The Role of a Psychiatrist in Bulimia Recovery

Contributor:  By Dr. Kim Dennis, CEO/Medical Director Emeritus of Timberline Knolls

Group of young people during psychotherapyDue to the extremely dangerous and complex aspects of eating disorders, effective treatment usually requires the expertise of many professionals. This is the case whether outpatient or inpatient treatment is sought. This team can include, but is not limited to, a medical doctor, a registered dietitian, a therapist specifically trained in treating eating disorders and a psychiatrist.

Mental Health is Key

The role a psychiatrist plays in the treatment of bulimia is an important one. If a woman admits to residential or inpatient care, it has probably already been established that she is struggling with bulimia; but if she remains in the general population, screening may be required to detect the presence of the disease. The SCOFF questionnaire is a useful diagnostic tool in which the following questions are posed to the individual:

  • Do you make yourself SICK because you feel uncomfortably full?
  • Do you worry you have lost CONTROL over how much you eat?
  • Have you recently lost OVER 14 pounds in a three month period?
  • Do you believe yourself to be FAT when others say you are too thin?
  • Would you say that FOOD dominates your life?

If there are more than two “yes” answers to these questions, it is likely that this person has an eating disorder. The next step is taking a full psychiatric history with special attention paid to the dietetic and developmental history of the woman.

Ideally the psychiatrist will monitor labs, which should be ongoing throughout treatment. Performing an electrocardiogram (ECG) and routine vitals such as blood pressure, pulse and temperature is standard. Testing must be done for electrolyte abnormalities, amylase levels, which could indicate ongoing purging during treatment. Repeated vomiting can cause hypokalaemia and metabolic alkalosis. Hypokalaemia can lead to cardiac arrhythmias and cardiac arrest, and a woman may require potassium supplementation. In extremely severe cases, hospital care may be required; in this clinical setting, the individual can receive intravenous fluid replacement and cardiac monitoring.

ED Specialists

Lady in TherapyPsychiatrists with eating disorder expertise understand the intricacies of this disease; it is not just about bingeing and purging. General psychiatric symptoms are prominent in this illness. Anxiety and behaviors associated with obsessive compulsive disorder (OCD) can be present. Depressive symptoms are often equivalent to that seen in major depressive disorder (MDD). Some women regularly engage in other maladaptive behaviors such as self-harm, alcohol and drug use, sexual disinhibition and/or shoplifting. All of these issues must be understood and addressed as part of complete care.

Often there is an underlying history of some degree or another of traumatic emotional, physical or sexual experiences.

Obtaining Medication Safely

Prescription MedicineAlthough the primary care physician on the team can prescribe psychotropic medications, this is best done under the purview of the psychiatrist. Some pharmaceuticals have been FDA approved for use in treating bulimia (namely, SSRI medications). However, many more medications can be potentially harmful to people with bulimia. For example, stimulant medications such as Adderall or other addictive medications such as Klonopin is not recommended for routine use and could prove counterproductive to treatment and recovery. Finally some medications have been found to increase the risk of seizure for patients with bulimia. Wellbutrin is an example.

More powerful many times than medication management is the provision of psychotherapy by the psychiatrist and others on the treatment team. The psychiatrist must have some understanding of the “whys” behind the disorder, and also work to provide the skills and tools required to establish new, healthy coping life strategies in place of binging and purging. It also requires a basic understanding of patient reluctance or resistance to give up the illness. Ambivalence about recovery is often a central feature of an eating disorder. This means a psychiatrist must assess the degree of motivation and the person’s readiness/willingness to change.

Fully understanding where a woman is in terms of commitment to recovery will impact the treatment planning. Moreover, this may reduce the likelihood of patient non-adherence or treatment failure.


Community Discussion – Share your thoughts here!

Have your or your loved one benefitted from Psychiatric care while in recovery from disordered eating?  Please share the impact this type of treatment made.

About the author:

Kim Dennis ImageDrKim Dennis is a board-certified psychiatrist who specializes in eating disorder treatment, addiction recovery, trauma / PTSD and co-occurring disorders. As CEO/Medical Director Emeritus, she provides consultation to the clinical director and participates in the Timberline Knolls Clinical Development Institute and other outreach initiatives. Dr. Dennis maintains a holistic perspective in the practice of psychiatry.  She incorporates biological, psycho-social and spiritual approaches into individually-tailored treatment plans. Dr. Dennis is published in the areas of gender differences in the development of psychopathology, co-occurring eating disorders and self-injury, and the use of medication with family-based therapy for adolescents with anorexia nervosa. Dr. Dennis received her undergraduate degree from the University of Chicago. She obtained her medical degree from the University Of Chicago Pritzker School of Medicine and completed her psychiatry residency training at the University Of Chicago Hospitals, where she served as chief resident. During her training, she was part of the multi-disciplinary eating disorders team specializing in treating adolescents with anorexia and bulimia and their families. She is a member of the American Medical Association, Academy for Eating Disorders, the American Academy of Addiction Psychiatry and the American Society for Addiction Medicine.  She is on the medical advisory board for the National Association of Anorexia Nervosa and Associated Disorders.

The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders.  These are not necessarily the views of Eating Disorder Hope, but an effort to offer a discussion of various issues by different concerned individuals.  We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors.  If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.

Last Updated & Reviewed By: Jacquelyn Ekern, MS, LPC on June 23, 2016. Published on