Dear Alice,

I have been bulimic for six years now. I have tried so many times to quit, but I always fail. When I eat I feel guilty about it sooo much that it is impossible not to purge. I feel so helpless. My boyfriend walked in on me the other day, and the look on his face broke my heart. I REALLY want to recover, but I need help. And I have no idea where to go. I will be a starting college this September, but I don't want to wait that long. I want help now.

Dear Reader,

Bulimia can be a serious and scary condition, and you’re not alone. Regardless of whether you’ve tried to quit on your own or if you’ve been in treatment, your frustration about not being able to quit the behaviors associated with disordered eating is very common. The good news is that there are some immediate steps you can take to get help. First, you could consider speaking with a health care provider or mental health professional about your experience, symptoms, and behaviors. A provider can make recommendations for treatment, such as therapy, medication, nutritional counseling, or a combination of all three. If you haven't received a diagnosis, they may also evaluate you to see whether one would be appropriate. If you’d like more information on bulimia nervosa, the National Eating Disorders Association website provides up-to-date information about bulimia and available treatment options across the country.

Although bulimia is challenging to overcome, it can be done. Oftentimes, a multi-disciplinary team that includes a number of health professionals — such as psychiatrists, therapists, registered dietitians, and primary care providers — may work with you and your family. They can help you gain insight into different aspects of your behavior and experiences (including eating behavior, medical concerns, and psychological symptoms) and work towards making changes.

Evidence shows that a combination of psychotherapy (specifically, cognitive behavior therapy (CBT)), antidepressant medication, and nutritional counseling could lead to better outcomes. In CBT treatment, individuals with bulimia may work to identify and change maladaptive thoughts about themselves and food, and learn more effective strategies for how to cope with stress. Nutritional counseling helps end the binge and purge cycle by providing folks with education around nutrition, promoting healthy, flexible eating habits, and offering up strategies for how to schedule and eat portioned meals that provide optimal nutrition.

It’s good to note that there are also a number of specific eating disorder treatment programs across the country, and that the type of treatment recommended for you may depend on the severity of your symptoms. With this in mind, it’s helpful to understand the difference between outpatient and inpatient treatment. Outpatient treatment is designed for people deemed medically stable and able to remain in their own environments during treatment without risk to their health. While outpatient treatment alone is sufficient for many people dealing with bulimia, some may benefit from inpatient or residential treatment. Ideal candidates for inpatient treatment include individuals who are struggling with other mental health conditions in addition to bulimia (e.g., depression or substance abuse), or people whose eating behaviors have led to life-threatening medical concerns, such as low weight, severe dehydration, or heart abnormalities.

You also mention that you’re planning to start college soon — congratulations! It also may be worthwhile to check out the services available at your school, and see if your school has any eating disorder-specific support. Many university counseling centers have experience treating students with eating disorders and may be able to provide you with continued care when you make the transition. 

The road to recovery will likely be challenging, and it’s common to experience a recurrence of binging and purging during times of stress or transition. If you believe that your symptoms are returning, it’s recommended to follow up with your providers as soon as possible. Practicing effective strategies for managing stress and maintaining healthy, supportive relationships are two ways to help prevent such a relapse from occurring. It may also be beneficial to identify situations or environments that could lead to binging and purging, and, with the support of your health care providers, build a plan for how to cope with such situations and future periods of emotional distress.  

It takes a lot of courage to reach out and acknowledge that you need help. Seeking out additional support may provide you with reassurance on how to best move forward, and bring you another step ahead on the path of recovery.

Alice!

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