A person suffering from bulimia nervosa is completely opposite to somebody who is anorexic. A patient with anorexia nervosa is nearly always in total denial about their situation, whilst most bulimics already know and admit that they suffer from a life-threatening illness. The stark truth is that the constant binging and purging over the years takes a toll on human bodies. Abusing laxatives and repeated vomiting can cause irreparable damage to both the rectum and the oesophagus, resulting in heavy bleeding that can happen so quickly a patient can “bleed out” in the time it takes for an ambulance to arrive.
The mindset of a bulimic is such that their denial comes in the form of hopelessness for recovery. Life to the bulimic appears to be no more than one long, endless cycle of binging and purging to lose weight or avoid gaining weight. If a bulimic reaches the age of thirty, figuring the individual started the behaviour when he or she were a teenage, he/she is so deeply ingrained with the bulimic mindset that the binging and purging becomes almost as second nature as breathing. Although some bulimics will try to reform themselves, they fall short in relapse prevention.
Because of these all-encompassing feelings of hopelessness, shame and self-disgust, very few bulimics will refer themselves for treatment. Instead, it is most likely a concerned doctor, friend, or family member who will provide the necessary support system that helps instil hope in the suffering bulimic that there is a way out. Reluctantly, but with some trace of hope, the bulimic breaks the silence and consents to intensive treatment.
For treatment to be successful, it is essential that the bulimic be hospitalized in a special unit staffed by physicians, nurses and mental health professionals who are skilled and experienced in treating eating disorders. Typical treatment regimes consist of the following –
- Nutritional counselling
- Medical care for co-existing physical problems such as electrolyte imbalance and erosion of dental enamel,
- Nursing care that monitors the patient’s vital signs for any evidence of adverse reactions to medications that may be prescribed
- Mental health care for intensive individual and group therapy to assist the bulimic in overcoming shame and guilt
- Increasing self-esteem and gaining life coping skills to prevent relapse.
If psychiatric evaluation reveals the presence of co-morbid disorders such as depression and/or anxiety, these conditions will be simultaneously treated.
An essential part of in-patient treatment is the close supervision of the patient’s eating behaviours. Meals are carefully planned, and staff members visibly monitor the patient’s consumption of the meals. After meals, the bulimic is closely monitored to prevent purging by self-induced vomiting. Clearly, this type of treatment is not punitive or overly intrusive in nature since it is based upon sincere compassion and belief that the binge-purge cycle must be interrupted by any means necessary. Until this has been accomplished, all other forms of treatment will be useless. Successful cessation of purging is a success a bulimic desperately needs.
It has been said that medical treatment is only as good as an insurance company will pay for. Thus, the average hospital stay for a bulimic is four to six weeks. This is not the preferable ninety-day hospitalization, but it is certainly better than no hospitalization at all.
Once the patient is discharged, the goals of his or her treatment plan have been largely achieved.
- Eating behaviour has returned to acceptable healthy practices
- Purging has been eliminated
- Mental health therapy has provided the patient with great strides in improving self-esteem, reducing or even eliminating co-morbid depression or anxiety, and most importantly, the patient has hope that the bulimia will go into full remission.
Relapse prevention and follow-up outpatient medical and mental health care is important for a bulimic’s continued recovery. If the illness is discovered at this early stage, there is still plenty of hope that the patient will survive and have a future without the binge and purge cycle.