for bulimia. They can help you feel better and eat normally again even if you've had bulimia for a long time.

We talk about two kinds of treatment here: medicines and talking treatments (psychotherapy).

Talking treatments are usually considered the best treatment for bulimia. But doctors sometimes suggest that people have medicines and therapy together.

Talking treatments

Several types of talking treatment are used to help people with bulimia, but the one used most often is cognitive behaviour therapy (CBT).

The aim of CBT is to help you stop thinking and acting in harmful ways. Sessions with a therapist can help you to learn how to cope with unhelpful thoughts. This should help you stop needing to binge and purge.

You'll probably start with about 20 sessions. Each lasts about an hour. You'll also be given homework to do between sessions. For example, you might be asked to keep a diary of what you eat and how often you binge or purge.

You might also be asked to make changes in your life. For example, your therapist may ask you to eat a small breakfast every day.

You may find some of these exercises stressful but if you stick to them there is a good chance that they will help. If you're worried about putting on weight it may help to know that most people don't put on weight during CBT.

Treatment doesn't end when you stop going to a therapist. You'll be able to keep using the techniques you've learned, to help you stay well in the future.

There's often a waiting list to see a therapist. So your doctor may suggest a kind of self-help CBT. This may mean reading a book, listening to CDs, or watching videos about bulimia.

You'll have exercises or worksheets to do afterwards. Seeing your doctor or a therapist every so often can help keep you motivated.

Medicines

Doctors sometimes prescribe medicines called antidepressants for bulimia. These drugs are usually used to treat depression. But they can help some people with bulimia to stop bingeing and purging as much, and sometimes completely.

You probably won't be recommended antidepressants for bulimia if you're under 18.

Antidepressants can take several weeks to start working. And they can cause side effects in some people. Your doctor will keep a regular check on you if you're taking them.

Milder side effects of antidepressants can include drowsiness, diarrhoea, a dry mouth, feeling sick, and not enjoying sex as much.

Sometimes antidepressants can slightly increase the risk of someone killing themselves. This risk seems to be greatest in teenagers and young adults. Doctors should carefully monitor young people who are prescribed antidepressants.

If you find yourself thinking about harming or killing yourself, talk to your doctor or another healthcare professional straight away.

Talk to your doctor if you get any side effects from antidepressants. Your doctor may be able to suggest a different antidepressant.

But don’t just stop taking your tablets without talking with your doctor first. Some antidepressants can cause unpleasant withdrawal symptoms if you stop taking them suddenly.

Support and counselling with nutrition

As well as talking treatments and possibly medicine, you should be offered help and counselling about how to get the nutrition you need to keep you healthy.

This is usually done by a dietician. You can talk with them about the kinds of things you eat and the kinds of things you should be eating, and together you can make a plan that suits your nutrition needs.

Bulimia and diabetes

Bulimia can be especially serious if you have diabetes, as the bingeing and purging can cause your blood sugar to go up and down very quickly. This can worsen the damage that diabetes causes to your blood vessels.

People with diabetes who have bulimia may need to be treated urgently in hospital.

Bulimia and pregnancy

Bulimia can be dangerous for unborn babies, because if the mother doesn't get enough nutrition then neither does the baby.

Doctors don't usually give antidepressants to pregnant women who have bulimia, as it's best to avoid exposing unborn babies to too many medicines. Instead doctors recommend talking treatments such as CBT.

If you have bulimia while pregnant your doctor should also make sure that you see a nutritionist who will give you support and advise you about the right kinds of foods you'll need to eat so that your baby can grow normally.

You will also have extra scans to check that your baby is healthy.