Bulimia Nervosa Treatment in Palm Beach
Evidence-based psychiatric care for binge-purge cycles
What Is Bulimia Nervosa?
Bulimia nervosa is an eating disorder characterized by recurrent episodes of binge eating followed by compensatory behaviors (purging, laxative use, excessive exercise) to prevent weight gain. Unlike anorexia, many individuals with bulimia are at a normal or near-normal weight, which can delay diagnosis.
Signs & Symptoms
- Recurrent binge eating (large amounts in short time, sense of loss of control)
- Recurrent inappropriate compensatory behaviors (purging, laxatives, fasting, exercise)
- Behavior occurs at least once weekly for 3 months
- Self-evaluation unduly influenced by body shape and weight
- Secrecy around eating
- Physical signs: dental erosion, calluses on knuckles, swollen cheeks
- Electrolyte abnormalities from purging
- Mood disturbances and shame
Treatment Approaches
CBT is the most effective psychological treatment for bulimia. High-dose SSRIs (particularly fluoxetine at 60 mg) have FDA approval for bulimia and significantly reduce binge-purge frequency. Combined CBT and medication is often more effective than either alone. Dr. Agresti coordinates with eating disorder therapists for comprehensive care.
Why Concierge Psychiatry?
With Dr. Agresti's concierge model, you get his direct cell number, same-day prescription refills, and 24-hour appointment availability — with no membership fee. Experience the difference that direct-access care makes.
Learn About Concierge CareFrequently Asked Questions
Clinical trials established that fluoxetine at 60 mg daily is significantly more effective for reducing binge-purge frequency than the standard 20 mg antidepressant dose. This higher dose appears to more fully modulate the serotonin pathways involved in appetite regulation and impulse control. Dr. Agresti carefully titrates to therapeutic doses while monitoring for side effects during extended appointments.
Chronic purging can cause serious medical complications including dental erosion, esophageal tears, electrolyte imbalances leading to cardiac arrhythmias, kidney problems, and chronic digestive issues. Many of these complications are reversible with treatment, but early intervention produces better outcomes. Regular psychiatric monitoring helps catch and address medical complications before they become permanent.
Most patients require 4-6 months of active treatment to achieve significant reduction in binge-purge cycles, with ongoing maintenance for 1-2 years to prevent relapse. CBT for bulimia typically involves 16-20 sessions. Medication may be continued longer. The timeline varies based on severity, co-occurring conditions, and treatment response.
Yes, most individuals with bulimia maintain a weight within the normal range, which is one reason the disorder often goes undiagnosed for years. Unlike anorexia, there may be no visible weight loss. The binge-purge cycle itself, regardless of weight, causes significant physical and psychological harm. A psychiatric evaluation focuses on behaviors and distress, not just weight.
Bulimia and substance use disorders frequently co-occur, with shared risk factors involving impulsivity, reward-system dysregulation, and difficulty tolerating distress. Up to 30% of people with bulimia also struggle with alcohol or drug use. Dr. Agresti has extensive experience treating co-occurring eating disorders and substance use, including outpatient detox services when needed.