As with all eating disorder treatment at Equip, the initial focus of bulimia treatment is normalizing eating habits, stopping eating disorder behaviors, and weight restoration if necessary.

We focus on these behavioral and nutritional aspects first and foremost, because it's difficult for patients to make progress in other areas when they're malnourished. This is true for all eating disorder patients, regardless of weight; disordered eating habits like restricting, binge eating, and purging—all hallmarks of bulimia—can lead to malnutrition. When the body is malnourished, the brain is, too. A malnourished brain doesn’t think clearly or take in new information well. People who are malnourished are more likely to be depressed, anxious, and have trouble paying attention.

Once patients have been able to normalize their eating habits and make progress toward restoring their weight (if necessary), the focus of treatment can shift to other areas. That might mean working on interpersonal relationships, setting goals outside of their eating disorder, learning to handle triggers in their daily life, or understanding potential root causes of the eating disorder.

To accomplish all this, our clinicians use a variety of different evidence-based treatment modalities, including CBT-E (a form of cognitive behavioral therapy designed specifically for eating disorders), DBT (dialectical behavioral therapy), and ERP (exposure and response prevention). For younger patients who live with their family, we generally use FBT (family-based treatment).

As frustrating as it is, there is rarely one identifiable cause of an eating disorder, and bulimia is no different. More often than not, it is a constellation of neurobiological and environmental factors: in other words, someone has a genetic predisposition to developing an eating disorder, and then the eating disorder is “turned on” by environmental factors. You can learn more about the causes of eating disorders on our blog.

Though the specifics of a binge or a purge will look different from person to person and circumstance to circumstance, there are some defining criteria. A binge is defined as an episode of eating in which a person eats a large quantity of food with a feeling of lack of control. This often means eating past the point of fullness until uncomfortable, eating extremely quickly, eating alone, and feeling shame after eating. A purge is defined as compensatory behavior meant explicitly to “make up for” or “get rid of” food eaten. In bulimia, this often takes the form of self-induced vomiting, or abuse of laxatives or diuretics.

Exercise bulimia is the term to describe purging through intense exercise. In exercise bulimia, someone will use exercise as a means to control their weight, exercising compulsively and excessively to compensate after binge or even non-binge eating. You can learn more about the role of exercise in eating disorders on our blog.