Warning Signs of Bulimia Nervosa

Families concerned about loved ones, particularly young women, who display some of the warning signs of an eating disorder should consider seeking medical or psychological intervention. Although people suffering from bulimia typically attempt to hide the binge eating and purging, vigilant family members will often notice something is wrong. Some indicators include:

• Trying to hide the consumption of large amounts of food in a short time
• Russell’s sign, or scars or calluses on knuckles from self-induced vomiting
• Swollen salivary glands or dental erosion from stomach acid
• Digestive problems
• Frequent trips to the bathroom after meals
• Mood swings, anxiety, depression and irritability
• Obsession with weight and body shape
• Using laxatives or diuretics or engaging in excessive exercise after secretive binging 

What Causes Bulimia Nervosa?

Eating disorders like bulimia may have a genetic component. Having a parent or sibling with an eating disorder may indicate a person has a higher risk of developing one, including bulimia.

Environmental or societal triggers may lead to the activation of an eating disorder in someone genetically predisposed to bulimia or anorexia. Societal ideals of thinness often contribute to the development of bulimia. Modern social media content can cause young people, particularly young women, to develop unrealistic body standards.

People who develop bulimia often struggle with other challenging personality traits or characteristics, such as perfectionism, low self-esteem and intense anxiety about body image. Co-occurring mental health challenges, such as anxiety, depression or obsessive-compulsive tendencies, can make developing bulimia or another eating disorder more likely.

How Bulimia Is Diagnosed

Bulimia nervosa is diagnosed according to DSM-5 criteria, including recurrent episodes of binge eating followed by compensatory purging of some kind at least once a week for three months.



The determination is often based on both psychiatric evaluations and physical evaluations. A psychologist or psychiatrist will attempt to ascertain the extent of the patient’s body image, self-esteem and emotional regulation challenges, and a doctor will look for physical signs of bulimia such as dental erosion, swollen glands, electrolyte imbalances, or the digestive issues that are indicative of frequent purging.

How Is Bulimia Treated?

Bulimia nervosa treatments should include several important components, some of which may vary depending on the patient’s age, the severity of their eating disorder, and any other co-occurring psychiatric conditions.

Cognitive behavior therapy (CBT) is the most common and effective treatment for bulimia. Therapists focus on helping patients identify and change distorted thinking patterns related to their body image, eating and relationship with food.

The goal is to help patients cope with stress without cycles of binging and purging and develop healthier eating habits. People diagnosed with bulimia may also undergo enhanced cognitive behavior therapy (CBT-E) to address the underlying emotional triggers of bulimia.

Bulimia sufferers may also benefit from interpersonal therapy (IPT) or family-based therapy (FBT) to address interpersonal issues contributing to bulimia. These group therapies can also be used to educate families on how to support the individual during their recovery.

Individuals affected by bulimia may be prescribed antidepressants, such as selective serotonin reuptake inhibitors (SSRIs). These may be able to reduce the frequency of binge-purge behavior while also alleviating co-occurring issues like depression and anxiety.

Although most patients do not require inpatient treatment, it may be recommended in severe cases, particularly if the sufferer’s physical health is at serious risk due to malnutrition or purging behaviors. These programs provide meal supervision, intensive therapy and 24/7 care.

Even after someone has recovered from bulimia, they should still consider joining support groups or attending ongoing therapy sessions to prevent relapses and maintain a healthy long-term recovery.

Providing Effective and Compassionate Bulimia Nervosa Treatments in Houston

Families in Houston who are concerned that a loved one has an eating disorder, or people who suspect they have bulimia and want help, should call St. Hope Healthcare at (713) 778-1300. Our compassionate behavioral health professionals are dedicated to helping all patients overcome their challenges and regain control over their life.