Bulimia Nervosa: Diagnosis, Treatment, and Resources

Bulimia nervosa involves episodes of eating large quantities of food (binging) and then purging through compensatory behaviors such as self-induced vomiting, inappropriate use of laxatives, fasting, and/or over-exercising. Learn about diagnosis, treatment, and resources for the treatment of bulimia nervosa below.

Definition, Symptoms, and Diagnosis

What is bulimia?

Bulimia nervosa involves episodes of eating large quantities of food (binging) and then purging through compensatory behaviors such as self-induced vomiting, inappropriate use of laxatives, fasting, and/or over-exercising.

How common is bulimia nervosa?

The lifetime prevalence of bulimia nervosa is 1.5% in women and 0.5% in men in the U.S. This means nearly 5 million women and 1.5 million men are affected by bulimia at some point in their lives.

What are the signs and symptoms of bulimia nervosa?

The following are some signs that indicate an individual may be struggling with bulimia:

  • Suddenly leaving at the end of a meal to use the bathroom or using it several times throughout the meal
  • Eating large quantities of food but not gaining the expected weight
  • Loss of tooth enamel from excessive vomiting
  • Callous or sores on knuckles from self-induced vomiting
  • Discovering vomit in unexpected places such as a shower or kitchen sink or bags of vomit in unexpected places

In addition, social isolation, withdrawal, and depression often accompany bulimia nervosa. 

How do you diagnose bulimia?

According to the DSM-V (Diagnostics and Statistics Manual), a manual that mental health professionals use to diagnose mental health conditions, the compensatory behavior must occur at least once a week for at least 3 months. These behaviors cannot be part of episodes of anorexia (Pocket DSM 173). Also, individuals must feel out of control during binge episodes. Additionally, low self-worth occurs due to the patient’s evaluation of their body shape, image, and weight.

What are medical complications of bulimia?

Chronic, self-induced vomiting can cause various symptoms within the digestive tract, mouth, and other parts of the body. These include but are not limited to:

  • Tooth decay
  • Ruptured esophagus
  • Continual sore throat
  • Stomach pain
  • Hair loss
  • Internal bleeding from vomiting
  • Swollen salivary glands (sialadenosis)
  • Acid reflux
  • Electrolyte abnormalities
  • Dehydration

Treatment for bulimia

What is the best treatment for bulimia?

Treatment for bulimia includes individual talk therapy, group therapy, family therapy, and nutritional counseling and education. In some cases medication is prescribed for mood and anxiety management. Research supports that cognitive behavioral therapy (CBT) can be an effective approach to eating disorder treatment, especially bulimia nervosa. Therapists may also use treatment approaches such as Acceptance and Commitment Therapy (ACT), Gestalt therapy, mindfulness approaches, and motivational interviewing. Treatment focuses on helping the individual to communicate their feelings, increase their sense of self-worth, identify negative patterns of thinking, and change their negative behaviors and self-harming behaviors all while helping to reduce their sense of shame.


Help a friend with bulimia

How can you help someone with bulimia?

Helping someone with bulimia nervosa involves being compassionate and understanding, even if you may not be able to fully understand what the individual is experiencing. Let the person know that you are there to listen and that you won’t judge them. Avoid making comments about what they eat or how. Avoid advising; rather, think more about listening and validating feelings. Researching the disorder to understand it better can be helpful, too. Ask if they are in treatment and what you can do as their friend or loved one to help support their treatment.

Here are some things to keep in mind when helping someone with bulimia nervosa:

Do

  • Do be empathetic and express your love and support.
  • Do be honest about your own struggles to understand.
  • Do recognize there is no a quick and easy solution or cure.
  • Do listen and validate their feelings.
  • Do be patient and at the same time know your own limits.

Don’t

  • Don’t try to be a therapist.
  • Don’t tell them to just eat something and to stop obsessing.
  • Don’t use shame or guilt to convince them to eat or change their behavior.
  • Don’t gossip to other people about what they are going through.
  • Don’t make critical or mean comments about their eating.

Learn more on how to help a friend >>
Learn how to help a friend struggling with anorexia nervosa >>
Learn how to help a friend struggling with binge eating disorder >>



Additional resources

What are some national advocacy organizations for bulimia nervosa?

National Eating Disorders Association: The National Eating Disorders Association (NEDA) is a nonprofit organization dedicated to supporting individuals and families affected by eating disorders. NEDA offers our programs and services to raise awareness, build communities of support and recovery, and fund research.

National Association of Anorexia Nervosa and Associated Disorders (ANAD): The National Association of Anorexia Nervosa and Associated Disorders (ANAD) is a non-profit organization headquartered in Illinois, providing support, awareness, advocacy, referral, education, and prevention work for people struggling with eating disorders.

Project HEAL: Project HEAL is a non-profit organization that advocates for everyone who is seeking treatment for eating disorders, regardless of their race, income, insurance plan, age, education level, sex, or sexual orientation. They provide financial assistance in accessing treatment for highly motivated applicants who want to recover from an eating disorder but cannot afford to pay for treatment. They also have a peer mentorship program called Communities for HEALing, in which they offer one-on-one support and local weekly support groups. Communities for HEALing is undergoing a research study that will demonstrate whether different kinds of mentorship can help people recover from an eating disorder, whether that is through peer mentorship or social support mentorship.

International Association of Eating Disorders Professionals (IAEDP): The International Association of Eating Disorders Professionals (IAEDP) provides ethical and professional standards for therapists, nutritionists, and other medical and mental health professionals  that treat eating disorders. They provide educational classes, and trainings in order to promote a standard of excellence in the field of eating disorders. They also certify that professionals have met prescribed requirements, help raise public and professional awareness for eating disorders, and assist in prevention efforts.




Sources

  • Bulimia statistics tell us that the lifetime prevalence of bulimia nervosa in the United States is 1.5% in women and 0.5% in men. This translates to approximate 4.7 million females and 1.5 million males who will have their lives threatened by this potentially deadly disorder.
    • Oullette, J. (2015). Statistics on Bulimia. Retrieved August 18, 2018, from https://www.mirror-mirror.org/bulimia/statistics-on-bulimia.htm
  • According to the DSM-5 criteria, to be diagnosed as having Bulimia Nervosa a person must display...
    • Classifying eating disorders - DSM-5. (2016, November 25). Retrieved August 18, 2018, from https://www.eatingdisorders.org.au/eating-disorders/what-is-an-eating-disorder/classifying-eating-disorders/dsm-5

About the contributors

Dr. Marianna Kessimian, MD

Dr. Marianna Kessimian is a child, adolescent, and adult psychiatrist in Providence, RI. She received her MD from Boston University where she was also selected for the Gold Humanism in Medicine society as well as the Ruth J Hunter Johnson Prize for excellence in psychiatry. Dr. Kessimian completed her adult psychiatry training and child psychiatry fellowship at Brown University, where she served as chief resident. Previously, she was a staff psychiatrist at the Young Adult Behavioral Health clinic, and in this role was afforded the opportunity to work on campus at the Rhode Island School of Design providing psychiatric care to their students.

 

Hannah Goodman, LMHC

Hannah Goodman is a Licensed Mental Health Counselor in Barrington, RI. She specializes in anxiety, including panic disorder, Obsessive Compulsive Disorder and worry. She also has expertise in depression, adolescent issues, life transitions, couples counseling, and family counseling. Outside of her counseling practice, Hannah works as a writing coach and college counselor, drawing on her years of experience in the school system to help individuals of all ages with writing projects and prospective college and graduate students with their applications.