Bulimia Nervosa
An eating disorder characterized by recurrent episodes of binge eating followed by inappropriate compensatory behaviors to prevent weight gain, such as self-induced vomiting or excessive exercise.
Prevalence: 1-1.5% of young women. Lifetime prevalence 1.5% females, 0.5% males (NIMH). More common than anorexia.
Common Symptoms
- Recurrent episodes of binge eating (eating large amounts in discrete period)
- Sense of lack of control during binges
- Recurrent compensatory behaviors (vomiting, laxatives, diuretics, fasting, excessive exercise)
- Self-evaluation unduly influenced by body shape and weight
- Preoccupation with food and eating
- Eating in secret
- Eating until uncomfortably full during binges
- Eating when not physically hungry
- Feeling disgusted, depressed, or guilty after binges
- Fluctuating weight (but usually normal or slightly overweight)
- Russell's sign (calluses on knuckles from inducing vomiting)
- Dental erosion and cavities from stomach acid
- Swollen salivary glands (chipmunk cheeks)
- Sore throat, hoarseness
- Heartburn and acid reflux
- Irregular menstrual periods
- Dehydration
- Electrolyte imbalances
- Gastrointestinal problems
Risk Factors
- Female gender
- Young adulthood
- History of dieting
- Body dissatisfaction
- Low self-esteem
- Perfectionism and impulsivity
- Family history of eating disorders
- History of trauma or abuse
- Depression or anxiety
- Substance abuse in family
Treatment Approaches
- Enhanced Cognitive Behavioral Therapy (CBT-E) - gold standard
- Dialectical Behavior Therapy (DBT)
- Interpersonal Psychotherapy (IPT)
- Family therapy if appropriate
- Group therapy
- Medication: SSRIs (fluoxetine FDA-approved), topiramate
- Intensive outpatient programs (IOP)
- Residential treatment if severe
- Nutritional counseling
- Medical monitoring
- Treat comorbid conditions
Self-Help & Natural Approaches
- Enhanced Cognitive Behavioral Therapy (CBT-E) - most effective
- Regular, structured eating (3 meals + 2-3 snacks)
- Eliminate dieting and food rules
- Challenge binge triggers
- Develop alternative coping strategies
- Stop all purging behaviors
- Address underlying emotions
- Build support network
- Mindful eating practices
- Self-monitoring of eating patterns
- Delay strategy for urges to binge/purge
- Distraction techniques
- Remove trigger foods from restriction (not from diet)
- Reduce stress
- Adequate sleep
- Limit social media
- Support groups
- Journaling
- Self-compassion practices
- Treat as medical condition, not moral failing
When to Seek Professional Help
- Binge eating episodes (weekly or more)
- Purging behaviors (vomiting, laxatives, diuretics)
- Excessive exercise to compensate
- Preoccupation with weight and shape
- Eating causing significant distress
- Physical symptoms (dental problems, GI issues, electrolyte imbalances)
- Unable to stop behaviors on own
- Depression or suicidal thoughts
- Interference with daily life
- Medical complications
Crisis Resources
- National Eating Disorders Association (NEDA): 1-800-931-2237
- NEDA Crisis Text Line: Text 'NEDA' to 741741
- 988 Suicide & Crisis Lifeline
- Emergency room if severe electrolyte imbalance or heart issues
- NEDA website: nationaleatingdisorders.org
- BEAT Eating Disorders (UK): beateatingdisorders.org.uk
This information is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment.