Bulimia nervosa is one of the most common eating disorders in the United States, affecting 1.5 percent of women and 0.5 percent of men. This translates to over 4 million people in the US, making it one of the most widespread behavioral health disorders. Despite, this the need for bulimianervosa treatment is often misunderstood among parents and the individuals suffering from it alike. Because of the severe health consequences resulting from bulimia nervosa symptoms, it’s important to make sure that parents are aware of what a bulimia nervosa diagnosis means and what they can do if their kid receives one.

The average age for the first incidence of bulimia nervosa is roughly 18, which means that millions of adolescents need bulimia treatment, even before they graduate high school. While this figure normally means that the symptoms begin to show in the early teenage years, there have been cases reported of children as young as 6 years old showing the signs of bulimia nervosa.

With these stark facts, the need for parents to gain awareness of how to react to the signs of bulimia nervosa becomes even more apparent.

Why Is Bulimia Treatment Necessary?

Before diving into the symptoms of bulimia nervosa, it’s essential to understand why this disease is among the most dangerous and potentially deadly of all mental health diseases. Bulimia nervosa is characterized by recurrent episodes of binge eating (ingesting large amounts of food in a short amount of time, usually in private and away from normal mealtimes), and then subsequent actions to remove the caloric intake from those episodes. Bulimia nervosa commonly presents in two types of behavior following the binge eating sessions, purging, and non-purging.

Purging type – The individual engages in actions that purge the food taken in during a binge eating session, most frequently by forced vomiting. Other commonly observed purging behaviors include abuse of laxatives, diuretics, or enemas.
Non-purging type – The individual follows the binge eating episode with compensatory behaviors that don’t involve purging. These kinds of actions are usually restrictive in nature; common actions include fasting, excessive dieting, and excessive exercise (past the point of exhaustion or even to the point of self-harm or injury).

Contrary to the common idea that people with eating disorders, especially those who need specialized bulimia nervosa treatment, are always skinny or emaciated, people with bulimia nervosa can range from under- to overweight and all points in between. In fact, specialized programs at bulimia nervosa treatment centers often focus on strategies to avoid the binge eating sessions as much as stopping the purging behaviors. Because of this, many of the health risk associated with obesity can also be present in people with bulimia nervosa. These may include various cardiopulmonary diseases such as hardened arteries, heart murmurs and palpitations, hypertension or high blood pressure, strokes and labored breathing. Sleep apnea is also not uncommon. Various blood conditions such as anemia and diabetes can also result from being overweight.

By no means are all people with bulimia nervosa overweight, however. Many appear to be “normal” or medically judged to be of average weight for their height, age, and sex. Due to the often low-nutrient, fatty, salty, or starchy foods that are eaten during a binge eating episode, however, some of these medical complications can be present in individuals who are of average or even low weights.

Purging type bulimia nervosa can contain other serious health risks. Because of the repetitive nature of the purging actions, several health complications requiring inpatient bulimia nervosa treatment can also arise. Those who engage in self-induced vomiting, in particular, can expect severe risks to their health that will necessitate medical as well as bulimia nervosa treatment. People who purge by vomiting often experience symptoms related to repeating vomiting, such as stained or eroded teeth, swollen glands in the jaws, a swollen or eroded esophagus (due to the presence of stomach acid), and cuts or scarring on the fingers from the repeated contact with the teeth and upper mouth.

The poor nutritional balance that also results from purging can result in anemia, degenerative bone disease (such as osteoporosis), and irregular menstrual periods.

All these health risks are treatable if the individual enters bulimia treatment early enough at a bulimia nervosa treatment center – but it’s even better if they can be prevented through early intervention. That’s why it’s so important for parents to know the symptoms of bulimia nervosa and act as soon as possible.

Typical Symptoms of Bulimia Nervosa

The distinguishing features of bulimia nervosa are a combination of physical and behavioral factors.

In addition to the binging and purging (or compensatory actions), people with bulimia nervosa often have intense feelings of shame, guilt, and self-loathing in reaction to their disordered behaviors. These feelings can often be tied up in comorbid mental health conditions including anxiety, depression, and OCD. In fact, the binge eating episodes that come with bulimia nervosa are very similar in nature to the compulsive behaviors exhibited in OCD. They act as coping mechanisms, releasing dopamine (a “feel-good” chemical naturally produced by the brain) into the system and temporarily relieving negative feelings. This can become addictive in a way. Many drugs also produce dopamine releases, and the brain becomes dependent on these releases. Parents should be aware of mental health conditions showing in their child, as these are often co-occurring with eating disorders like bulimia nervosa.

Other behavioral symptoms to be aware of include:

Nervousness or discomfort at mealtimes
Preoccupation with weight or body size
Frequent dieting and engaging in fad diets
Going to the bathroom directly after meals
Evidence of “hoarded” food to be eating in secret
Low self-esteem or poor self-image (body dysmorphia)
Smells of vomit
Overuse of laxatives, diuretics, or enemas (or their packaging)

So What Steps Should I Take?

It’s clear that bulimia nervosa is a startlingly dangerous, and even deadly, condition. When the warning signs are left ignored, the disorder can progress to the point that outpatient or even inpatient bulimia nervosa treatment is necessary. However, parents who have suspicions that their kid is developing an eating disorder should take care to handle the situation carefully; a confrontation or tearful ultimatums are likely to do more harm than good.

When the signs and symptoms outlined above are starting to pop up, it’s important to calmly and methodically address the situation. Parents must not throw out accusations or try to “guilt” a child or teen with a growing disorder. Instead, every interaction should be conducted with a compassionate, listen-first approach. If you think your child may be developing an eating disorder, there are a few useful steps you can take.

Have a Serious but Caring Conversation

The first step should always be to talk to your child. It’s counterproductive to go snooping through their room for hidden stashes of food or boxes of empty laxative pills; accusatory or guilt-inducing confrontations are more likely to accelerate the feelings of guilt, shame, and self-loathing they may be having. Start by simply asking if they’re all right – sometimes people just need a friendly ear that they can ask for help.

You can then proceed to gently ask if there’s been anything wrong recently. If you’ve noticed any new behaviors or changes in routine, it’s best to bring them up with care – something like, “I’ve noticed you’re not eating much at dinner lately. Is everything OK?” Most likely they will avoid the question or deny anything is happening, and if so it may take several conversations to breakthrough.

It’s essential that you remind them that you love them and want to help. Never make your child feel guilty or that you are somehow punishing them. People with bulimia nervosa quite often go to great lengths to hide their disordered behaviors and can become defensive when pressed. For this reason, it’s best not to press the issue immediately.

However, the longer the disorder is allowed to progress, the more potential physical, mental and social damage can happen. If you as caring parents can’t break through, it may be time to move on to a second step.

Contact a Therapist, Psychiatrist, or Even Your Doctor

If your concerns continue to grow and the telltale signs of bulimia nervosa don’t abate, it’s time to go for a professional intervention. Although they do not specialize in bulimia nervosa treatment, a general practitioner or your family doctor is likely familiar enough with eating disorders to make initial recommendations. The doctor, if they know your kid well or have been treating the family for years, may also provide more comfort when discussing eating disorders than someone brand new.

Another option at this point is to seek out a therapist or psychiatrist (assuming there isn’t one in the picture already) and ask them to make an assessment with your child. Many therapists have lots of experience in diagnosing and treating eating disorder – not only bulimia nervosa but also anorexia nervosa, binge eating disorder, orthorexia, and excessive exercise, all of which average and onset of symptoms in the teenage years.

If your family doctor isn’t familiar with the diagnosis or treatment of eating disorders, they can normally provide a reference to someone who can. At this point, it should be clear to your child that the people who love them are trying to help, and you can decide on how to get further assistance.

Contact a Bulimia Nervosa Treatment Facility

The last step you can take when the symptoms of bulimia nervosa are readily apparent is to contact a specialized eating disorder treatment facility. In fact, the referral your doctor will make after diagnosing bulimia nervosa will likely be to one of these centers. The best centers most normally offer both day treatment, residential and inpatient bulimia nervosa treatment programs. One of the main advantages of a program like this is the presence of full-time specialized staff with years of experience treating eating disorders of all stripes.

This kind of intense care can make all the difference in the reduction of disordered behavior stemming from bulimia nervosa. Additionally, these facilities are normally equipped to handle co-occurring mental health illnesses such as anxiety disorder and depression, which are very common in people with bulimia nervosa. They may also be able to provide medical care for the health consequences associated with bulimia nervosa and other eating disorders.

Even more appropriate for adolescent clients are facilities which specialize in the treatment of teens and young adults. These facilities can provide not only eating disorder care and medical treatment but also incorporate teenage-specific programs into the overall recovery process. These can include academic courses so the clients don’t fall behind in their schoolwork, experiential therapies which encourage mindful living, and family counseling programs which get the parents involved in treatment and provide long-lasting lessons about recovery which can be used well after inpatient bulimia nervosa treatment ends.

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.

Crucial Steps to Take If Your Child Is Showing Symptoms of Bulimia Nervosa