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A Closer Look at Bulimia

A Closer Look at Bulimia

By: Eleanor Vincent, EdD, CSAC

This article is one in a series which InRoads is publishing designed to provide information on various aspects of mental health. 

Bulimia Nervosa is characterized by repeated episodes of binge eating followed by inappropriate compensatory behaviors such as self-induced vomiting, misuse of laxatives, diuretics, or other medications, fasting, or excessive exercise (Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision (DSM-IV-TR, 2000)).  In addition, individuals with this disorder self report being excessively influenced by body shape and weight.  To meet the criteria for a diagnosis of Bulimia Nervosa, the binge eating and compensatory behaviors must occur at least twice a week for three months (DSM-IV-TR, 2000).

Bulimia Nervosa has been reported to occur with roughly similar frequencies in most industrialized countries including the United States.  Ninety-percent of sufferers are female with onset in late adolescence or early adult life (DSM-IV-TR, 2000).  Also, individuals with bulimia nervosa have been found to have ineffectual coping strategy implementation and a tendency to rely extensively on a limited number of coping strategies  compared with controls (Hawkins & Clement, 1984 as cited in Binford, Crosby, Mussell, Peterson, Crow, & Mitchell, 2005).


Bulimia Nervosa
Flickr Photo Courtesy: Laura Lewis
Someone with bulimia may have a distorted body image, exhibited by thinking she or he is fat, hating her or his body, and fearing weight gain.

Suggested Treatment Methods

In treating bulimia nervosa, it is important to consider family dynamics and the possibility of comorbid psychiatric disorders, such as a mood disorder, since this can sometimes co-occur in individuals with bulimia nervosa (DSM-IV-TR, 2000).Some of the most often recommended treatments for bulimia nervosa include psychotherapy, especially cognitive-behavioral therapy (CBT), and medications.  According to First & Tasman (2004), approximately 25% to 50% of individuals with bulimia nervosa achieve abstinence from binge-eating and purging during a course of CBT, and this improvement seems to be sustained in most.  In other research, manual CBT is said to be the most researched evidence-based treatment for bulimia nervosa (Wilson, Grilo, & Vitousek, 2007).  Interpersonal Therapy has also received some empirical support.  It places emphasis on helping clients identify and modify current interpersonal problems that are hypothesized to be maintaining the eating disorder.  Some aspects of interpersonal therapy may be useful in conjunction with CBT as a means of exploring some of the residual family dynamics that sometimes play a role in the presentation of this illness.

The use of antidepressants in the treatment of bulimia nervosa was initially prompted by the high rates of depression among individuals with bulimia nervosa (First & Tasman, 2004).  However, several studies suggest that antidepressants are generally inferior to a course of CBT in treating this disorder (First & Tasman, 2004; Wilson et al., 2007).  Also, CBT typically eliminates binge eating and purging in roughly 30% to 50% of all cases, reduces the level of general psychiatric symptoms and improves self-esteem and social functioning (Wilson et al., 2007).  In other research about the efficacy of pharmacotherapy in treating bulimia nervosa, follow-up data suggest high rates of rapid relapse (Stunkard et al., 1996 as cited in Wilson et al., 2007) and high noncompliance with open label extended treatments for binge-eating disorder (McElroy et al., 2004, as cited in Wilson et al., 2007).



American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders (4th-TR ed.). Washington, DC: Author.

Binford, R.B., Mussell, M., Crosby, R.D., Peterson, C.B., Crow, S.J., & Mitchell, J.E. (2005).  Coping strategies in bulimia nervosa treatment: Impact on outcome in group cognitive-behavioral therapy. Journal of Consulting and Clinical Psychology, 73(6), 1089-1096.  Available at

First, M.B., & Tasman, A. (2004). DSM-IV-TR Mental Disorders: Diagnosis, Etiology & Treatment. West Sussex, England: John Wiley & Sons, Ltd.

Wilson, G.T., Grilo, C.M., & Vitousek, K.M. (2007).  Psychological treatment of eating disorders.  American Psychologist, 62(3), 199-216.  Available at

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