Some doctors recommend a stepped approach for patients with bulimia. This treatment approach follows specific stages, depending on the severity of the bulimia, and the person's response to treatments:

• Support groups. This is the least expensive approach. It may be helpful for patients with mild conditions who do not have any health problems.
• Cognitive-behavioral therapy (CBT) and nutritional therapy is the preferred first treatment for bulimia that does not respond to support groups.
• Drugs. The drugs used for bulimia are typically antidepressants known as selective serotonin-reuptake inhibitors (SSRIs). A combination of CBT and SSRIs is very effective if CBT is not effective alone.

Patients may drop out of programs if they have unrealistic expectations of being "cured" from therapy alone. Before a program begins, the following should be made clear:

• The process is painful and requires hard work on the part of patients and their families.
• A number of therapies are likely to be tried until the patient succeeds in overcoming this difficult disorder.
• It is common for bulimia to return (relapse), and this is no cause for despair.

Self-help groups like Overeaters Anonymous may help some people with bulimia. The American Anorexia/Bulimia Association is a source of information about this disorder.

See: Eating disorders - support group

Bulimia is a chronic illness and many people continue to have some symptoms despite treatment. People with fewer medical complications of bulimia, and who are willing and able to engage in therapy, tend to have a better chance of recovery.

Bulimia can be dangerous and may lead to serious medical complications over time. For example, frequent vomiting puts stomach acid in the esophagus (the tube from the mouth to the stomach), which can permanently damage this area.

Possible complications include:

• Constipation
• Dehydration
• Dental cavities
• Electrolyte abnormalities
• Hemorrhoids
• Inflammation of the throat
• Pancreatitis
• Tears of the esophagus

Call for an appointment with your health care provider if you (or your child) have symptoms of an eating disorder.