What is the first-line treatment for bulimia nervosa?

The first-line treatment for bulimia nervosa is cognitive-behavioral therapy (CBT). This approach is effective because it addresses the underlying thought patterns and behaviors that contribute to the disorder. CBT helps individuals identify and modify distorted beliefs about body image, food, and self-worth. It teaches coping skills to manage urges to binge and purge, making it a powerful therapeutic option.

While selective serotonin reuptake inhibitors (SSRIs) can also play a role in the treatment of bulimia nervosa, they are generally considered adjunctive to therapy rather than a standalone first-line treatment. SSRIs like fluoxetine have demonstrated efficacy in reducing binge-purge episodes, but the foundational work done in CBT establishes a robust framework for long-term management and recovery.

Other forms of therapy exist and can be beneficial; however, CBT has the most research support and is recognized as the best initial approach due to its structured nature and focus on behavior modification. Traditional antidepressant treatments like tricyclic antidepressants (TCAs) are less commonly used in this context due to their side effect profiles and lower efficacy compared to SSRIs and behavioral psychotherapies. Therefore, CBT stands out as the primary recommendation for effectively treating bulimia nervosa.