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Bulimia nervosa is a potentially life-threatening disorder that affects more than 5.2 million people in America alone. Despite the seriousness of this disorder and its consequences on general health and well-being, it is entirely possible to cure it before it’s too late. As with most types of eating disorders, bulimia nervosa treatment takes place at varying levels of care to guide patients on their path to recovery. The exact level of care one may require depends on multiple factors, including mental and physical health, the severity of the symptoms, and available treatment options.

Bulimia Nervosa

Bulimia nervosa is an eating disorder that includes episodes of binge eating followed by compensatory mechanisms to avoid weight gain or relieve the physical discomfort associated with overeating. Some examples of compensatory mechanisms that someone with bulimia may use include the use of laxatives, fasting, excessive exercising, or self-induced vomiting.

Like other types of eating disorders, people with bulimia are often secretive about their disorder due to the feelings of guilt or shame associated with their behaviors. They may go to great lengths to hide these symptoms, making it difficult for their family members and friends to recognize them.

Mentioned below are some exciting bulimia nervosa facts that indicate the severity of this disorder and the common challenges associated with it:

  • Approximately five percent of women in the U.S. suffer from bulimia nervosa
  • Around half of the people with bulimia suffer from a comorbid mood disorder
  • More than half of people with bulimia have a co-existing anxiety disorder
  • One in ten people with bulimia suffers from a co-existing substance abuse disorder, which most likely includes alcohol as the substance of dependence.

Despite the pervasiveness of bulimia and the life-threatening consequences associated with it, help is readily available to overcome it. With proper treatment, anyone can expect to recover from bulimia and lead an everyday and healthy life.

The most common bulimia nervosa symptoms can be categorized into physical, behavioral, and emotional categories. These include:

Physical Symptoms

Among all healthcare professionals, dentists are usually the first ones to notice self-induced vomiting as a sign of bulimia nervosa. When frequently performed, this habit can lead to dental erosion on the internal surface of teeth. In addition to this oral concern, other physical symptoms of bulimia nervosa include:

  • Bloodshot eyes
  • Decaying teeth
  • Heart palpitations
  • Chest pains
  • Chronic bouts of constipation due to laxative abuse
  • Dehydration
  • Swollen glands near the jaw
  • Calluses on the back of the hand
  • Stomach aches
  • Frequent sore throat
  • Tooth Sensitivity
  • Headache
  • Lightheadedness
  • Decaying teeth
  • Mouth ulcers
  • Swelling of hands and feet
  • Tooth cavities
  • Electrolyte imbalances
  • Vomiting blood

People who frequently induce self-vomiting to purge may also have puffy cheeks. Their hands may have calluses because of repeatedly using them to induce vomiting, a sign known as Russell’s sign. However, this sign may be absent in people with chronic bulimia as they might be able to vomit without mechanically stimulating their gut.

Behavioral Symptoms

Following are some common behavioral bulimia nervosa symptoms that may be picked up by the friends and family members of a patient:

  • Creating schedules or following rituals that permit binging and purging
  • Evidence of binge eating, such as stealing or stashing food or eating large amounts in one go
  • A desperation to exercise excessively no matter what the circumstances are
  • Evidence indicative of purging, for example, the need to go to the restroom or shower after meals or finding excessive packages of laxatives or diuretics at home or in bags
  • Extreme eating habits, for example, strict dieting followed by overeating episodes.
  • Exercising a specific amount to get rid of the calories consumed
  • Frequent trips to the bathroom
  • High levels of fatigue
  • Use of drugs or detox teas to suppress appetite
  • Frequent discussions about calories, dieting, food, or body weight
  • Missing food from the cabinets or pantry
  • Finding empty food packaging or wrappers in trashcans
  • A withdrawal from friends, families, and social activities

Emotional Symptoms

Emotional symptoms are typically more difficult to notice than behavioral symptoms. However, many family members and friends might be able to recognize it even without knowing about the purging and binging behaviors. Some of these emotional symptoms include:

  • Depression
  • Extremely self-critical behaviors
  • Irritability
  • Mood swings
  • Feeling out of control
  • Strong need for approval
  • A tendency to measure attractiveness and self-confidence by appearance and weight

Fortunately, there are plenty of rehabilitation centers and eating disorders units effectively helping people get over bulimia nervosa successfully. During the treatment process, a team of professionals will collaboratively work with patients to develop critical goals and achieve them to set the foundation for ongoing recovery. Some of these important treatment goals include:

Learning New Patterns of Behavior

It is entirely possible to stop the cycle of purging and binging. To achieve this, experts apply a range of interventions, such as psychoeducation, a regular nourishment pattern, and a therapeutic environment where patients can learn and apply their newer, healthier behaviors.

Developing New Emotional Coping Skills

A lot of people with bulimia seek comfort in their eating disorders from painful emotions. For such people, experts aim to develop a toolbox of healthy emotional coping skills that these patients can utilize to soothe themselves.

Increasing Self-Confidence

Learning to challenge difficult situations is the core of exposure work in an eating disorder recovery plan. Whether it is a social situation, a food item, body image, or exercise, taking baby steps toward these challenging areas can help patients develop self-confidence without using any eating disorder behavior to escape.

Professional Treatment for Bulimia Nervosa

For most people, treatment for bulimia nervosa includes changing their binging-purging behaviors while working on controlling their distorted thought patterns. A comprehensive treatment plan often combines psychotherapy with medications to achieve goals effectively. The plan takes place under the supervision of a care team which may include mental health professionals, medical doctors, and dietitians.


The following three forms of psychotherapy are particularly helpful in the management of bulimia nervosa:

  • Cognitive behavioral therapy focuses on recognizing and changing the underlying negative thoughts and behaviors about one’s body shape and weight. With CBT, patients learn how to change these thoughts or replace them with healthier ones while learning new coping mechanisms to delay or avoid purging behaviors. 
  • Dialectical behavioral therapy works on the principles of CBT while focusing on practicing mindfulness, improving relationships, learning emotional regulation skills, and increasing distress tolerance.
  • Family-based treatments include several approaches that involve a patient’s caregivers, parents, or other family members to help them take complete control over their eating behaviors. Eventually, these therapy sessions allow the patient to regain control of their meal planning and execution until they free themselves from an unhealthy relationship with food.


Many individuals with underlying bulimia nervosa suffer from co-existing mental health issues, such as depression or anxiety. To manage these co-occurring disorders, an expert may prescribe:

  • Selective serotonin reuptake inhibitors (SSRIs), for example, sertraline), fluoxetine, and paroxetine, to treat low mood
  • Selective norepinephrine reuptake inhibitors (SNRIs), for example, venlafaxine and duloxetine to manage anxiety and depression

It can be challenging to navigate through bulimia as multiple areas of concern relate to the disorder. In addition to helping a patient understand their behaviors, thoughts, and relationships with others, a therapist must also focus on their relationship with food. In most cases, it is imperative to deal with a patient’s diet first to stabilize their physical health before targeting mental health. This is why most levels of care for bulimia nervosa include meal support and nutritional counseling programs.

Nutrition counseling takes place under the supervision of a registered professional, a therapist, a nurse, or a nutritionist. The main focus of this therapy is on education as these professionals help patients learn about:

  • The types of foods and drinks they need to be healthy
  • How their bodies make use of different vitamins, nutrients, and minerals
  • How to effectively plan meals to meet these needs

Additionally, nutrition counseling also educates people with bulimia about the mental aspect of eating, which includes common types like:

  • The association between eating and emotions
  • How to recognize and manage the fear of certain food groups
  • How and why their most feared foods can be healthy for them

As patients continue to engage in frequent nutritional counseling lessons, experts also focus on providing meal support. Meal support comes in the form of a more hands-on approach where the therapists sit down with patients through their mealtimes, encouraging them to follow the “four c’s” including:

  • Being confident about their dietary choices
  • Practicing being calm during eating
  • Practicing consistency with healthy dietary choices
  • Developing compassion for themselves

While seeking appropriate treatment for bulimia is essential, there are other things you can do to boost your chances of recovery. These include the following:

Treat yourself kindly

Do not criticize yourself for bulimia, and try taking things slowly without expecting immediate results from treatment. It takes time to develop newer ways of thinking and adopt healthier habits.

Stick to the plan

No matter how tempted you are to stray from your professional recovery plan, try your best to stick to it as closely as possible. It is normal to feel uncomfortable sometimes, but when things start getting out of hand, reach out to your therapist or doctor and discuss how you can manage these issues.

Use relaxation techniques

Search for different ways and techniques to cope with feelings of distress and low moods, such as progressive muscle relaxation, deep breathing, or visualization.

Rely on the support system

Consider talking to people close to you and discussing the kind of support you need to heal from bulimia.

Make use of positive self-talk

In addition to suppressing negative self-perceptions and thoughts, use positive self-talk in your daily life to boost yourself. If you find yourself blocked by negative thoughts, try to reframe them more positively and realistically.



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