• Individualized plan centering on proper nutrition and behavior modification.
  • Basal energy needs plus 300-400 cal/day
  • Controlled portions of regular diet and snacks.
  • Stabilize fluid and electrolyte intake to prevent edema.
  • Decrease sugar intake; stress importance of other key nutrients.
  • Prevent vomiting to eliminate further enamel erosion (perimolysis).

Because poor body image and low self-esteem underlie bulimia, psychotherapy is an important aspect of treatment. Many people with bulimia feel isolated and shamed by their bingeing and purging.

• Cognitive behavior therapy focuses on the thoughts that envelop food and eating. One of the main goals is to become more self-aware of the relationship to food.
• Behavior therapy uses rewards and repercussions to change the behaviors of bingeing and purging. Recognize triggers for bingeing and purging and to interrupt the “rituals” of bulimic episodes by substituting relaxation and other coping strategies.
• Family therapy looks at the family dynamics that may contribute to bulimia and often includes some therapy sessions without the patient. Family therapy is often important  when the person with bulimia denies the eating disorder.

Mrs. Franklin can be helped and fortunately, there have been no ill effects to her baby.

Next is the case of a very sociable man.