I have been bulimic for 6 years now. I have tried so many times to quit, but I always fail. When I eat I feel guilty about it sooo much that it is impossible not to purge. I feel so helpless. My boyfriend walked in on me the other day, and the look on his face broke my heart. I REALLY want to recover, but I need help. And I have no idea where to go. I will be a student at Columbia College starting this September, but I don't want to wait that long. I want help now.

It is understandable that you feel eager to get better and frustrated with the idea that you have tried to quit many times, and that it hasn't worked. It isn't clear if you have tried to quit on your own, or if you have been in a program or have gotten the help you need. Bulimia is a serious eating disorder that needs intensive long-term treatment to overcome. Healing takes time, as well as support, skills of a clinician, and your own involvement each day. The clinician will assess which level of care is appropriate for you.

Although the eating disorder may not disappear immediately, what needs to be done immediately is intervention. And you want it now.

Your pediatrician or family doctor may be able to help you find an in-/outpatient program in your area for intensive treatment before the semester begins. Then you can receive follow-up treatment at Columbia University and be referred to an outside provider for long-term care, if necessary. Websites such as www.eating-disorder.com are designed as "treatment finders" and may guide you towards programs near you.

Research shows that the longer bulimia goes on, the more ingrained the behavior becomes, and the more difficult it is to treat and change. Since the causes of bulimia are so complex, effective treatment requires a multidisciplinary team of professionals who specialize in eating disorders treatment. The team will address the medical, psychological, psychiatric, and medical nutrition needs of the person with the eating disorder. Because persistent vomiting erodes tooth enamel, dental care also needs to be a part of the treatment program. According to National Institute of Mental Health studies, a combination of therapy and anti-depressant medication provides the most effective treatment for bulimia. Cognitive-behavioral therapy is also useful in helping individuals with bulimia overcome long-standing unhealthy eating behaviors. Group therapy and support groups have been found to be helpful in the long-term recovery of individuals with bulimia.

Some options include:

Out-patient treatment

Out-patient treatment programs are community programs set up for people with eating disorders who are more medically stable and are able to remain in their own environments during treatment without risk to their health. Hospitals that treat people with eating disorders may also have out-patient programs, but they may also be privately owned. Many universities also have multi-disciplinary teams that treat eating disorders.

In-patient/Residential treatment

While out-patient treatment alone is sufficient for the recovery of most people with bulimia, some individuals may require hospitalization or residential treatment. Extreme purging puts a tremendous strain on the body's organs, and drugs such as ipecac (used to stimulate vomiting), laxatives, and diuretics can be toxic when abused. Conditions warranting hospitalization include heart abnormalities, metabolic imbalances, substance abuse, clinical depression, or risk of suicide. A physician, nurse practitioner, or nurse can assess whether or not hospitalization is medically necessary.

Eating Disorders Team of Health Services at Columbia

This team is composed of health care professionals who work with students with eating issues for informational purposes, medical and psychological evaluations, and/or referrals for treatment. The team understands both medical complications of eating disorder symptoms and the emotional component that accompanies its behavior. The EDT is multi-disciplinary, and includes a psychological component with psychologists and psychiatrists; a medical component with doctors, nurse practitioners, and nurses; a nutritional component with a nutritionist; and, an outreach component with a health educator. The EDT has a website for more information. You can set up a confidential consultation with a team member by calling the EDT's private voicemail line at x4-1177. And the team follows students who are managing their healing.

Regardless of treatment modality, family therapy is a necessary aspect of the recovery process. The treatment team involves the person's family to help the family understand treatment goals, the eating disorder itself, and the functions it serves for both the person and family.

Even after the end of intensified treatment, on-going follow-up is extremely important with sustained contact between the person and those who work with the treatment program. Many people with bulimia benefit from participating in self-help or psychotherapy groups during their on-going recovery.

It's courageous and admirable of you to acknowledge that you need help and would like to recover. By taking these first steps, and by taking them in a measured, informed way, you can find the treatment plan that is more likely to work, and can then begin to heal.

Alice

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