Treatments For Bulimia
Treatments For Bulimia
Barton Blinder, MD (Clinical Professor, Dept. of Psychiatry) gives expert video advice on: When should I seek treatment for bulimia?; What is the first step in getting help for bulimia?; What can I expect when I first seek treatment for bulimia? and more...
When should I seek treatment for bulimia?
I think at the earliest possible time when the habits have not set in, because, for instance, the regurging and compensatory habitual behavior can become a thing in itself. For instance, even in later life, individuals that have had bulimia in their earlier years will still regurgitate in response to tension and so on, maintaining some of those compensatory behaviors later in life. So we want to intervene as early as possible before this so-called habit circuit has set in. That's why education... we are educating children, we are educating parents in elementary school and junior high school to be aware of early signs, to have healthy eating habits. Nutritionists have become very important in helping both working along with psychiatrists, working along with the schools. The earlier the intervention, the better. The truth is though, in many instances in the past, treatment did not occur until the individual was suffering with this for a year, two years and three years. I would say today intervention is occurring in the early teens. It's occuring much more frequently. I think that's a very positive sign.
What is the first step in getting help for bulimia?
Often the first step is with your family practitioner, for instance, getting a physical examination and getting some advice from a paediatrician or a family practitioner. Then after a reasonable physical examination and a reasonable understanding of some of the difficulties that are happening, then getting a psychiatric or psychological consultation along with consultation with a nutritionist to understand and define the eating disturbance.
What can I expect when I first seek treatment for bulimia?
The medical treatments involve careful physical examination and laboratory examination and there we look for evidence of mineral depletion, especially potassium depletion, anaemia. We look for evidence of protein malnutrition, weakness along with the medical, we have dental examinations. We look for abnormalities in the teeth. We also look for osteoporosis which can occur when menstrual cycle declines in anorexia nervosa due to the weight loss and restriction. This lowers estrogen which then leads to mineral depletion in the bones. So we often get certain X-rays to help us there. The paediatrician and physician needs to be an integral part of the treatment. We also monitor the weight gain as it occurs and also the changes in the laboratory findings. One other measure we take is body composition, the percentage of water, fat and muscle in the body. In order for the body to return to total normal endocrine functioning you need a certain percentage of fat, like 17% or 18% for menses to occur. That has to be monitored very carefully, as well.
What is the psychological treatment for bulimic patients?
The psychological treatments for bulimia involves both individual psychotherapy and work with the family. Right now our best evidence for individual psychotherapy is what we call cognitive behavioral therapy. Also, for children and adolescents below the age of 17, 18, or 19, we usually involve family therapy as well. That's considered very important.
How is 'cognitive behavioral therapy' used to treat bulimia?
Our best evidence for individual psychotherapy is what we call cognitive behavioral therapy. This defines the triggers of the binge eating episodes, the feelings that the individual has about their self esteem, their body image, and their peer relationships. In cognitive behavioral therapy we try to help the individual, not to exaggerate, but to identify their own thought process, their own feeling and then to practice more adaptive and more effective coping behaviors.
How are medications used to treat bulimia?
We have medication treatment approved for bulimia nervosa, and those are the serotonin uptake inhibitors and medications such as Floaxatine or Prozac. Actually, I did some of the original research showing the effectiveness of Prozac in reducing food on the mind and binge eating in bulimia, and vomiting in bulimia nervosa. The medicine, though, has to be given very carefully, with caution. We have precautions in the use of medicines of this type, and also, the medicine has to be given at the proper dose level.
How can a nutritionist help treat bulimia?
We work very closely with nutritionists in treating bulimia. I often make the statement that although usually the psychiatrist or the physician is the leader of the team because of medical responsibility, really, probably the nutritionist is the most important. The relationship to the nutritionist as a guide, as a mentor, as an educator, both to the patient and the family is essential. The nutritionist is an essential component of the team and often works very closely with the physiotherapist, with the psychiatrist, and with the attending paediatrician in order to advance things.
Why is a nutritionist important in treating bulimia?
The nutritionist advances small snips of change in the eating habits. They monitor weight, they monitor body composition, and they form a trusting bond with the patient that is a cornerstone of the treatment.