Updated on March 26, 2024
6 min read

Bulimia Nervosa: Signs, Symptoms, and Treatment Options

Bulimia nervosa is a complex but treatable condition. If you or someone you know struggles with these patterns, finding the right support and guidance will go a long way in your recovery.

Bulimia nervosa, commonly referred to as bulimia, is an eating disorder where people engage in a cycle of binge eating. Healthcare professionals define the cycle as consuming large amounts of food in a short period while feeling a loss of control.

It’s followed by behaviors to prevent weight gain, known as purging. Purging behaviors might include:

  • Self-induced vomiting
  • Misuse of laxatives and diuretics
  • Enemas
  • Fasting
  • Excessive exercise

If you're struggling with bulimia, know that you're not alone. We're here to support you by sharing information about the signs and treatment options for this difficult condition.  Understanding bulimia is a powerful first step towards healing and recovery.

What are the Signs and Symptoms of Bulimia Nervosa?

Bulimia nervosa affects people of all body shapes and sizes, making it challenging to identify based solely on appearance. The signs of the condition can be categorized into physical, behavioral, and emotional indicators.

Understanding these symptoms is crucial for recognizing the disorder in oneself or others, as early detection and treatment can significantly improve outcomes.

Physical Symptoms

While there are no definitive ways to diagnose someone through physical appearance alone, a person will still exhibit physical signs of bulimia nervosa. These include:

  • Tooth enamel erosion due to frequent vomiting
  • A chronically inflamed and sore throat due to the acidic content of vomit
  • Swollen salivary glands, leading to a swollen appearance
  • Stomach cramps, acid reflux, and constipation
  • Electrolyte imbalance leading to severe dehydration, heart problems, and kidney failure
  • Irregular periods or amenorrhea (absence of menstruation)
  • Calluses or scars on the knuckles or hands from inducing vomiting (Russell's sign)

Behavioral Symptoms

Along with the physical signs of bulimia, a healthcare provider will also try to identify behavioral symptoms of the condition. These include:

  • Consuming large amounts of food in a short period with a feeling of loss of control
  • Self-induced vomiting, misuse of laxatives, diuretics, or enemas.
  • Using physical activity as a means to "burn off" calories consumed during binge episodes
  • Severely restricting calorie intake between binges, often selecting low-calorie or "diet" foods
  • Eating in private or disappearing after meals
  • Avoiding social situations involving food

Emotional Symptoms

A person with bulimia may constantly worry or complain about being fat even when they’re at a normal weight. They may also judge themselves harshly based on body image.

It’s also common to experience wide emotional swings, including feelings of guilt or shame after bingeing. Often co-occurring with bulimia are anxiety and depression, contributing to or resulting from the disorder.

What Are the Treatment Options for Bulimia Nervosa?

Bulimia nervosa is a complex eating disorder. Overcoming it requires a personalized treatment approach that addresses its psychological and physical aspects.

This typically involves a combination of psychotherapy, nutritional counseling, and sometimes medication. Recovery is possible, and there are numerous support systems and professional treatment options to help you on your journey.

Professional Treatment Options

Seeking guidance from healthcare professionals specializing in eating disorders is vital for effective treatment. Here's what professional treatment might involve:

1. Psychotherapy

  • Cognitive Behavioral Therapy (CBT): Evidence-based therapy focuses on changing negative thought patterns and behaviors related to eating, body image, and self-esteem.
  • Interpersonal Psychotherapy (IPT): Treatment addresses interpersonal relationship issues that might contribute to bulimia, improving communication and problem-solving skills.
  • Family-Based Therapy (FBT): This treatment is particularly helpful for adolescents. It empowers the family to provide support and help the person with bulimia regain healthy eating patterns.

2. Nutritional Counseling

Registered dietitians specializing in eating disorders provide personalized meal plans and education on balanced nutrition. They can also help you develop a healthy relationship with food, correcting misconceptions and fears.

3. Medication

Antidepressants like Selective Serotonin Reuptake Inhibitors (SSRIs,) particularly fluoxetine (Prozac), are approved for treating bulimia. They can help reduce binge-purge cycles and improve mood. They’re typically used alongside therapy and nutritional counseling.

4. Supportive Care & Monitoring

Some people have severe cases of bulimia nervosa and require more intensive care and monitoring. This can include hospitalization for medical and psychological support.

Other forms of care and monitoring include outpatient programs. People will have regular appointments with a therapist, dietitian, and medical provider.

Eating disorder clinics and residential programs are also an option for supportive care. They provide focused, structured environments with a multidisciplinary approach for those who need additional support.

5. Emerging & Alternative Therapies

Alternative therapies are often used in combination with traditional medical treatments. These alternative therapies include:

  • Mindfulness and meditation: Complements traditional treatments by increasing awareness of triggers and reducing impulsiveness around eating
  • Online and virtual therapy: Provides convenient, accessible care from the comfort of your home

Seeking help is a sign of strength, and caring professionals are ready to guide you toward recovery. Treatment options will be personalized to your specific needs, so don't be afraid to ask questions and actively participate in your recovery journey.

Remember that recovery from bulimia nervosa is a process. You can build a healthier and happier life with patience, dedication, and the right support.

What are Common Coping Mechanisms for Bulimia Nervosa?

Aside from professional help, developing a toolkit of coping mechanisms can empower you throughout your recovery. These strategies can help you manage the urge to binge and purge and address the underlying emotional factors:

  • Journaling: Writing provides a safe space to express emotions, identify patterns, and process the triggers related to your eating disorder.
  • Having a support system: Build a strong network of friends, family, and professionals. Support groups offer a sense of community and understanding to those facing similar challenges.
  • Self-care activities: Relaxing activities like baths, walks, or yoga can promote well-being and reduce the urge to engage in disordered behaviors.
  • Structured eating plans: A dietitian can help you create regular, balanced meal plans to stabilize blood sugar and reduce cravings.
  • Challenging disordered thoughts: Actively question negative thoughts about food, body image, and self-worth, replacing them with compassionate and realistic perspectives.
  • Using distraction techniques: When you feel the urge to binge or purge, call a friend, engage in a hobby, or find any activity that distracts from the urge.

Online Therapy Can Help

Over 3 million people use BetterHelp. Their services are:

  • Professional and effective
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Resources for People with Bulimia

Finding support is crucial when facing bulimia nervosa. Here are some well-established organizations offering help for people with the disorder and their loved ones:

Some additional resources outside of the US include:

These organizations provide safe spaces, understanding, and practical guidance as you navigate the path to recovery.

Get matched with an affordable mental health counselor

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Updated on March 26, 2024
13 sources cited
Updated on March 26, 2024
  1. Mayo Clinic's Bulimia Nervosa Overview: https://www.mayoclinic.org/diseases-conditions/bulimia/symptoms-causes/syc-20353615
  2. Cleveland Clinic's Guide to Bulimia Nervosa: https://my.clevelandclinic.org/health/diseases/9795-bulimia-nervosa
  3. Walden Eating Disorders' 8 Warning Signs of Bulimia Nervosa: https://www.waldeneatingdisorders.com/blog/8-warning-signs-of-bulimia-nervosa/
  4. Nationwide Children's Information on Bulimia Nervosa: https://www.nationwidechildrens.org/conditions/bulimia-nervosa
  5. National Institutes of Mental Health on Eating Disorders: https://www.nimh.nih.gov/health/topics/eating-disorders
  6. Hopkins Medicine's Information on Bulimia Nervosa: https://www.hopkinsmedicine.org/health/conditions-and-diseases/eating-disorders/bulimia-nervosa
  7. Eating Disorder Foundation on Coping with Eating Disorders: https://eatingdisorderfoundation.org/learn-more/about-eating-disorders/coping/
  8. Central Coast Treatment Center: Mindfulness in Eating Disorder Treatment: https://www.centralcoasttreatmentcenter.com/blog-1/mindfulness-in-eating-disorder-treatment
  9. Cityscape Counseling: 6 Helpful DBT Skills for Eating Disorder Recovery: https://www.cityscapecounseling.com/post/6-helpful-dbt-skills-for-eating-disorder-recovery/
  10. Eating Disorder Hope: Eating Disorder Hotlines: https://www.eatingdisorderhope.com/treatment-for-eating-disorders/eating-disorder-hotlines
  11. Center for Discovery: How to Recover from Bulimia: https://centerfordiscovery.com/blog/how-to-recover-from-bulimia/
  12. NCBI Article on Mindfulness-Based Interventions for BN: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8668447/
  13. Eating Disorder Hope: Effective Coping Strategies for Eating Disorders: https://www.eatingdisorderhope.com/recovery/self-help-tools-skills-tips/effective-coping-for-eating-disorders

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