Dear caz,
She needs to do two things, get an objective measurement of her statistics, like waist, hip , breast size and obviosuly her weight record. There can be a certain subjective feeling in her that she is not feeling better, but if over a period of time it can be obje3ctively demonstrated to ehr that she is on fact losing weight/ getting better, then she may find it easier to deal with her proble.
The other thing I would suggest is using a mutual friend/ enlisting the help of some of her other friends/ relatives since this is a potentially life threatening condition (10 % people can DIE! due to this condition). Get her to go to any doctor that she trusts / or is comfortable with, brief the doc about the reason for the visit and encourage a referral to a mental health care professioanl. If she is more comfortable she can try going to a psychologist instead of a psychiatrist too!
Initial care may be on an inpatient or outpatient basis, depending on the clinical presentation. Factors that may indicate a need for inpatient care include significant metabolic abnormalities, medical complications, risk of suicide, failed outpatient treatment, inability to care for self, and diagnostic uncertainty.
Treatment should be comprehensive and multidisciplinary and may include the following components:
* Cognitive behavioral psychotherapy (CBT): Distorted or maladaptive cognitions regarding weight and shape are identified and addressed. Irrational beliefs are explored and confronted. Behavioral approaches to avoiding undesirable eating habits are employed, including exposure to food. Cognitive distortions are examined to allow better understanding, enhanced self-control, and improved body image.
* Interpersonal psychotherapy (IPT): Interpersonal psychotherapy works with specific issues in the interpersonal arena that create the context for the patient's symptoms; these fall within the categories of grief, role transition, role conflict, or interpersonal deficits. Brief focused therapy in these areas can be effective in producing improvements in those with mood disturbance and low self-esteem, which may trigger and maintain the symptoms of bulimia. Its efficacy is similar to CBT in reducing binge eating but may be somewhat less effective in curbing purging.
* Supportive-expressive psychotherapy (SEP) or group therapy: SEP or group therapy may be helpful for patients with bulimia.
* Family therapy: Explores family dynamics and factors that may precipitate or perpetuate abnormal eating and bingeing behaviors. This technique often views eating as a means of communication within a family.
* Pharmacotherapy: Antidepressants as a group are the mainstay of pharmacotherapy. Pharmacotherapy is generally recommended as an adjunct to psychotherapy.
o Selective serotonin reuptake inhibitors (SSRIs) are among the agents best validated for use in managing bulimia. Both fluoxetine (Prozac) and sertraline (Zoloft) are approved by the Food and Drug Administration (FDA) for treatment of bulimia. Antidepressant treatment using SSRIs is suggested regardless of whether the patient appears depressed. The exact mechanism underlying the efficacy of antidepressants in bulimia is unclear, but the effects may be mediated through their salutary impact on cerebral serotonin systems.
o Bupropion (Wellbutrin) is relatively contraindicated in the treatment of bulimia nervosa because of a higher risk of seizures induced by the medication.
o Other agents that are being explored for potential use in bulimia management include anticonvulsants, lithium, L-tryptophan, and naltrexone.
o Some recent reports indicate that the selective serotonin antagonist, ondansetron (Zofran), which is indicated for use as an antiemetic, may have utility in the treatment of bulimia nervosa. Reports also show the potential utility of topiramate (Topamax). Trials investigating the potential utility of lithium (Eskalith) and naltrexone (ReVia) have, however, shown no significant benefit.
* Support and self-help groups (guided self-help): These are highly variable in constitution and methods used. While some are run by professionals, others are run by laypersons. Although anecdotal reports exist of their usefulness, no well-designed studies have confirmed these claims.
* With CBP and maintenance treatment with follow-up, as many as 50% of patients with bulimia are asymptomatic 2-10 years after completing the treatment period. Evidence for similar improvements from other forms of psychotherapy (eg, IP, SEP) is currently not available.
Source
So with proper treatment she has a good chance of getting back to a normal life, and the sooner we begin the better are her chances,
Please remember to accept the reply if you find it useful. A BONUS and a positive rating would be duly appreciated,
regards
Dr. Gupta
