A practical guide to the treatment of bulimia nervosa

Bulimia nervosa is a fascinating but challenging disorder to treat. There is no single treatment approach that suits all patients. Some patients make it clear that they would never consider taking drugs, others that group therapy is totally unacceptable and some, however hard they try, just never seem to get the hang of a cognitive behavioural approach. The principles that I have described above relate specifically to bulimic behaviour and attitudes. It is self-evident that other aspects of the patient functioning must not be ignored. Interpersonal, work and social problems may all need to be addressed at some stage during the treatment process and individual therapists will have their own therapeutic style and techniques for tackling these problems. In our experience it is best to tackle the presenting complaint, the bulimic behaviour, as energetically as possible and then to review the other problem areas. Many patients feel that once they have tackled their eating problem they can begin to tackle other problem areas in their life with relatively little outside help. Tackling things in the reverse order, addressing the underlying or background interpersonal difficulties first and paying little or no attention to the presenting behaviour appears to be less acceptable to patients, leads to lengthier and therefore more costly treatment and makes it difficult to distinguish between problems which are causes and those which are effects of the bulimic behaviour. (ABSTRACT TRUNCATED AT 250 WORDS)