A 17-year-old female exhibits binge eating followed by guilt and purging. What is the best initial treatment for her condition?

In the scenario described, the 17-year-old female is exhibiting behaviors consistent with bulimia nervosa, which is characterized by binge eating followed by compensatory behaviors such as purging. The best initial treatment for bulimia nervosa often involves a combination of psychotherapy and pharmacotherapy.

Starting an antidepressant, particularly a selective serotonin reuptake inhibitor (SSRI), is considered an effective first-line treatment for bulimia nervosa. Studies have shown that SSRIs not only help alleviate the depressive symptoms that often accompany eating disorders but can also reduce binge-eating and purging behaviors. Medications can lead to improvements in mood and decrease the frequency of binge-purge cycles, making them a suitable choice for initial treatment.

Cognitive behavioral therapy (CBT) is an important aspect of treatment as well, but it typically requires more time and commitment; therefore, while it’s a highly effective approach, starting with medication can provide more immediate relief and stabilization. In this case, referring for hospitalization is generally reserved for severe cases presenting significant health risks, and implementing dietary changes alone is unlikely to address the underlying behavioral aspects of the disorder effectively. Thus, using an antidepressant addresses both the eating disorder symptoms and associated mood disturbances, making it a strong initial treatment choice