Bulimia Nervosa Treatment: From Recognition to Recovery

Eating more than usual on occasion, like at a holiday family dinner, is something many people do from time to time. However, people with bulimia nervosa consume a lot of food at once on a regular basis and may engage in purging behavior afterward.

This disordered eating can take a toll on their physical and mental well-being. In severe cases, it can become life-threatening. Recognizing the warning signs of bulimia nervosa can help signify when someone may need treatment.   

What treatments are helpful for bulimia nervosa? We’ll go over different treatment approaches and provide diagnostic criteria and warning signs of this eating disorder. 

What is bulimia nervosa?

Bulimia nervosa is an eating disorder that includes binge eating and purging behaviors or other behaviors aimed at preventing weight gain. Those with this disorder often struggle with their self-esteem due to their perceived weight or body shape. 

Individuals with bulimia nervosa eat large amounts of food within a short time period. Afterward, they might make themselves vomit or use other ways to purge the food they’ve eaten, such as laxatives. 

This eating disorder can have harmful effects on people’s physical, mental, and emotional well-being. But there are treatments available to help manage it.  

Diagnostic criteria for bulimia nervosa

Mental health professionals diagnose bulimia nervosa based on criteria that The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) provides. A formal diagnosis can help individuals with this disorder get the help they need. 

In the following sections, we’ll go over the DSM-5’s diagnostic criteria for bulimia nervosa. As you read, keep in mind that only a licensed professional can diagnose bulimia nervosa, and anyone experiencing these symptoms is encouraged to see a therapist or medical professional.

1.  Recurrent episodes of binge eating 

Occasional overeating isn’t uncommon. However, regular episodes of binge eating are associated with bulimia nervosa. What does this behavior look like? Binge eating includes these characteristics:

• Eating an amount of food that’s considered unusually large within a short period of time, such as one or two hours
• Feeling unable to stop eating or control the amount of food — or kinds of food — eaten during these episodes

2.  Recurrent inappropriate compensatory behaviors to prevent weight gain 

Those with bulimia nervosa often take measures to stop themselves from gaining weight after binge eating. This differs from binge eating disorder, in which people eat large amounts of food, but don’t engage in purging behaviors afterward.  

To prevent weight gain, individuals with bulimia nervosa might do any of the following:

• Make themselves throw up.
• Fast or limit food intake. 
• Exercise at excessive levels. 
• Misuse certain medications, such as laxatives, enemas, or diuretics.  

3.  Both behaviors occur, on average, at least once a week for three months 

Binge eating or engaging in behaviors to prevent weight gain, such as fasting, every once in a while aren’t enough for a formal bulimia nervosa diagnosis. Those who are diagnosed with this eating disorder have engaged in both behaviors one or more times per week for at least three months. 

4.  Self-evaluation is unduly influenced by body shape and weight 

People with bulimia nervosa may be at a weight that’s considered healthy for them based on height and other individual factors. But, they might have distorted views of their body shape and weight, which can lead to self-esteem and self-confidence issues. 

For this to be considered bulimia nervosa, the disturbance doesn’t happen only during episodes of anorexia nervosa — characterized by restricting food intake to prevent weight gain. 

Warning signs and symptoms of bulimia nervosa 

Being familiar with warning signs can encourage individuals to seek a diagnosis and treatment for themselves or a loved one. 

Below, we’ll discuss some warning signs and symptoms of bulimia nervosa. However, as you read, keep in mind that bulimia nervosa can only be diagnosed by a licensed professional.

Symptoms of bulimia nervosa include:

• Eating large amounts of food in short time periods, such as in one sitting
• Trying to eliminate food through self-induced vomiting, laxatives, or other purging methods 
• Having a strong fear of gaining weight 
• Being preoccupied with thoughts of food 
• Feeling a lack of control over eating behaviors when binge eating 
• Hiding food and binge eating in private out of shame or guilt 
• Having a puffy face 
• Having abdominal bloating
• Fainting 

Treatment for bulimia nervosa 

Bulimia nervosa may raise the risk of having serious health problems. People with this eating disorder may also develop other health issues due to a lack of nutrients. These complications can range from a sore throat and tooth decay from frequent vomiting to heart failure or damage to the esophagus. 

Bulimia nervosa can also have a negative impact on emotional and mental wellness. In fact, individuals with this eating disorder may have a higher risk of self-harm or suicide. But effectively managing bulimia nervosa can help reduce the risk of complications and improve mental and emotional well-being. 

Below, we’ll explore several treatment approaches used for this eating disorder. The exact treatments that people receive vary based on individual factors.

Cognitive behavioral therapy (CBT)

This type of talk therapy or psychotherapy is the gold standard for bulimia nervosa treatment. Cognitive behavioral therapy (CBT) involves helping individuals identify and change maladaptive thought patterns and behaviors associated with disordered eating, weight, and body image. 

CBT also helps people with bulimia nervosa learn coping strategies for managing their emotions and stress. Using these strategies helps them avoid turning to binge eating or purging when faced with eating disorder relapse triggers. 

For example, someone with bulimia nervosa might learn to replace unhelpful thoughts about their body image with adaptive ones. Research has shown that CBT can be highly effective at treating this eating disorder. 

Interpersonal therapy (IPT)

For some individuals, problems in personal relationships may contribute to the development of bulimia nervosa. For example, family members making comments about their appearance or weight might cause them to begin binge eating and purging. 

Problems in personal relationships might also contribute to ongoing bulimic behaviors. For example, continuing to hear comments about their weight might cause them to keep engaging in binge eating and purging. 

Interpersonal therapy (IPT) helps people address difficulties in their relationships as a way to manage bulimia nervosa. Those who go through IPT can work on developing effective ways of handling conflict or improving relationships with others.

Dialectical behavior therapy (DBT)

Those with bulimia nervosa may experience intense emotions, especially related to eating and weight or body image. They may also engage in self-destructive behaviors as a way of coping. 

Dialectical behavior therapy (DBT) provides a way to help individuals learn skills for handling strong emotions, such as mindfulness and emotional regulation. They learn to tolerate distress instead of resorting to binge eating and purging behaviors. 

DBT can also help them learn skills to improve their relationships with others, such as expressing their needs. This can help in cases where bulimia nervosa is associated with relationship difficulties. 

Family therapy 

Therapy for bulimia nervosa can sometimes involve family members. This therapeutic approach can be helpful for adolescents with this eating disorder or others who may rely on family support for recovery. 

How does family therapy help? Family members become involved in helping their loved one make changes to their eating behaviors. They also learn effective ways to provide support, such as reinforcing healthy eating patterns. 

Nutritional counseling 

Part of bulimia nervosa treatment is learning healthy eating behaviors. Those who have this eating disorder may not be getting enough nutrients due to purging behaviors. Changing to healthier eating habits helps ensure that they get the nutrients they need. 

Nutritional counseling with a registered dietitian helps these individuals create eating plans that meet their nutritional needs. This counseling also helps teach people to manage cravings or handle other feelings associated with hunger or eating in adaptive ways. 

With a dietitian’s help, those with bulimia nervosa can learn to eat healthy amounts of food regularly.  

Support groups 

Hearing from others who are facing similar challenges can offer emotional support to those with bulimia nervosa. Taking part in support groups provides this opportunity. 

Being in a support group helps people with this eating disorder feel a sense of community. They’re able to interact with others who understand what they’re going through. 

This kind of support can help individuals with bulimia nervosa feel encouraged and motivated to work on recovering, even if it’s a struggle. 

Medication (prescribed by a doctor)

Prescription medication may be used to treat bulimia nervosa. Several studies have shown certain ones to be effective at managing this eating disorder. Examples of these medications include antidepressants, such as citalopram, sertraline, and fluoxetine. However, fluoxetine is the only medication with FDA approval for bulimia nervosa treatment.

Despite the efficacy of certain medications, the most effective treatment for this eating disorder is an interdisciplinary approach. For example, someone with bulimia nervosa might have a treatment plan that includes CBT, medication, and nutritional counseling. This combination of treatment approaches may work better than relying on one type of treatment. 

Start the road to recovery with SonderMind 

Bulimia nervosa is one example of mental health disorders that benefit from therapy, such as CBT. Those who have recognized the warning signs of this eating disorder and been diagnosed with it can focus on recovering with the right treatment plan. 

If you’re experiencing mental health concerns of any kind, working with a therapist can help. Finding a therapist doesn’t have to be overwhelming — with SonderMind, you can connect with a therapist who meets your therapeutic needs and preferences right from the comfort of your own home.

Connect with a therapist through SonderMind today.