Bulimia Nervosa Treatment and Recovery
What does bulimia look like?
Bulimia nervosa (commonly known as "bulimia") is an eating disorder where people regularly binge eat and purge.
Binge eating
Eating what most would consider a large amount of food in a short amount of time
Purging
Trying to get rid of food eaten or calories consumed in order to lose weight
Common purging behaviors include:
Abusing diet pills
Abusing Ipecac
Abusing laxatives [Mehler, p. 139, 2022]
Bulimia: A very secretive illness
People with eating disorders often hide bingeing and purging behaviors. And people with bulimia may look as though they are “physically healthy” [Mehler, p. 139, 2022]. In other words, you can’t tell if someone has an eating disorder just by looking at them. Often, you can’t tell if someone has an eating disorder even if you are watching their behavior closely.
Is it bulimia?
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BULIMIA SYMPTOMS
Warning signs of bulimia
Someone who regularly makes themselves throw up may experience:
Erosion of dental enamel and other dental changes
Swelling of the cheeks (sometimes called “chipmunk cheeks”)
Calluses on the back of the hands (”Russell’s sign”)
Self-harm can also co-occur with eating disorders [Mehler, p.137-9, 2022]. If any of these signs look familiar, please reach out for help.
Being fixated with weight or size
Irregular periods
Heart palpitations
Fatigue
GI complaints (bloating, constipation, diarrhea)
Acid reflux
Headaches
Swelling of the feet and ankles (edema)
Frequent sore throats
Hemorrhoids
Nosebleeds
Worsening mental health
Long-term health risks of bulimia
Bingeing and purging can lead to serious health risks, including:
Dehydration
Edema (uncomfortable swelling)
Ulcers or pancreatitis
Cardiac complications (irregular heartbeat or heart failure stemming from electrolyte imbalances in the levels of key minerals such as potassium, sodium, and chloride)
Esophageal inflammation and/rupture (resulting from vomiting)
Digestive irregularity (chronic irregular bowel movements and constipation, sometimes stemming from laxative abuse)
Fatigue and muscle weakness (from over-exercise or electrolyte imbalances)
The health complications listed above can prevent people from enjoying a full and rewarding life. Along with these physical health risks, bulimia is often accompanied by other mental health issues like anxiety, depression or substance abuse.
Bulimia Treatment
Treatment for bulimia starts with:
Medical and psychiatric stabilization
Therapeutic intervention
Nutrition education and support
Weight restoration, if needed
Once stable, the treatment team helps each person move towards their personal goals for recovery.
Nutrition education and support
In treatment, patients work closely with registered dietitians. Daily meal planning and nutrition education help patients:
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1.5 percent of American women will suffer from bulimia nervosa in their lifetime.
[Hudson, 2007]
Nearly half of bulimia patients have a comorbid mood disorder.
[Ulfvebrand, 2015]
More than half of bulimia patients have comorbid anxiety disorders.
[Ulfvebrand, 2015]
1 in 10 bulimia patients have a comorbid substance abuse disorder, usually alcohol use.
[Ulfvebrand, 2015]
Bulimia relapse rates range from 25% to 45% within the first year.
[Halmi, 2002; McFarlane, 2008; Olmsted, 2015.]
The mortality rate of bulimia nervosa is lower than that of anorexia nervosa. However, the mortality rate is still twice as high as the general population of the same age. Deaths from bulimia often stem from purging behaviors or from suicide.
[Crow et al, 2009] [Mehler, p.136, 2022]
The mortality rate of bulimia nervosa is lower than that of anorexia nervosa. However, the mortality rate is still twice as high as the general population of the same age. Deaths from bulimia often stem from purging behaviors or from suicide.
[Crow et al, 2009]
[Mehler, p.136, 2022]
Bulimia FAQs
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Like other eating disorders, bulimia is caused by a mix of biological, psychological and social/cultural factors. There is a strong genetic link. If someone in your family has had an eating disorder, you are more likely to have an eating disorder. Other causes include:
Having a highly impulsive personality
Perfectionism
A history of trauma
Low self-esteem
Engaging in activities or occupations that emphasize weight and appearance
Social media
Being exposed to a “thin beauty ideal” [Morrissey, 2019]
You may notice people with bulimia:
Binge eating (look for hidden food wrappers or foods unexpectedly missing)
Purging (look for laxatives, enemas, or cuts on the knuckles/hands from self-induced vomiting)
Using the bathroom immediately after meals
Fixating on their weight or body size
Over-exercising
Having trouble concentrating
Isolating or socially withdrawing
Bulimia can cause problems with nearly all body systems and vital organs. People struggling with bulimia can experience mild, moderate or severe health complications in the following systems:
Digestive
Throat
Cardiac
Reproductive
Dermatologic
Pulmonary
Mental
Most complications resolve with treatment.
Bulimia is associated with many serious health risks. Serious complications are more likely to occur for people with:
Severe bulimia (8-13 binge/purge episodes weekly) and
Extreme bulimia (more than 14 binge/purge episodes weekly)
The more frequently one binges and purges, the more negative health consequences they can face.
Bulimia, like other eating disorders, can be effectively treated with a multi-disciplinary approach that includes medical, mental health, nutritional and psychosocial interventions. Initial treatment focuses on resolving physical and medical complications. As the brain and body heal, additional therapies are started. People can fully recover from bulimia with evidence-based treatment.
Bulimia Resources
In this library of bulimia nervosa resources, you’ll find effective resources to support your loved one’s journey.
Bulimia Resources
Bulimia Books
References
1. Morrissey, R. A., Gondoli, D. M., & Corning, A. F. (2019). Reexamining the restraint pathway as a conditional process among adolescent girls: When does dieting link body dissatisfaction to bulimia? Development and Psychopathology, 32(3), 1031–1043.
2. Mehler, P.S., & Andersen, A.E. (2022). Eating disorders: A comprehensive guide to medical care and complications (4th ed.). Johns Hopkins University Press.
3. Hudson, J. I., Hiripi, E., Pope, H. G., & Kessler, R. C. (2007). The prevalence and correlates of eating disorders in the national comorbidity survey replication. Biological Psychiatry, 61(3), 348–358.
4. Arcelus, J., Mitchell, A. J., Wales, J., & Nielsen, S. (2011). Mortality rates in patients with anorexia nervosa and other eating disorders: a meta-analysis of 36 studies. Archives of General Psychiatry, 68(7), 724-731.
5. Ulfvebrand, S., Birgegard, A., Norring, C., Hogdahl, L., & von Hausswolff-Juhlin, Y. (2015). Psychiatric comorbidity in women and men with eating disorders results from a large clinical database. Psychiatry Research, 230(2), 294-299.
6. Romano SJ, Halmi KA, Sarkar NP, Koke SC, Lee JS. A placebo-controlled study of fluoxetine in continued treatment of bulimia nervosa after successful acute fluoxetine treatment. Am J Psychiatry. 2002 Jan;159(1):96-102.
7. Spechler SJ, Souza RF. Barrett's esophagus. N Engl J Med. 2014 Aug 28;371(9):836-45.
8. Kovacs D, Palmer RL. The associations between laxative abuse and other symptoms among adults with anorexia nervosa. Int J Eat Disord. 2004 Sep;36(2):224-8.
9. Mehler PS and Linas S. 2002. Use of a proton-pump inhibitor for metabolic disturbances associated with anorexia nervosa. New England Journal of Medicine 347:373-4.
10. Halmi, K.A., Agras, W.S., Mitchell, J., Wilson, G.T., Crow, S., Bryson, S.W., & Kraemer, H. (2002). Relapse predictors of patients with bulimia nervosa who achieved abstinence through cognitive behavioral therapy. Archives of General Psychiatry, 59(12):1105-1109. doi:10.1001/archpsyc.59.12.1105.
11. McFarlane, T., Olmsted, M.P., & Trottier, K. (2008). Timing and prediction of relapse in a transdiagnostic eating disorder sample. International Journal of Eating Disorders, 41(7), 587-593. doi: 10.1002/eat.20550.
12. Olmsted, M.P., MacDonald, D.E., McFarlane, T., Trottier, K., & Colton, P. (2015). Predictors of rapid release in bulimia nervosa. International Journal of Eating Disorders, 48(3), 337-340. doi: 10.1002/eat.22380.
13. Eddy, K.T., Tabri, N., Thomas, J.J., Murray, H.B., Keshaviah, A., Hastings, E., Edkins, K., Krishna, M., Herzog, D.B., Keel, P.K., & Franko, D.L. (2017). Recovery from anorexia nervosa and bulimia nervosa at 22-year follow up. Journal of Clinical Psychiatry, 78(2), 184-189. doi: 10.4088/JCP.15m10393.
14. Crow SJ, Peterson CB, Swanson SA, Raymond NC, Specker S, Eckert ED, Mitchell JE. Increased mortality in bulimia nervosa and other eating disorders. Am J Psychiatry. 2009 Dec;166(12):1342-6.