Though cognitive behavior therapy is generally considered the treatment of choice for bulimia nervosa, dialectical behavior therapy (DBT) may be particularly effective in treating bulimia nervosa due to its targeting of emotional dysregulation problems, which often underlie the eating disorder. One study has shown a significant decrease in binge/purging behaviors in patients with bulimia nervosa who underwent DBT with a focus on emotional regulation, though more research into this area is necessary.

Dialectical Behavior Therapy for treating Bulimia Nervosa

Numerous factors have been found to be associated with poorer outcomes and increased vulnerability to relapse following treatment for bulimia nervosa, although the exact rates of remission versus relapse are unclear:

- Severe global function impairment
- Later initial treatment 
- Less follow-up time
- Greater desire for thinness
- Severe weight and body image concerns

Predictors of Relapse in Bulimia Nervosa

No drug exists that is specifically designed to treat bulimia nervosa, but 60mg of fluoxetine per day is FDA-approved as a treatment if psychotherapy is ineffectual. If fluoxetine fails to manage comorbid depressive or anxiety disorder, sertraline or escitalopram may be effective second options. Other SSRIs, in addition to topiramate, an antiepileptic, have demonstrated some efficacy, and stimulants may similarly be prescribed to treat continued binge-eating after purging cessation or to manage comorbid conditions. However, treatment with such drugs are considered off-label usages and are not FDA-approved. Certain psychiatric medications should also be avoided among bulimia nervosa patients. Bupropion should not be prescribed due to the increased risk of seizure. Similarly, citalopram should not be used due to increased risk of QT prolongation, and paroxetine should not be prescribed since it often leads to weight gain which may prompt purging relapses.

Bulimia Nervosa Psychiatric Medication

Psychotherapy is generally the first-line for treatment for bulimia nervosa before psychiatric medication is prescribed. Cognitive behavioral therapy is the standard treatment, however research has indicated promise for other forms of therapy such as guided cognitive behavioral self-help and individual cognitive behavioral therapy for eating disorders in inducing remission of bulimia nervosa symptomatology.

Bulimia Nervosa Psychotherapy

Depending on the severity of the case of bulimia nervosa, treatment methods may vary, but often include the following: 

- Purging cessation
- Nutritional support
- Monitoring 
- Medical treatment for complications
- Psychotherapy
- Psychiatric medication

Kalamazoo College

This list includes different types of methods for treating and/or managing different feeding and eating disorders. These include, but are not limited to the following:
-	Mindfulness for Patients with Eating Disorders
-	Cognitive-Behavioral Therapy vs. Behavioral Weight Loss (BWL) as Treatment for Binge-Eating Disorder
-	Mindfulness-Based Interventions for Binge Eating Disorders
-	Dialectical Behavior Therapy for treating Bulimia Nervosa
-	Dialectical Behavior Therapy for treating Anorexia Nervosa
-	Subjective Experiences of Eating Disorder Treatments
-	Pharmacological Treatment for Binge Eating Disorders
-	Enhanced Cognitive Behavioral Therapy (CBT-E) for Eating Disorders
-	Family-Based Treatment of Eating Disorders in Adolescents

Treatment & Management Methods for Feeding and Eating Disorders

Nitsch, A., Dlugosz, H., Gibson, D., & Mehler, P. S. (2021). Medical complications of bulimia nervosa. Cleveland Clinic Journal of Medicine, 88(6), 333-343.

Medical Complications of Bulimia Nervosa

Mindfulness interventions have been shown to be beneficial for those suffering with eating disorders including anorexia nervosa, binge eating disorder, and bulimia nervosa.

Mindfulness for patients with eating disorders

- Dialectic Behavior Therapy
- Mindfulness-Based Eating Awareness Training

Mindfulness-Based Interventions for Binge Eating Disorder

Dialectical behavior therapy (DBT) has been shown to be effective in treating anorexia nervosa (AN), as patients with the disorder who underwent DBT saw low dropout rates and increased BMIs which were sustained 6 months later. While standard DBT has been shown to be effective, a DBT program that was augmented to focus on overcontrolled emotions and behaviors which contribute to AN was more helpful in encouraging long term results.

Dialectical Behavior Therapy as Treatment for Anorexia Nervosa

One study examined the current literature on the experiences and perspectives of those across healthcare interfaces for eating disorders, to include individuals with eating disorders, people close to or caring for those with eating disorders such as family and friends, and health professionals.

Subjective Experiences of Eating Disorder Treatments 

One study explored the different pharmacological treatments for BED. The study found that antidepressants, appetite suppressants, and anticonvulsants, specifically, desipramine, fluvoxamine, fluoxetine, sertraline, citalopram, dexfenfluramine, sibutramine, and topiramate can aid in BED treatment. 

Pharmacologic Treatment for Binge Eating Disorder

Enhanced cognitive behavior therapy (CBT-E) is a transdiagnostic approach that is designed to treat multiple clinical conditions, including the complete list of eating disorders identified in DSM-V, such as anorexia nervosa, bulimia nervosa, binge eating disorder (BED), among others. It is different from typical CBT in that it aims to treat the underlying pathological factors contributing to several disorders, rather than any one condition. 

CBT-E is comprised of four stages, yet the details of each stage differ based on the individual patient and their clinical circumstances.

The overarching goal of CBT-E is to assist the patient in first acknowledging their harmful eating patterns and body-image concerns so that they can eventually begin actively participating in therapeutic sessions targeted at addressing the emotions, beliefs/thoughts, and behaviors (e.g., body-image concerns, low self-esteem stressful life events, interpersonal relationship conflicts, etc.)  sustaining their condition. 

After the patient has begun to heal, CBT-E treatment provides them with coping mechanisms to manage challenges to their recovery so that they can maintain their progress.

Enhanced Cognitive Behavioral Therapy (CBT-E) for Eating Disorders 

The family-based treatment (FBT) method for eating disorders entails a clinician working with the adolescent patient and their family to establish a comprehensive care plan that extensively engages the patient's home/family life.

Comprised of three phases, FBT is characterized by granting the patient's family responsibility to monitor and oversee their child's eating behaviors in order to support the patient's sustainable adoption of healthy eating habits. As the patient progresses in their recovery, they are incrementally granted more autonomy over their dietary decisions and eating preferences.

Family-based Treatment of Eating Disorders in Adolescents

Research unfortunately indicates that anorexia nervosa treatment outcomes are not always ideal. Although oftentimes significant weight is restored by the end of treatment, psychological symptoms frequently go largely unaddressed, indicating a gap in current treatment procedures that may leave patients more vulnerable to relapse.

Anorexia Nervosa Treatment Outcomes

Bulimia Nervosa Treatment

CBT is known as an effective treatment for binge-eating disorder (BED) in that it helps people to stop binge-eating, but it does not actually help people to lose weight (which is important because BED puts people at high risk for obesity and the health problems associated with that).  Because of this shortcoming, perhaps another treatment option is necessary to help people with BED to lose weight.

Cognitive-Behavioral Therapy vs. Behavioral Weight Loss (BWL) as Treatment for Binge-Eating Disorder

Multiple forms of treatment exist for binge eating disorder, each with different levels of efficacy in terms of prompting remission of binge-eating episodes, lessening psychological symptoms, and reducing body weight:

- Psychotherapy
- Structured self-help treatment
- Combined treatment
- Pharmacotherapy
- Behavioral weight loss treatment
- Self-help weight loss treatment
- Inpatient treatment 

Binge Eating Disorder Treatment Outcomes

In general, treatments for ARFID can be divided into two major groups: 

- Psychological treatment
- Adjunctive pharmacological treatment

Avoidant/Restrictive Food Intake Disorder (ARFID) Treatment

Several models exist to include family members in anorexia nervosa treatment. These models strive to put theory-based strategies into action, either by addressing intra- and inter-personal factors that maintain the disorder, by addressing behaviors of the illness, or by focusing on improving the well-being of the family as a whole: 

- CBT-oriented family module
- Systemic family therapy
- Maudsley model of family-based therapy (FBT)
- New Maudsley Model for Collaborative Care (NMCC)

Family Inclusion in Anorexia Nervosa Treatment

Neuromodulatory techniques are also being studied to directly affect the brain to regulate food intake and reduce AN’s psychological symptoms. Multiple forms on neuromodulation have been studied or are being studied currently, including the following:
- Transcranial direct-current stimulation (tDCS) 
- High-frequency repetitive transcranial magnetic stimulation (rTMS) 
- Deep brain stimulation (DBS)

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