Bulimia nervosa is a very serious illness that can lead to problems in all parts of the body, including the heart, brain, bones and digestive system. A range of treatments are available to help a person with bulimia nervosa recover from their disorder. If they are going through a lot of bingeing and purging, they may need to be hospitalized to help stop the cycle. They will also need treatment at home and may need psychological treatment or medications.
The goal of treatment is to:
- ensure that your child is medically safe
- achieve a weight that guarantees healthy growth and development
- stop the cycles of bingeing and purging
- work on having all types of food in moderation, including foods your child may have binged on
- help manage any emotions about eating, including any worries about weight
In-hospital medical treatment
If your child is medically unstable (has a low or irregular heart rate or low blood pressure) or needs to break a severe cycle of bingeing and purging, they will need to be treated in hospital until it is safe for them to be treated as an outpatient.
While your child is in hospital, staff will check their heart rate, breathing and blood pressure. Blood work may also be done to monitor their electrolyte (mineral) levels.
A person with bulimia nervosa often has very chaotic eating. Treatment often needs to address breaking the binge/purge cycle. This is done by making sure the person is on a regular amount of nutrition that contains a variety of foods and meets their body's daily requirements. Your child will be supervised during and right after meals and snacks to limit the chances that they will binge or purge.
Outpatient treatment with a care team
Your child’s health-care provider will decide if your child can be managed as an outpatient (outside the hospital), either in the health-care provider’s office, or in a specialized eating disorder program.
The first treatment recommended for young people is an outpatient treatment called family-based treatment (FBT), which focuses on recovery of the eating disorder. Parents/caregivers play an essential role in the treatment and recovery of their child. Family-based treatment includes three treatment phases.
- Phase 1 focuses on weight restoration. Parents, supported by the therapist, take responsibility for making sure that the adolescent is eating sufficiently and also take on all meal planning and preparation.
- Phase 2 is when substantial weight recovery has occurred, and the adolescent gradually assumes responsibility for their own eating.
- Phase 3 is when weight is restored, and the focus is on general issues of adolescent development.
Bulimia nervosa in older teens can be treated with a therapy called cognitive behavioural therapy (CBT). CBT involves working with a therapist and addressing relationships between feelings and behaviours. Sometimes the therapy will also involve the patient’s family, as they can help the patient regulate their eating and offer support. Medications, such as selective serotonin update inhibitors, a type of antidepressant, may also be helpful.
Your child will visit the hospital for appointments, but they will not stay overnight. These appointments will include regular checks of your child's weight as well as their heart rate and blood pressure. Stabilizing your child's weight and ending their binge/purge symptoms are vital parts of the treatment to return their body to full health.
At-home nutritional treatment
Nutritional treatment at home often requires structured meal and snack times to make sure your child eats regular amounts of food. Another element of home nutritional treatment involves supervising your child during and after mealtimes.
Families are also encouraged to have a child or teen with bulimia nervosa eat a variety of foods from all the food groups, including the foods on which they have binged (but not a binge amount of those foods).
Psychological treatment
Treatment for children and teens with bulimia nervosa generally takes a ‘whole family' approach. This means that the care team will involve the entire family in the therapy. The most common therapy provided is FBT. Older teens may be offered CBT.
Families are included so parents can learn how to support their child with eating at home and any related anxiety that the child might express. Older teens who are motivated to address the symptoms of bulimia nervosa may be treated with CBT.
Recovery from bulimia nervosa does not happen overnight; it may take years of treatment to fully recover.
Medication
Some children and teens with bulimia nervosa may also experience depression and/or anxiety. If these interfere with someone’s ability to function or take part in their bulimia nervosa treatment, they may be prescribed antidepressants with psychological therapy.
At SickKids
SickKids has an eating disorder program that treats children and teens who are struggling with symptoms of anorexia nervosa, bulimia nervosa and avoidant restrictive food intake disorder. For more information on our program visit: www.sickkids.ca/adolescentmedicine/eating-disorders-program
Further information
For more information on bulimia nervosa, please see the following pages:
Bulimia nervosa: Signs and symptoms
Bulimia nervosa: Medical complications
Bulimia nervosa: How to help your child at home
Please visit our teen mental health hub for teen-specific resources on treatment and long-term outcomes for bulimia nervosa.
Resources
NEDIC – National Eating Disorder Information Centre (Canada)
NEDA – National Eating Disorder Association (United States)
American Academy of Pediatrics – Eating Disorders in Children
BEAT – Beating Eating Disorders (United Kingdom)
Kelty Eating Disorders (Kelty Mental Health Resource Centre, BC Children's Hospital)
Children's Hospital of Eastern Ontario – Eating Disorders