THERAPEUTIC MANAGEMENT OF BULIMIA NERVOSA: MULTIDISCIPLINARY APPROACH PROTOCOLS AND THERAPEUTIC ALLIANCE

Abstract

Bulimia nervosa (BN) is a serious, chronic, and recurrent eating disorder characterized by episodes of binge eating followed by inappropriate compensatory behaviors (self-induced vomiting, laxative use). It has a notable prevalence in adolescents and young adults and is frequently associated with body image distortion, resulting in significant physical, emotional, and social impacts. Due to the potential for systemic medical complications (such as electrolyte imbalances, dental erosion, and gastrointestinal alterations) and a high rate of psychiatric comorbidities (depression, anxiety, and personality disorders), effective management of BN requires early diagnosis and a structured approach. Treatment is essentially multidisciplinary, involving medical, psychiatric, psychological, and nutritional teams. Psychotherapy is the first-line intervention: Enhanced Cognitive Behavioral Therapy (EBT) is the gold standard for adults, and Family-Based Treatment (FBT-BN) is preferred for adolescents, aiming to interrupt the restriction-binge cycle. Nutritional monitoring is crucial for dietary re-education, normalization of eating patterns, and work on dietary flexibility. Pharmacological treatment (e.g., selective serotonin reuptake inhibitors) is most frequently used for associated comorbidities. A central pillar for the success and adherence to treatment is the construction of a solid therapeutic alliance between the patient, family, and healthcare professionals, given the ambivalence and shame that often accompany the disorder. The document also discusses the importance of mitigating disparities in treatment for vulnerable populations.