Most patients with bulimia nervosa come to the hospital with irreversible eating behaviour, severe somatic weakness and malnutrition. As those who present are often weak and malnourished, nutritional support is the primary treatment and secondly, strict limits need to be placed on the amount of food the patient can eat and not overeat, which will reduce or prevent induced vomiting behaviour and avoid aggravating the somatic weakness.
In addition, where appropriate, psychotropic medication with few adverse effects and a high degree of safety, commonly antipsychotics and antidepressants, should be used to help correct eating behaviour and improve poor mood, if physically possible. It is difficult to improve a patient’s eating disorder quickly and effectively with medication alone, and medication supplemented with psychotherapy can often be more effective.