Bulimia Nervosa: What You Need to Know

What is bulimia nervosa?

Bulimia nervosa (BN) is an eating disorder in which a person has episodes of binge eating and uses ways like vomiting, laxatives, diet pills, exercise, or fasting (not eating for long periods of time) to make up for the calories eaten. Binge eating is when a person eats a large amount of food in a short period of time and feels out of control. During a binge eating episode, someone may feel like they cannot stop eating or that they are unaware of how much or what they ate.

BN is a serious mental health disorder that affects a person's physical and mental health.

Which risk factors can raise a person's risk of developing BN?

There can be many factors that raise a person's risk of developing BN, including one or more of the following:

• Certain mental health disorders (such as anxiety, depression, borderline personality disorder or obsessive-compulsive behaviors)
• Genetics or a family history of BN
• Environmental factors (such as peer pressure, bullying, being around friends and family who diet and/or the media's focus on being thin)

What are the signs of bulimia nervosa?

People with BN often have erratic (scattered or random) eating patterns. For example, a person with BN might skip meals or wait a long time between meals. Over time, these behaviors can cause harm to the body. In some cases, they can lead to death. A person with BN can be of average or above-average body weight.

Common signs of BN can include:

• Frequent changes in weight
• Damage to the teeth, gums or mouth (caused by vomiting)
• Chronic dehydration
• Swelling in the face
• Abdominal (belly area) pain or acid reflux (heartburn)
• Checking weight frequently
• Seeking reassurance about weight or body shape
• In women and girls, irregular menstrual periods or loss of periods (also called amenorrhea)

How do doctors diagnose bulimia nervosa?

Doctors can diagnose BN with the following tests:

• Checking for signs of the binge-purge cycle (such as cavities in the teeth, changes in growth or unusual injuries from exercise)
• Physical exam
• Blood tests and electrolyte tests to check for electrolyte (salt) imbalances caused by purging behaviors
• Interview with a mental health provider about eating habits and body image
• Answering questions about your child's eating habits and behaviors

How do doctors treat bulimia nervosa?

Treatment for BN focuses on medical monitoring and psychological therapy. The care team will talk with you to create a treatment plan for your child's medical and mental health needs.

Common treatments supported by research for BN can include:

• Cognitive behavioral therapy (CBT) to help manage your child's thoughts, feelings, and behaviors around the eating disorder and body image
• Interpersonal therapy (IPT) to help your child identify and express emotions and understand how they affect their eating disorder
• For children and adolescents, family-based therapy (FBT) to learn ways on how your family can support your child during BN treatment
• Medical treatment for health issues caused by BN
• Prescription medications for underlying mental health problems
• Therapy to address underlying mental health concerns and learn healthy eating behaviors and coping skills
• For some people, a higher level of care such as residential treatment or hospitalization for individuals at serious medical risk or those with very frequent binge eating and purging

BN can be challenging to treat. The care team can help you and your child create a plan that raises the chances of recovery.