Bulimia Nervosa (Part 3)

How is bulimia treated?

Your doctor may refer you to a team of doctors, nutritionists, and therapists who will work to help you get better. Treatment plans may include one or more of the following:¹

• Nutrition therapy—People who purge (make themselves throw up or take laxatives) regularly should be treated by a doctor. Purging can cause life-threatening electrolyte imbalances. Some people with bulimia may need to be hospitalized if they have serious heart or kidney problems.²
• Psychotherapy—Sometimes called "talk therapy," psychotherapy is counseling to help you change harmful thoughts or behaviors. This type of therapy may focus on the importance of talking about your feelings and how they affect what you do. For example, you might talk about how stress triggers a binge. You may work one-on-one with a therapist or in a group with others who have bulimia.
• Nutritional counseling—A registered dietitian or counselor can help you eat in a healthier way than binging and purging.
• Support groups—Support groups can be helpful for some people with bulimia when added to other treatment. In support groups, individuals and sometimes their families meet and share their stories.
• Medicine—Fluoxetine (Prozac) is the only medicine approved by the Food and Drug Administration (FDA) for treating bulimia, but only in adults.³ It may help reduce binging and purging and improve your thoughts about eating. Some antidepressants may help those with bulimia who also have depression or anxiety.

Most people do get better with treatment and are able to eat and exercise in healthy ways again.⁴ Some may get better after the first treatment. Others get well but may relapse and need treatment again.

How does bulimia affect pregnancy?

Bulimia can cause problems getting pregnant and during pregnancy.

Repeated purging and binging can make your menstrual cycle irregular (your period comes some months but not others) or your period may stop for several months. Irregular or missing periods mean you may not ovulate, or release an egg from the ovary, every month. This can make it difficult to get pregnant.⁵ However, if you do not want to have children right now and you have sex, you should use birth control.

Bulimia can also cause problems during pregnancy. Bulimia raises your risk for

• Miscarriage (pregnancy loss)⁶
• Premature birth (also called preterm birth), or childbirth before 37 weeks of pregnancy
• Delivery by cesarean section (C-section)
• Having a low birthweight baby (less than five pounds, eight ounces at birth)
• Having a baby with a birth defect⁷
• Depression after the baby is born⁸ (postpartum depression)

If I had an eating disorder in the past, can I still get pregnant?

Women who have recovered from bulimia and have normal menstrual cycles have a better chance of getting pregnant and having a safe and healthy pregnancy.

If you had an eating disorder in the past, it may take you a little longer to get pregnant (about six months to a year) compared to women who never had an eating disorder.⁹

Tell your doctor if you had an eating disorder in the past and are trying to become pregnant.

If I take medicine to treat bulimia, can I breastfeed my baby?

Maybe. Some medicines used to treat bulimia can pass through breastmilk. Certain antidepressants can be used safely during breastfeeding.

Talk to your doctor to find out which medicine works best for you. You can enter a medicine into the LactMed® database (Link opens in a new windowhttps://www.ncbi.nlm.nih.gov/books/NBK501922) to find out if the medicine passes through breastmilk and about any possible side effects for your nursing baby.

References

1. Rushing, J.M., Jones, L.E., & Carney, C.P. (2003). Bulimia nervosa: A primary care review. The Primary Care Companion to the Journal of Clinical Psychiatry, 5(5), 217–224.
2. Jauregui-Garrido, B., & Jauregui-Lobera, I. (2012). Sudden death in eating disorders. Vascular Health and Risk Management, 8, 91–98.
3. Food and Drug Administration. (2016). Label for PROZAC (fluoxetine). Retrieved November 19, 2021, from https://www.fda.gov
4. Eddy, K.T., Tabri, N., Thomas, J.J., Murray, H.B., Keshaviah, A., Hastings, E., et al. (2017). Recovery from anorexia nervosa and bulimia nervosa at 22-year follow-up. Journal of Clinical Psychiatry, 78(2), 184–189.
5. Morgan, J.F., Lacey, J.H., & Sedgwick, P.M. (1999). Impact of pregnancy on bulimia nervosa. British Journal of Psychiatry, 174, 135–140.
6. Morgan, J.F., Lacey, J.H., & Chung, E. (2006). Risk of postnatal depression, miscarriage, and preterm birth in bulimia nervosa: retrospective controlled study. Psychosomatic Medicine, 68(3), 487–492.
7. Morrill, E.S., & Nickols-Richardson, H.M. (2001). Bulimia nervosa during pregnancy: A review. Journal of the American Dietetic Association, 101(4), 448–454.
8. Mazzeo, S.E., Slof-Op't Landt, M.C., Jones, I., Mitchell, K., Kendler, K.S., Neale, M.C., et al. (2006). Associations among postpartum depression, eating disorders, and perfectionism in a population-based sample of adult women. International Journal of Eating Disorders, 39(3), 202–211.
9. Easter, A., Treasure, J., & Micali, N. (2011). Fertility and prenatal attitudes towards pregnancy in women with eating disorders: Results from the Avon Longitudinal Study of Parents and Children. BJOG: An International Journal of Obstetrics & Gynaecology, 118, 1491–1498.