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Multidisciplinary Approaches to Treating Bulimia Nervosa

Bulimia nervosa affects millions of people, despite the common misconceptions that it is a rare disorder. According to the National Eating Disorder Association, one percent of young women and 0.1 percent of young men are shown to display symptoms of this disorder at some point. The numbers are similar for other forms of eating disorders. We mention young women and men because, most often, in their early adulthood. However, eating disorders can begin at any age. Treatment programs need to be comprehensive to successfully address a variety of demographics in need t treatment.

People with bulimia nervosa or other serious mental health disorders usually enter traditional treatment programs when the issue becomes too intrusive to ignore. Often this is after extensive therapy with a traditional one-on-one therapist, only choosing residential treatment when other options have been exhausted. Treatment centers continue using these evidence-based therapeutic techniques, but often include “alternative” or otherwise non-traditional methodologies as well. These programs incorporate several kinds of therapy that assist with self-awareness, mindfulness, and emotional connection.Here, we’ll break down some of these alternative forms of therapy that can be beneficial for treating bulimia nervosa, many of which can be included in a comprehensive bulimia nervosa treatment plan.

But first, let’s go over the mainstay aspects of a residential eating disorder treatment center.

Forms of Therapy Used to Treat Various Eating Disorders

Bulimia nervosa, like other eating disorders, requires a treatment plan that addresses the client’s disordered behaviors, the underlying causes of the eating disorder, and their physical and spiritual needs. For residential treatment, the first thing the staff looks to do is stabilize the client medically if necessary. Another major component of eating disorder recovery is nutritional education and meal planning, which we cover in more detail here. The medical and nutritional aspects are every bit as important as the psychological ones, and the client’s safety is paramount. When they are capable of beginning psychological and nutritional treatment and education, the recovery begins in earnest.

Psychological treatment for eating disorders is based on traditional talk therapy methodologies. Sessions with a therapist are conducted regularly, if not daily, in a residential facility. Some sessions may be solo, and group sessions are commonplace as well – many recovered clients point to group therapy as their favorite part of treatment. Within psychological treatment, several methodologies are frequently used. They help regulate behavior and allow clients to gain a better self-understanding of their disorder. Some of these include:

  • Cognitive Behavioral Therapy (CBT)– The most prominent form of behavioral therapy in psychological circles, CBT was developed in the 1950s and 1960s. CBT centers around the idea that the way we think ad perceive events in life influences our feelings and behaviors. As an example, a person with bulimia nervosa may have a distorted perception that they are overweight, which leads to dieting and eventually binging and purging behaviors and the negative emotions that surround them. CBT works as a dialogue between the therapist and clients(s) that helps them identify which of their thinking patterns are disordered and how they are driving negative behaviors. CBT is standard treatment in most eating disorder treatment programs.
  • Cognitive Processing Therapy (CPT) –This form of therapy is primarily used for treating the symptoms of PTSD and how they lead to negative coping behaviors. Many studies have shown a link between trauma and disordered behavior as a response, and eating disorders such as bulimia nervosa are no exception. This makes CPT a powerful tool for eating disorder recovery. CPT is administered in a series of steps, (usually 12, one per session) designed to help the client understand how they think about their trauma and how their feelings about it are leading to negative coping mechanisms. The steps help a person in treatment break their accustomed ways of thinking about (or avoiding) their trauma, and replace them with more healthful alternatives. While trauma cannot ever be completely “gotten over,” treatment can help individuals reach a better balance with them.
  • Dialectical Behavioral Therapy (DBT) –DBT is a variation of CBT developed in the 1970s and 1980s.While both techniques are used to help individuals understand how thinking influences behavior, and replace unhealthy behaviors with healthier ones, DBT is specialized for cases when self-harm is a possibility. It’s used in cases of suicidal ideation, BPD<, and other behaviors that can cause harm to an individual (including disordered eating behaviors). “Dialectical” means bringing together two opposite ideas; DBT works on reconciling the person’s distorted thinking patterns with more healthful ones to synthesize a workable solution. It can also be performed in group and solo sessions and is useful in treating severe co-occurring disorders as well as eating disorders.

Other kinds of specialized treatment like Acceptance and Commitment Therapy (Act) are also used at eating disorder treatment centers, as is traditional talk therapy. Psychiatric applications are usually present as well; although there are no medications specifically designed for eating disorders, some prescriptions can be made for co-occurring disorders like depression, anxiety, OCD, and BPD which can influence disordered eating behaviors.

Forms of “Alternative” Therapy You Might Encounter During Residential Treatment

The therapies listed above are well-established psychological practices; they are evidence-based and tested in clinical trials. However, complimentary therapies are also known to supplement and enhance the effectiveness of these treatments. Although they are sometimes called “alternative” treatments, this term refers to the fact that they are not based in psychiatric practice; none of them should act as a standalone alternative to the methods mentioned above. They are each, however, wonderful ways for an individual in eating disorder treatment to gain further understanding f their bodies, psyches, and relationships with food and eating. So me fo these methods include:

  •  Yoga Therapy – Yoga is a form of physical exercise that centers around slow, mindful, and calculated movements, focused breathing, and a sense of self-awareness. Because many eating disorders involve distorted feelings about movement and body image, yoga as part of a bulimia nervosa treatment plan can be a highly useful tool. Bulimia treatment centers have begun to include daily yoga sessions as bulimia treatment options for clients in addition to the more clinical talk therapy and medical treatment programs they’ve had for decades.

In a study of how yoga affected women, the participants saw noticeable improvements in:

  • Their body image
  • Their relationships with movement
  • Increasing wellbeing and connection to their body

People with many kinds of eating disorders tend to struggle with excessive, compulsive exercise practices, which can have a devastating effect on their overall health. By slowing down and helping them regulate their movements, yoga could be a powerful tool to help people overcome some of their struggles during treatment.

  • Meditation Therapy – In some ways, you can compare yoga to a kind of “movement meditation.” However, less impactful meditation is also quite useful during eating disorders. For centuries, meditation has helped people achieve a calmer state of being in which they can achieve mental clarity, find renewed energy, and gain a new perspective on their personal issues. Meditation as part of bulimia nervosa treatment is beneficial because individuals often struggle with overcoming feelings of anxiety and stress that can trigger their eating disorder behaviors. Meditation can be guided by a mediation expert or performed solo; most people find that a combination of both ways leads to making it a sustained practice.
  • Body Awareness Therapy – Body awareness therapy can come in many different forms, and it’s a central part of any modern bulimia nervosa treatment plan. Body awareness therapy helps people in recovery understand how their relationship with their body influences their emotions and psyche. Studies of body awareness therapy suggest that using this as a therapeutic tool during treatment for eating disorders could help people establish a more realistic body image, directly addressing the body dysmorphia (disordered self-image) so commonly associated with bulimia nervosa. Negative portrayals of the self-image in the mind can drive bulimic behaviors and thoughts, so through body awareness therapy, individuals are better capable of seeing their bodies objectively.

Art and music therapy, nature therapy (like hikes and outdoor meditation as well as gardening), animal-assisted therapy like equine therapy, and many others are also useful “alternative” therapy methods. Please check with any potential eating disorder treatment center before admitting to seeing which methods might apply to your case, and to help design the most effective treatment plan for your needs.

Finding a Comprehensive Treatment Plan

While medical, nutritional, and psychiatric treatments are necessary for a successful recovery, bulimia nervosa therapy should include several “alternative”treatment options, and methods, and the best treatment centers work to incorporate many alternative and traditional treatments in their plans. Recovery doesn’t have to be an ordeal – by including alternative treatments into a comprehensive continuum of care, it can become a positive, life-changing experience.  If you or a loved one has bulimia nervosa, don’t hesitate – reach out to a center that includes a variety of treatment types today.

Melissa Orshan Spann, PhD, LMHC, RTY 200, is Chief Clinical Officer at Monte Nido & Affiliates, overseeing the clinical operations and programming for over 50 programs across the U.S. Dr. Spann is a Certified Eating Disorder Specialist and clinical supervisor as well as an accomplished presenter and passionate clinician who has spent her career working in the eating disorder field in higher levels of care. She is a member of the Academy for Eating Disorders and the International Association of Eating Disorder Professionals where she serves on the national certification committee, supervision faculty, and is on the board of her local chapter. She received her doctoral degree from Drexel University, master’s degree from the University of Miami, and bachelor’s degree from the University of Florida.