Editing Bulimia nervosa (section)

==Treatment==
There are two main types of treatment given to those with bulimia nervosa; psychopharmacological and psychosocial treatments.<ref>{{cite journal |vauthors=Hoste RR, Labuschagne Z, Le Grange D |title=Adolescent bulimia nervosa |journal=Current Psychiatry Reports |volume=14 |issue=4 |pages=391–7 |date=August 2012 |pmid=22614677 |doi=10.1007/s11920-012-0280-0 |s2cid=36665983}}</ref>

===Psychotherapy===
[[Cognitive behavioral therapy]] (CBT) is considered the gold standard for the treatment of bulimia nervosa. This approach focuses on helping patients identify and change distorted thought patterns related to eating, body image, and self worth.<ref name=":2">{{Cite journal |last=Hay |first=Phillipia |date=Jul 19, 2010 |title=Bulimia Nervosa |journal=BMJ Clinical Evidence |page=1009 |pmid=21418667 |pmc=3275326 }}</ref><ref name=":3">{{Cite journal |last1=Hagan |first1=Kelsey E. |last2=Walsh |first2=B. Timothy |date=2021-01-01 |title=State of the Art: The Therapeutic Approaches to Bulimia Nervosa |journal=Clinical Therapeutics |volume=43 |issue=1 |pages=40–49 |doi=10.1016/j.clinthera.2020.10.012 |pmid=33358256 |pmc=7902447 |issn=0149-2918}}</ref>

CBT helps patients identify and challenge the distorted thinking individuals might have about food, weight and body image. It also helps by offering the chance to identify the unhelpful thoughts about food and body image.<ref name=":3" />

By using CBT people record how much food they eat and periods of vomiting with the purpose of identifying and avoiding emotional fluctuations that bring on episodes of bulimia on a regular basis, as a component of this therapy is food journaling.<ref name="Psychiatry"/> CBT is necessarily good for those with bulimia as it targets the binge-purge cycle, which is the hallmark of bulimia.<ref name=":0" /><ref>{{cite journal | vauthors = Agras WS, Crow SJ, Halmi KA, Mitchell JE, Wilson GT, Kraemer HC | title = Outcome predictors for the cognitive behavior treatment of bulimia nervosa: data from a multisite study | journal = The American Journal of Psychiatry | volume = 157 | issue = 8 | pages = 1302–8 | date = August 2000 | pmid = 10910795 | doi = 10.1176/appi.ajp.157.8.1302 }}</ref><ref>{{cite journal | vauthors = Wilson GT, Loeb KL, Walsh BT, Labouvie E, [[Eva Petkova|Petkova E]], Liu X, Waternaux C | title = Psychological versus pharmacological treatments of bulimia nervosa: predictors and processes of change | journal = Journal of Consulting and Clinical Psychology | volume = 67 | issue = 4 | pages = 451–9 | date = August 1999 | pmid = 10450615 | doi = 10.1037/0022-006X.67.4.451 | citeseerx = 10.1.1.583.7568 }}</ref> People undergoing CBT who exhibit early behavioral changes are most likely to achieve the best treatment outcomes in the long run.<ref>{{cite journal | vauthors = Trunko ME, Rockwell RE, Curry E, Runfola C, Kaye WH | title = Management of bulimia nervosa | journal = Women's Health | volume = 3 | issue = 2 | pages = 255–65 | date = March 2007 | pmid = 19803857 | doi = 10.2217/17455057.3.2.255 | doi-access = free }}</ref>

Researchers have also reported some positive outcomes for [[interpersonal psychotherapy]] and [[dialectical behavior therapy]].<ref>{{cite journal | vauthors = Fairburn CG, Agras WS, Walsh BT, Wilson GT, Stice E | title = Prediction of outcome in bulimia nervosa by early change in treatment | journal = The American Journal of Psychiatry | volume = 161 | issue = 12 | pages = 2322–4 | date = December 2004 | pmid = 15569910 | doi = 10.1176/appi.ajp.161.12.2322 }}</ref><ref>{{cite journal | vauthors = Safer DL, Telch CF, Agras WS | title = Dialectical behavior therapy for bulimia nervosa | journal = The American Journal of Psychiatry | volume = 158 | issue = 4 | pages = 632–4 | date = April 2001 | pmid = 11282700 | doi = 10.1176/appi.ajp.158.4.632 }}</ref> These therapies have good outcomes for treating bulimia, especially in patients with emotional regulation difficulties or interpersonal issues. While these therapies are not as extensively researched as CBT, they can be beneficial when integrated into a comprehensive treatment plan.<ref name=":2" />

For adolescents, Family-Based therapy (FBT) has been identified as an effective treatment. FBT involves the family in the treatment process, where parents are empowered to take an active role in helping their child recover from bulimia nervosa. This approach is particularly helpful in younger patients who are still living with their families<ref name=":2" />

The use of CBT has been shown to be quite effective for treating bulimia nervosa (BN) in adults, but little research has been done on effective treatments of BN for adolescents.<ref name="ReferenceB">{{cite journal | vauthors = Keel PK, Haedt A | title = Evidence-based psychosocial treatments for eating problems and eating disorders | journal = Journal of Clinical Child and Adolescent Psychology | volume = 37 | issue = 1 | pages = 39–61 | date = January 2008 | pmid = 18444053 | doi = 10.1080/15374410701817832 | s2cid = 16098576 | citeseerx = 10.1.1.822.6191 }}</ref> Although CBT is seen as more cost-efficient and helps individuals with BN in self-guided care, Family Based Treatment (FBT) might be more helpful to younger adolescents who need more support and guidance from their families.<ref>{{cite journal | vauthors = Nadeau PO, Leichner P | title = Treating Bulimia in Adolescents: A Family-Based Approach | journal = Journal of the Canadian Academy of Child and Adolescent Psychiatry  | date= February 2009 | volume = 18 | issue = 1 | pages = 67–68 | pmc = 2651218 }}</ref> Adolescents are at the stage where their brains are still quite malleable and developing gradually.<ref>{{cite journal | vauthors = Le Grange D, Lock J, Dymek M | title = Family-based therapy for adolescents with bulimia nervosa | journal = American Journal of Psychotherapy | volume = 57 | issue = 2 | pages = 237–51 | year = 2003 | pmid = 12817553 | doi = 10.1176/appi.psychotherapy.2003.57.2.237 | doi-access = free}}</ref> Therefore, young adolescents with BN are less likely to realize the detrimental consequences of becoming bulimic and have less motivation to change,<ref>{{cite journal | vauthors = Castro-Fornieles J, Bigorra A, Martinez-Mallen E, Gonzalez L, Moreno E, Font E, Toro J | title = Motivation to change in adolescents with bulimia nervosa mediates clinical change after treatment | journal = European Eating Disorders Review | volume = 19 | issue = 1 | pages = 46–54 | year = 2011 | pmid = 20872926 | doi = 10.1002/erv.1045}}</ref> which is why FBT would be useful to have families intervene and support the teens.<ref name="ReferenceB" /> Working with BN patients and their families in FBT can empower the families by having them involved in their adolescent's food choices and behaviors, taking more control of the situation in the beginning and gradually letting the adolescent become more autonomous when they have learned healthier eating habits.<ref name="ReferenceB" />

===Medication===
Antidepressants, particularly [[selective serotonin reuptake inhibitor]]s (SSRI), are often prescribed to treat bulimia nervosa, especially when comorbid depression or anxiety disorders are present. However, medications alone are generally not sufficient and are typically used in conjunction with psychotherapy.<ref name=":1" /><ref name=":2" /> Compared to placebo, the use of a single antidepressant has been shown to be effective.<ref name="pmid14583971">{{cite journal | vauthors = Bacaltchuk J, Hay P | title = Antidepressants versus placebo for people with bulimia nervosa | journal = Cochrane Database Syst Rev | volume = | issue = 4 | pages = CD003391 | date = 2003 | pmid = 14583971 | doi = 10.1002/14651858.CD003391 | pmc = 6991155}}</ref> Combining medication with counseling can improve outcomes in some circumstances.<ref>{{cite journal | vauthors = Bacaltchuk J, Hay P, Trefiglio R | title = Antidepressants versus psychological treatments and their combination for bulimia nervosa | journal = The Cochrane Database of Systematic Reviews | issue = 4 | pages = CD003385 | date = 2001 | volume = 2001 | pmid = 11687197 | pmc = 6999807 | doi = 10.1002/14651858.CD003385}}</ref> Some positive outcomes of treatments can include: abstinence from binge eating, a decrease in obsessive behaviors to lose weight and in shape preoccupation, less severe psychiatric symptoms, a desire to counter the effects of binge eating, as well as an improvement in social functioning and reduced relapse rates.<ref name=Hay2010/>

A combination of psychotherapy, especially CBT and pharmacological treatments, such as SSRIs, often lead to better outcomes for individuals with bulimia. Combining both approaches is particularly beneficial in severe or chronic cases, where behavioral modification and mood stabilization are crucial.<ref name=":2" />

===Alternative medicine===
Some researchers have also claimed positive outcomes in [[hypnotherapy]].<ref>{{cite journal | vauthors = Barabasz M | title = Efficacy of hypnotherapy in the treatment of eating disorders | journal = The International Journal of Clinical and Experimental Hypnosis | volume = 55 | issue = 3 | pages = 318–35 | date = July 2007 | pmid = 17558721 | doi = 10.1080/00207140701338688 | s2cid = 9684032}}</ref> ''The first use of hypnotherapy in Bulimic patients was in 1981. When it comes to hypnotherapy, Bulimic patients are easier to hypnotize than Anorexia Nervosa patients. In Bulimic patients, hypnotherapy focuses on learning self-control when it comes to binging and vomiting, strengthening stimulus control techniques, enhancing ones ego, improving weight control, and helping overweight patients see their body differently (have a different image).''<ref>{{Cite journal |last1=Vanderlinden |first1=Johan |last2=Vandereycken |first2=Walter |date=September 1988 |title=The use of hypnotherapy in the treatment of eating disorders |url=http://dx.doi.org/10.1002/1098-108x(198809)7:5<673::aid-eat2260070511>3.0.co;2-r |journal=International Journal of Eating Disorders |volume=7 |issue=5 |pages=673–679 |doi=10.1002/1098-108x(198809)7:5<673::aid-eat2260070511>3.0.co;2-r |issn=0276-3478}}</ref>

=== Risk factors ===
Being female and having bulimia nervosa takes a toll on mental health. Women frequently reported an onset of anxiety at the same time of the onset of bulimia nervosa.<ref>{{Cite journal |last1=Bulik |first1=Cynthia M |last2=Sullivan |first2=Patrick F |last3=Carter |first3=Frances A |last4=Joyce |first4=Peter R |date=September 1996 |title=Lifetime anxiety disorders in women with bulimia nervosa |url=http://dx.doi.org/10.1016/s0010-440x(96)90019-x |journal=Comprehensive Psychiatry |volume=37 |issue=5 |pages=368–374 |doi=10.1016/s0010-440x(96)90019-x |pmid=8879912 |issn=0010-440X}}</ref> The approximate female-to-male ratio of diagnosis is 10:1.<ref name="DSM5" /> In addition to cognitive, genetic, and environmental factors, childhood gastrointestinal problems and early pubertal maturation also increase the likelihood of developing bulimia nervosa.<ref>{{Cite journal |last1=Jacobi |first1=Corinna |last2=Hayward |first2=Chris |last3=de Zwaan |first3=Martina |last4=Kraemer |first4=Helena C. |last5=Agras |first5=W. Stewart |date=2004 |title=Coming to Terms With Risk Factors for Eating Disorders: Application of Risk Terminology and Suggestions for a General Taxonomy. |url=https://doi.apa.org/doi/10.1037/0033-2909.130.1.19 |journal=Psychological Bulletin |language=en |volume=130 |issue=1 |pages=19–65 |doi=10.1037/0033-2909.130.1.19 |pmid=14717649 |issn=1939-1455}}</ref> Another concern with eating disorders is developing a coexisting [[substance use disorder]].<ref>{{Cite journal |last1=Carbaugh |first1=Rebecca |last2=Sias |first2=Shari |date=2010-04-01 |title=Comorbidity of Bulimia Nervosa and Substance Abuse: Etiologies, Treatment Issues, and Treatment Approaches |url=http://dx.doi.org/10.17744/mehc.32.2.j72865m4159p1420 |journal=Journal of Mental Health Counseling |volume=32 |issue=2 |pages=125–138 |doi=10.17744/mehc.32.2.j72865m4159p1420 |issn=1040-2861}}</ref>