Bulimia Signs & Treatment Options

By: Jayson Tripp, MD


Bulimia, also known as bulimia nervosa, is a serious and potentially life-threatening eating disorder . This condition is characterized by a cycle of binge eating followed by purging (via self-induced vomiting, laxatives, and/or diuretics) or other compensatory behaviors like excessive exercise, fasting, and the use of diet pills.   

Causes of Bulimia Nervosa

While the exact cause of bulimia isn’t known, there are a number of biological, emotional, and environmental factors that are associated with this eating disorder and may increase the likelihood of someone developing it.  

Biological Causes of Bulimia  

Researchers believe that there may be certain genes that are associated with bulimia  and other eating disorders. Other studies suggest that serotonin levels also have something to do with emotional eating. Bulimia, anorexia, and binge eating disorder can also be hereditary, meaning that someone is more likely to develop an eating disorder if they have a close family member who has one.  

Emotional Causes of Bulimia 

Bulimia and other eating disorders are also closely related to a person’s self-esteem and emotional state of mind. Eating disorders also often occur along with a mood disorder like anxiety or depression. With bulimia, a person essentially binges as a way to cope with negative feelings that come with mental health conditions like depression and anxiety. But then they feel guilty and try to purge the food they just ate, exercise excessively to counteract the calories, or starve themselves as compensation.  

Environmental Causes of Bulimia 

Researchers also believe that a person’s experiences can contribute to their eating disorder. Things like trauma and abuse may trigger this type of behavior. The societal pressure to be thin can also cause someone to have low self-esteem and engage in eating disorder behaviors.  

Signs of Bulimia

Someone who struggles with bulimia will usually do a good job at hiding it, but there are behavioral signs you can look out for, including:  

  • Refusal to eat in front of others 
  • Withdrawing from social situations 
  • Taking small portions or even skipping regular meals  
  • Showing extreme concern about body weight and shape 
  • Frequently checking the mirror for flaws  
  • Extreme mood swings 
  • Continually trying different fad diets 
  • Excessive exercise 
  • Use of excessive amounts of mouthwash, gum, mints, etc. 
  • Disappearing after eating, usually to the bathroom 
  • Stealing or hoarding food 
  • Wearing baggy clothes to hide the body 
  • Evidence of binge eating (disappearance of large portions of food, empty food wrappers and containers in strange places) 
  • Evidence of purging (smell or sounds of vomiting, frequent bathroom trips, packages of laxatives and diuretics)  

People with bulimia will also have physical symptoms like:  

  • Unusual swelling in the cheeks or jaw 
  • Bloating due to fluid retention 
  • Calluses on the back of the hands and knuckles from self-induced vomiting 
  • Stained/discoloration in the teeth 
  • Bad breath 

Bulimia can also cause serious, life-threatening health issues, including dehydration, malnutrition, heart failure, tooth decay, ulcers, pancreatitis, and many other problems. This is why it is vital to encourage someone with bulimia to seek treatment.  

How to Help Someone With Bulimia

Friends and family members are usually vital to someone’s recovery from an eating disorder. People with bulimia and other eating disorders usually have a difficult time recognizing that they have a problem let alone asking for help. Consequently, loved ones will likely be the ones to recognize the symptoms of an eating disorder and encourage the person to seek treatment.  

That being said, approaching the topic of an eating disorder can be difficult. Discussing it can be scary for both the person with an eating disorder and their loved ones. One of the most important things you can do for a loved one who is struggling with bulimia or another eating disorder is research as much as you can .  

The more you know about eating disorders, the more you can help your friend understand the danger of their behavior. Something else to keep in mind is to not accuse your loved one of anything. Instead of saying “you’re eating too much,” or “you’re spending a lot of time in the bathroom lately,” say things like, “I’ve noticed you eating a lot more than usual,” and “I’ve noticed you spend a lot of time in the bathroom after meals, is everything OK?”  

Using “I” statements will help keep the blame off your loved one and hopefully, keep them from getting defensive about their behavior. And of course, let your loved one know that they shouldn’t be ashamed of themselves and you aren’t judging their behavior.  

Bulimia Treatment Options

If you want to encourage someone to seek professional help for their bulimia, then you need to understand what bulimia treatment options are available. Traditionally, bulimia is treated with a combination of psychotherapy and medication.  


Typically, psychiatrists prescribe antidepressants to treat bulimia. Doctors have found that antidepressants can help treat some of the symptoms of this eating disorder. The FDA has even approved fluoxetine, a.k.a. Prozac, as a bulimia treatment.  


Professional counseling is another traditional bulimia treatment. Most commonly, cognitive behavioral therapy (CBT) will be the best option for someone with an eating disorder. CBT involves discussing your self-esteem and eating habits with a mental health professional who will help you replace your negative beliefs and behaviors with positive ones.  

Alternative Treatments 

If medication and therapy are unsuccessful, there are alternative options that might help. Transcranial magnetic stimulation (TMS therapy) is an FDA-approved treatment for depression and OCD. However, studies show  that this treatment may also help reduce the symptoms of bulimia and binge eating disorder. Since eating disorders are closely associated with compulsive behaviors (like those found in OCD) and mood disorders like depression, it’s no wonder TMS shows promise in treating bulimia and binge-eating disorder.  

Another alternative treatment for bulimia is ketamine treatment. In one study , more than half of the patients significantly lowered their compulsive eating behaviors and some people even went fully into remission.  

If you would like to learn more about eating disorder treatment options, contact us  at Serenity Mental Health Centers.  

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*All information subject to change. Images may contain models. Individual results are not guaranteed and may vary.