Bulimia Nervosa

As a serious eating disorder, bulimia nervosa can become life-threatening if it goes untreated. At UT Southwestern Medical Center, our eating disorders team has extensive expertise in care and services for people with bulimia nervosa.

Our program includes psychiatrists, psychologists, and other providers who support each patient with personalized care to help them recover safely for a better quality of life.

Caring, Evidence-Based Treatment and Services for Bulimia Nervosa

Bulimia nervosa is an eating disorder that involves cycles of binge eating along with compensatory behaviors to prevent weight gain.

Binge-eating episodes involve consuming a large amount of food in a short time, with a loss of control to stop eating. Compensatory behaviors to prevent absorption of food vary, and may include fasting, exercising, vomiting, or taking medications such as laxatives or diuretics.

Eating disorders are mental health conditions that cause dangerous, potentially life-threatening eating problems – but treatment can help. Treatment for bulimia nervosa can help people learn techniques to interrupt and stop the thoughts and behaviors, develop healthy eating patterns, and reverse the serious physical complications of this illness.

At UT Southwestern, we work as a team with multiple specialties to provide compassionate care. Our eating disorders program includes psychiatrists, psychologists, psychiatric physician assistants, psychiatric nurse practitioners, social work therapists, and registered dietitians. We have advanced training and years of experience in tailoring care plans for each patient, using the most advanced treatments currently approved.

Symptoms of Bulimia Nervosa

Bulimia nervosa can affect people in different ways. Sometimes, it can be difficult to notice signs and symptoms because many people with the disorder try to hide them. And not everyone with bulimia nervosa exhibits all the signs and symptoms.

Physical signs and symptoms include:

• Frequent, noticeable changes in weight
• Dizziness or fainting
• Red (bloodshot) eyes
• Sore throat
• Digestive disorders, such as gastroesophageal reflux disease (GERD), stomach cramps, or constipation
• Dental problems, such as discolored and loose teeth from stomach acid
• Calluses or cuts on the knuckles and back of the hand
• Sensitivity to cold and cold hands or feet
• Thinning hair on the head
• Dehydration, dry skin, brittle nails, and chapped lips

Behaviors that can occur with bulimia nervosa include:

• Uncontrollable eating, with signs such as missing food and many empty food containers
• Bathroom trips right after meals and signs of vomiting
• Excessive exercise, even when tired, sick, or injured
• Frequent comments about losing weight, being “fat,” or controlling food
• Use of laxatives, diuretics (water pills), or diet aids
• Food hoarding
• Frequent weight and appearance checks
• Frequent use of gum, mints, or mouthwash

Emotional signs and symptoms include:

• Low self-esteem
• Preoccupations with negative body image
• Mood changes such as irritability, anxiety, or depression
• Social isolation
• Difficulty sleeping
• Low sex drive

Complications From Bulimia Nervosa

Bulimia nervosa can have serious effects on a person’s physical health, mental health, and social functioning.

Physical health problems include:

• Malnutrition (lack of vitamins, minerals, protein, and other nutrients)
• Damage to the stomach from overeating
• Ulcers in the throat and esophagus from vomiting
• Imbalance of electrolytes (minerals such as sodium, potassium, and magnesium) in the blood
• Tooth decay and gum disease
• Heart conditions, such as irregular heartbeats (arrhythmia), heart valve disease, or heart failure
• Difficulty with bowel movements, constipation, hemorrhoids, or intestine damage due to laxative overuse

Emotional and mental health complications include:

• Difficulty with relationships and social functioning
• Anxiety, depression, bipolar disorder, or personality disorders
• Alcohol or substance abuse or dependence
• Self-injury and suicidal thoughts or attempts

Diagnosing Bulimia Nervosa

It can be difficult to diagnose bulimia nervosa because people often hide their eating habits, symptoms, and feelings from the people around them. For the best possible care, it’s important to see a licensed mental health specialist with experience in caring for people with eating disorders. If someone concerned about bulimia nervosa is experiencing acute medical issues, such as inability to walk, feeling dizzy, uncontrolled vomiting, severe abdominal distress, chest pain, or rapid weight loss, then an Emergency Department evaluation is the first step. However, if physical complications from this illness are not acute – or occur intermittently in response to behaviors – then an outpatient evaluation is appropriate.

At UT Southwestern, our psychiatrists and psychologists take a compassionate, nonjudgmental approach to build relationships with our patients. We work closely with each patient for a careful evaluation, beginning with a:

• Discussion of symptoms, personal medical history, and family medical history
• Psychiatric evaluation to assess cognitive and social functioning and screen for mental health conditions
• Psychological assessment to discuss feelings, thoughts, eating patterns, and possible purging behaviors

Depending on each patient’s symptoms and overall health, they may also see a physician for:

• Physical exam
• Blood and urine tests to measure levels of blood electrolytes and assess kidney function
• Electrocardiogram (EKG/ECG) to check for heart symptoms
• X-rays to evaluate bone density and check for pneumonia or other health issues

To confirm a diagnosis of bulimia nervosa, the bingeing, purging (such as vomiting), and purging behaviors (such as exercise) must occur at least once a week for three months, on average. Our team can also determine whether bulimia ranges from mild to severe based on how often the behaviors happen each week, such as:

• Mild: 1 to 3 episodes
• Moderate: 4 to 7 episodes
• Severe: 8 to 13 episodes
• Extreme: 14 or more episodes

Treatments for Bulimia Nervosa

Our eating disorders program brings together specialists from several fields and we tailor a treatment plan for each patient’s symptoms and to manage their overall health.

For people with bulimia nervosa, outpatient treatment includes:

• Medications to treat medical and psychiatric symptoms common in bulimia nervosa, including fluoxetine – the only medication currently approved by the U.S. Food and Drug Administration (FDA)
• Individual psychotherapy, which can include cognitive behavioral therapy for eating disorders, diaelectical behavioral therapy, interpersonal psychotherapy, and supportive therapy.
• Group psychotherapy
• Psychoeducation sessions
• Referral and coordination for nutritional counseling with a registered dietitian for nutrition education and meal planning
• Coordinated care with primary care providers and specialists, as needed, for physical health related to other conditions