Bulimia: Diagnosis & Therapy

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Bulimia: Diagnosis & Therapy
Bulimia: Diagnosis & Therapy
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Video: Bulimia nervosa - causes, symptoms, diagnosis, treatment & pathology 2023, February

Bulimia: Diagnosis & Therapy

In order to diagnose bulimia nervosa, the doctor will have a detailed discussion. Among other things, questions about eating habits, physical and mental state, lifestyle and social environment of the patient are asked.

He / she will also perform a thorough physical examination or initiate examinations. The aim of treating BN is often to "normalize" eating behavior and keep body weight stable.


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  • Diagnosis of bulimia nervosa
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  • How are the costs going to be covered?

Diagnosis of bulimia nervosa

The diagnosis is made based on the conversation and the clarification of physical and psychological complaints or problems:

  • Medical history, illnesses & complications. The doctor informs himself, for example, about tooth damage (e.g. tooth decay). Possible other diseases and complications are clarified - such as esophagitis (inflammation of the mucous membrane of the esophagus), malabsorption syndromes, osteomalacia, osteoporosis, severe constipation (constipation) and hypertrophic osteoarthropathy, electrolyte disorders, tumor diseases and mental illnesses (e.g. depression, personality disorders). Possible alcohol or drug consumption as well as drug abuse are also considered.
  • Laboratory values. In the course of the diagnosis, the doctor arranges for various laboratory values ​​to be determined, such as blood count, kidney values ​​(creatinine and urea), lipid metabolism (triglycerides and cholesterol), urine status, electrolytes, total protein and albumin, amylase, transaminase and blood glucose. Hormones such as thyroid hormones can also be collected. In the individual case, further laboratory values ​​are also clarified. Information on the respective values ​​can be found under laboratory values ​​table.
  • Further investigations. The doctor can have an ultrasound examination of the abdomen carried out and, if necessary, order an EKG, gastroscopy and / or CT scan.

Therapy of bulimia nervosa

The aim of treating BN is often to "normalize" eating behavior and stabilize body weight. This is usually done through psychotherapy. It may also be necessary to take medication. Physical and psychological comorbidities are treated. The doctor decides which forms of therapy are necessary for the person affected. Both patients and relatives are informed about the disease, its consequences and the treatment. It may be necessary to motivate those affected for therapy.

Outpatient, day clinic or inpatient

The therapy of bulimia nervosa often takes place on an outpatient basis and according to a step-by-step plan. Accompaniment by professional helpers has recently proven its worth. Under certain conditions, day-care or in-patient care may be necessary (e.g. in the case of a very poor state of health, risk of self-harm, suicide or an addiction). The form of treatment is decided based on the individual physical, psychological and social factors of the person affected. In any case, it is essential to start therapy as early as possible.

Eating and drinking behavior

Eating behavior can be normalized through a balanced mixed diet. In addition, certain vitamins and minerals may be necessary (e.g. vitamin D, calcium, etc.). For example, it is often necessary to ensure that there is sufficient fluid and electrolyte intake - for example by drinking mineral water and mixtures of fruit juice with mineral water. Additional electrolyte administration may also be necessary.

Food cravings can be avoided, for example, by eating regularly. Patients often have to learn to orientate themselves by their appetite and feeling of hunger. Those affected can obtain information about a healthy, balanced diet and the consequences of starvation through nutritional advice.


In certain cases, patients with bulimia are prescribed to take medication - e.g. antidepressants, if the eating disorder is related to depression.

Family environment

The decisive factor is the contribution of the parents or legal guardians in all phases of the treatment, from recognizing a possible problem, through the first presentation to intensive cooperation with the therapeutic team in order to adequately counter the disease.

Especially with children, but also with younger adolescents, parents / legal guardians take on important decisions and tasks and often have to convince the affected person first of a treatment, if possible without interfering too much with their autonomy (especially with young people).

At the same time, it is usually difficult for relatives to accept that they can only help relatively little. Many relatives find it difficult not to monitor permanently, but to participate in the course of therapy with interest and support. It may be necessary to address conflict behavior in the family, delimitation difficulties, perfectionism, etc. in the course of therapy - for example through psychotherapy, family or couple therapy (which also includes relatives). Binge eating with compensatory measures occurs secretly. Not least because of this, relatives often do not notice the binge eating, at least at the beginning.

For more information, see Eating Disorders: What Family Members Can Do

Specialized counseling centers and outpatient clinics, addresses of resident psychotherapists and psychologists can be found under Eating Disorders: Advice & Help.

Therapy monitoring & relapse prophylaxis

Relapses may occur during and after treatment. Treatment discontinuation is also possible. Regular follow-up checks are carried out during therapy. It is also necessary to prepare for the time after therapy with those affected and their relatives - for example, discussing what to do in the event of a relapse.

Whom can I ask?

The first point of contact for adults is often the family doctor. He / she will initiate transfers if necessary. For children and adolescents, specialists in paediatrics and child and adolescent psychiatry are the first point of contact. Doctors from various disciplines are usually involved in a therapy. Psychotherapists can also be involved.

You can find special outpatient clinics, advice centers and hotlines under Eating Disorders: Advice & Help.

How are the costs going to be covered?

The costs of the medical examination to clarify a bulimia nervosa as well as the treatment are usually covered by the social security institutions.

For certain services (e.g. psychotherapy with resident psychotherapists), an application for a cost subsidy can be submitted by the health insurance. The interdisciplinary treatment of eating disorders (including psychotherapy) also takes place in specialized outpatient facilities that have contracts with health insurance providers. For these treatment cases, the costs are generally covered in full.

For information on the respective provisions, please contact your health insurance provider, which you can find on the social security website.

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