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Treatment for eating disorders in both young adults and older individuals is a complex, challenging process typically involving cognitive behavioral therapy, family therapy, individual counseling, and group therapy. In addition, bulimia nervosa recovery relies on ongoing support from the client’s family, close friends, and counselors providing services at eating disorder treatment centers. This can take the form of either residential or day treatment (AKA outpatient) service or both. Before starting the recovery process, eating disorder therapists develop a personal, comprehensive treatment plan based on the unique life experiences of clients that are designed to address all mental and physical health needs.

Recognizing Signs of Bulimia Nervosa

Bulimia nervosa is the product of several underlying factors. A prime factor is a negative self-evaluation among people with bulimia nervosa – it often focuses on the external body size, shape, and weight. People with nascent bulimia nervosa perceive themselves as overweight, unattractive, or otherwise flawed. Whether or not the person is actually above medical recommendations for weight, this perception persists. In many cases, self-worth and self-esteem become tied to body weight, and the individual begins to take more extreme measures to lose or control weight.

As a psychological phenomenon, people with bulimia nervosa obsess about achieving what they think is an “ideal” body shape and weight. Perfectionism of this magnitude leads to a negative and distorted self-evaluation process that responds to a failure to meet unattainable high standards. Mood intolerance (an inability to cope with adverse states of mind and emotion) promote participation in bulimia nervosa behaviors as well as sustained depression and generalized anxiety.

One of the foremost signals that a person is struggling with self-image concerns related to weight is frequent and unnecessary dieting. They may experiment with fad diets or refuse to eat certain kinds of food entirely. The physical and psychological experience of depriving the self of food through extreme dieting ultimately contributes to binge-eating episodes. After eating a large amount of food, the individual becomes panic-stricken with fear of gaining weight combined with deep shame and guilt over losing control during a binge-eating episode.

Binge eating episodes are common to several kinds of eating disorders, notably with binge eating disorder, but also known to occur in gaps in restrictive behavior. Bulimia nervosa is defined not by solely the binge eating episodes, but the subsequent purging behaviors that follow. The most common form of purging is self-induced vomiting, but excessive exercising and abuse of medications like laxatives and diuretics are also known to happen.

Health Risks Related to Bulimia Nervosa

Some of the side effects related to bulimia nervosa involve health problems that may require extensive medical treatment or hospitalization. They include:

  • Tooth decay due to repeated vomiting after a binge-eating episode. Over time, stomach acid erodes tooth enamel and may cause tooth loss and gum disease
  • Visible swelling of salivary glands
  • Chronic sore throat
  • Hoarse voice (stomach acid damages the lining of the esophagus. Accumulation of scar tissue may also make it difficult to swallow)
  • Dehydration
  • Anemia
  • Electrolyte imbalance (lack of potassium, chloride, and sodium in the body could cause heart arrhythmias and/or heart failure)

Other bulimia nervosa side effects involve worsening of depression, anxiety, panic, and obsessive-compulsive habits that propagate most eating disorders. Consequently, a bulimia nervosa recovery requires specialized treatment with experienced eating disorder therapists who fully understand the challenging issues clients must cope with to achieve recovery. In advanced cases or those which have been continuing for a long time, medical treatment may be necessary. In these cases, residential treatment is usually recommended.

How Do People Recover from Bulimia Nervosa?

Gaining control of signs of bulimia nervosa begins with individuals developing a desire to change their relationships with their body, self-image, and holding on to optimism about their ability to overcome their eating disorder. Therapists provide the counseling, insight, and support necessary for clients to understand that bulimia nervosa recovery is attainable in all situations. It’s a long, ongoing process that can see breakthroughs as well as setbacks; people entering treatment should not expect a “quick fix.”

Recovering from bulimia nervosa or any eating disorder is an ongoing, subjective process uniquely experienced by the client. Eating disorder therapists show clients how to identify with being a “healthy” individual who does not depend on an eating disorder to define their core identity. During recovery, bulimia nervosa clients also learn to manage unpleasant or intrusive emotions and thoughts without resorting to binge-eating and purging. Equipped with healthy coping strategies following the completion of their treatment program, individuals with bulimia nervosa are better able to solve problems critically and rationally while keeping control of negative emotions.

Principles of a successful bulimia nervosa recovery include:

  • Valuing the body as functional, healthy, and strong rather than how it “looks”
  • Restoring a compassionate relationship with the body
  • Learning to focus thoughts on more important, meaningful things instead of food
  • Treating the self with more kindness and flexibility
  • Setting boundaries and limits with other people
  • Discovering a purpose in one’s life
  • Constantly improving emotional stability
  • Renewing relationships with family members
  • Creating a rewarding and beneficial social life

Psychiatry, Medical, and Psychological Health

Psychiatry is separated from psychology by the ability of the practitioner to complete medical school prescribe medication. Although bulimia nervosa is listed as a psychiatric disorder in the DSM-V, however, there are no medications designed specifically to treat it. Co-occurring disorders such as depression, anxiety, or OCD are relatively common in people with bulimia nervosa. Medications may be prescribed to treat these. It is also vital for bulimia nervosa clients to follow their physician’s orders and take medication as prescribed if they suffer from bulimia nervosa side effects impacting their physical health. A healthy body is essential for treating psychological disorders underlying the development of an eating disorder.

Whereas medication may not specifically be designed to treat eating disorders, psychological therapies often are. They usually combine proven, evidence-based talk therapy methods with nutritional education and exposure therapy. Some of these techniques include:

  • Cognitive behavioral therapy (CBT)

    A well-known, empirically proven technique used for treatment among a wide variety of mental health disorders, is a client-therapist dynamic of guided thinking designed to isolate and negate negative thoughts and thinking patterns. For example, a person who turns to binge-eating episodes when feeling especially depressed will work with their counselor at an eating disorder treatment center to “talk through” the feelings and thoughts of depression without engaging in a disordered behavior as a response to those feelings. CBT can be done in group settings, although it’s usually one-on-one between the client and therapist.

  • Cognitive processing therapy (CPT)

    Was developed in the late 1980s using the CBT method as its base, is a highly effective technique designed to help people process PTSD. Post-Traumatic Stress Disorder is a very potent trigger for various disordered behaviors, from substance abuse to eating disorders. This makes addressing PTSD an important foundation for continued recovery; promoting the ability to cope with negative emotions caused by PTSD helps prevent relapses after the individual has left the treatment center. The treatment consists of 12 sessions between a client and a trained therapist, usually once a week. It can be done in residential or outpatient treatment and can be done virtually, a boon in a time when in-person visits can be impossible.

  • Dialectical Behavior Therapy (DBT)

    Another offshoot of CBT which was originally intended to help people with borderline personality disorder. DBT is useful for other behavioral health issues as well, especially eating disorders. It focuses on emotional regulation, interpersonal relationships, distress tolerance, and impulse control. DBT is useful in counteracting triggers for disordered eating behaviors. For example, a common method taught by DBT when a person is faced with an urge to restrict food is to do the opposite – in this case, have a snack. It’s often a long and arduous process to be able to accomplish this, but with support and practice, permanent behavior modification is possible.

Start Recovering Sooner Rather Than Later

Bulimia nervosa is treatable. Despite the intensity of treatment, and the possibility of relapse, the techniques outlined earlier can be effective in helping people achieve a happier life, free of disordered eating. It’s essential, however, to get started on treatment as soon as possible. Recovery takes time, and eating disorders can become more entrenched as time goes on. If you or a loved one is experiencing the symptoms of bulimia nervosa or another eating disorder, reach out for help as soon as you can.


Melissa Spann, PhD, LMHC, CEDS-S

Melissa Orshan Spann, PhD, LMHC, RTY 200, is Chief Clinical Officer at Monte Nido & Affiliates, overseeing the clinical operations and programming for over 50 programs across the U.S. Dr. Spann is a Certified Eating Disorder Specialist and clinical supervisor as well as an accomplished presenter and passionate clinician who has spent her career working in the eating disorder field in higher levels of care. She is a member of the Academy for Eating Disorders and the International Association of Eating Disorder Professionals where she serves on the national certification committee, supervision faculty, and is on the board of her local chapter. She received her doctoral degree from Drexel University, master’s degree from the University of Miami, and bachelor’s degree from the University of Florida.