Psychological treatment for bulimia nervosa
Use psychological therapies initially for the treatment of bulimia nervosa. Specific training and protocols are required for psychological therapies for eating disorders; only a healthcare professional with appropriate expertise in the management of eating disorders (usually a psychologist, social worker, psychiatrist or occupational therapist) can deliver psychological treatment to a person with bulimia nervosa.
If a comorbid psychiatric disorder is present, refer to recommendations for the disorder and manage it concurrently. Substance abuse and deliberate self-harm need to be addressed first to enable a person with bulimia nervosa to engage in therapy.
For children and adolescents, bulimia nervosa-focused family therapy (ie family-based therapy modified for bulimia nervosa) is recommended. However, focal psychodynamic psychotherapy (FPT) or transdiagnostic enhanced cognitive behavioural therapy (CBT-E) adapted for young people may also be used.
For adults with bulimia nervosa, an individual psychological therapy such as CBT-E or its parent therapy, CBT for bulimia nervosa (CBT-BN) is most effective.
Some adults with bulimia nervosa can find CBT to be unnecessarily intensive, or insufficient. In these instances, other psychological therapies may be used. See Psychological therapies for adults with bulimia nervosa for a list of psychological therapies for patients suffering from bulimia nervosa.
|
Therapy [NB1] |
Targets |
Tools |
|---|---|---|
|
transdiagnostic enhanced cognitive behavioural therapy (CBT-E) and cognitive behavioural therapy for bulimia nervosa (CBT-BN) |
eating habits and weight control behaviours preoccupation with body shape and weight |
education about nutrition, shape and weight issues, and important complications with purging behaviours (eg hypokalaemia) encouraging daily self-monitoring of relevant disorder-related thoughts and behaviours information about a suitable eating pattern and the harms of restrictive dieting gradual introduction of avoided foods into the patient’s diet cognitive restructuring procedures to identify and challenge problematic thoughts and attitudes relapse prevention strategies. |
|
focal psychodynamic psychotherapy (FPT) |
intra- and interpersonal maintaining factors (eg low self-esteem) |
exploration of beliefs or schema interpersonal therapy goal setting new behaviours |
|
dialectical behaviour therapy (DBT) |
the dialectic of 2 opposing views of eating disorder behaviours distress intolerance and use of binge eating and weight control behaviours to reduce distress |
training in emotion regulation skills (mindfulness) ‘meaning making’ as acceptance and change validating the worth of the individual |
|
interpersonal psychotherapy (IPT) |
interpersonal problem areas (eg grief, role transitions, role disputes, interpersonal deficits) |
exploration of interpersonal function encouraging affect clarification communication analysis therapeutic relationships |
Note: NB1: All of these therapies are manualised and require specific training.
| ||
If barriers to psychological therapies exist for patients with bulimia nervosa, guided cognitive behavioural self-help, where clinicians support patients in following a self-help program or manual, are effective. Unguided self-help may also be effective, but has been shown to have poorer outcomes than guided self-help. There are several suitable self-help books and websites available for use by both the patient and their clinician (see Principles of managing bulimia nervosa).