From the Guidelines
To stop purging and manage fluid retention in bulimia nervosa, a comprehensive approach involving medical supervision, psychological treatment, and nutritional rehabilitation is essential, with the American Psychiatric Association recommending eating disorder-focused cognitive-behavioral therapy and a serotonin reuptake inhibitor, such as 60 mg fluoxetine daily, for adults with bulimia nervosa 1. First, seek professional help immediately from an eating disorder specialist, as stopping purging abruptly can cause dangerous electrolyte imbalances. Medical professionals may prescribe medications like fluoxetine (Prozac) at 60mg daily, which is FDA-approved for bulimia and helps reduce binge-purge behaviors. For fluid retention, which commonly occurs when purging stops as the body readjusts its fluid balance, understand that this is temporary and typically resolves within 1-2 weeks. During this period, maintain consistent, regular eating patterns with 3 meals and 2-3 snacks daily, avoid weighing yourself, and resist the urge to restrict food intake despite feeling bloated. Some key points to consider include:
- Gradually introduce foods that may trigger binges
- Drink adequate water (6-8 glasses daily)
- Limit sodium intake
- Incorporate gentle movement like walking rather than intense exercise Cognitive-behavioral therapy (CBT) is highly effective for addressing the psychological aspects of bulimia, helping to challenge distorted thoughts about body image and develop healthier coping mechanisms. Remember that fluid retention is a normal, temporary physiological response as your body heals, not actual weight gain, and will resolve as your body's electrolyte and fluid balance normalizes. It's also important to note that technology-based interventions, such as guided computer- and Internet-based interventions, may be a useful adjunct to traditional therapy for bulimia nervosa, particularly for those who have difficulty accessing in-person treatment 1.
From the Research
Stopping Purging and Managing Fluid Retention in Bulimia Nervosa
To address the issue of stopping purging and managing fluid retention in bulimia nervosa, several treatment approaches have been studied. These include:
- Medication: Fluoxetine, an antidepressant, has been shown to be effective in reducing the frequency of binge eating and purging in individuals with bulimia nervosa 2, 3, 4.
- Psychotherapy: Cognitive-behavioral therapy (CBT) is a psychological treatment that has been found to be effective in reducing the core symptoms of bulimia nervosa, including binge eating and purging 3, 4, 5.
- Combination Therapy: The combination of medication (such as fluoxetine) and psychotherapy (such as CBT) may be more effective than either treatment alone in reducing symptoms of bulimia nervosa 3, 5.
Managing Fluid Retention
Fluid retention is a common issue in individuals with bulimia nervosa, particularly those who engage in purging behaviors.
- Electrolyte and Acid-Base Abnormalities: Purging behaviors can lead to electrolyte and acid-base abnormalities, including hypokalemia, hyponatremia, and metabolic alkalosis 6.
- Treatment: Definitive medical treatment is necessary to address these abnormalities and prevent dangerous medical complications 6.
Key Findings
Some key findings from the studies include:
- Fluoxetine (60 mg/day) decreases the core symptoms of binge eating and purging in the short term 4.
- CBT reduces core behavioral and psychological features in the short and long term 4.
- The combination of medication and psychotherapy may be superior to either treatment alone in reducing symptoms of bulimia nervosa 3, 5.