Frequent binge eating, self-induced vomiting, laxative abuse, and excessive exercise are common indicators of bulimia nervosa – a serious and potentially deadly eating disorder that impacts many teens. Bombarded with messages from the media, their peers, and society in general that suggest their value, self-worth, and desirability are directly tied to being thin, some teens develop a very unhealthy relationship with food and an unrelenting fear of gaining weight. This often leads to behaviors that can cause serious – and potentially irreversible – damage to their health over time.
Many teens today try out new diets like they try on shoes at the mall, and obsess at times over their weight and body shape. As a parent, you may find it difficult to discern between normal adolescent behavior and the red flags of an eating disorder. This brief guide is designed to help you spot the signs and know what steps to take if you suspect your teen is suffering from bulimia nervosa.
Bulimia Nervosa Statistics and Facts
Following are several statistics and facts about bulimia:
- Approximately 8 out of 10 bulimia sufferers are female
- Unlike anorexia, many individuals with bulimia have a normal or above average body weight
- An estimated 1 to 2% of teens and young adult females suffer from bulimia
- Compared to the general population, someone suffering with bulimia is 7.5 times more likely to commit suicide
- Approximately 50% of those with an eating disorder also have a substance abuse problem
- An estimated 40% of adolescent females have some type of eating disorder
- Over 6% of youth in the U.S. will develop an eating disorder at some point between the ages of 12 and 18 years
- As many as 8 out of 10 individuals with bulimia have battled anxiety
- Individuals with eating disorders have a higher risk for anxiety and depression than those without eating disorders
- Although bulimia usually develops during adolescence, many individuals with the disorder don’t seek help until they’re in their 30s or 40s (often due to the shame they feel about their abnormal behaviors)
- Disliking one’s body is a key factor in the development of both anorexia and bulimia
Co-Occurring Disorders
It’s not uncommon for individuals with bulimia to have other psychiatric disorders as well. The most common co-occurring disorders are: Individuals with bulimia often have other co-occurring psychiatric disorders as well. The most common disorders are:
- Obsessive-compulsive disorder
- Depression
- Anxiety disorders
- Substance use disorders
- Borderline personality disorder
- Post-traumatic stress disorder (PTSD)
Self-harm behaviors (e.g. cutting) and suicidal thoughts and behaviors are also common with bulimia.
Risk Factors
Following are several risk factors for the development of bulimia nervosa in teens:
- Strong perfectionistic tendencies
- Struggles with weight in the past
- Family history of eating disorders
- History of physical or sexual abuse
- Participation in activities with an emphasis on weight or appearance, such as dance (especially ballet), sports, modeling, acting, and other activities may lead to pressure on your teen to be very thin or lose weight, even if your teen is already at a healthy weight
- Having depression or anxiety
- Low self-esteem
- Stressful life events
- Difficulties coping with negative emotions
Looking for and Recognizing the Signs of Bulimia Nervosa
It can be difficult for parents to tell the difference – especially in the early stages of bulimia – between a relatively healthy teens’ seeming preoccupation with dieting and being thin from time to time, and the signs of an emerging or full-blown eating disorder.
Once you understand what to look for and how to recognize the symptoms of bulimia, you’ll be prepared to intervene when necessary. Remember, early intervention can make a world of difference when it comes to helping your teen overcome an eating disorders. One of the most important things to remember is to:
- Look for and pay close attention to any changes from your teen’s normal personality or behavior, particularly pertaining to your teen’s body image and relationship with food.
Signs to watch for include:
- Frequent trips to the bathroom during or immediately after meals (to induce vomiting)
- Smell of vomit on their clothing or body
- Highly dissatisfied with weight or body shape
- Perceiving themselves as fat even if at a normal weight
- Weight fluctuations
- Secretive behavior (bulimics often try to hide their binge eating and purging)
- Frequent use of laxatives, diuretics, ipecac, or diet pills (may be stashed in their bedroom, purse, backpack, or clothes pockets)
- Food hoarding
- Constant or intense fear of gaining weight or “getting fat”
- Eating despite already feeling very full
- Compulsive or excessive exercise, even if injured or sick
- Frequently weighing or measuring their body
- Severely restricting calories or skipping meals to offset an eating binge
- Often looking in the mirror to look for any signs of fat or weight gain
- Tooth decay or bleeding gums (due to self-induced vomiting)
- Calloused or scarred hands or fingers (also due to self-induced vomiting)
- Irregular periods
- Hoarse voice
- Digestive complaints
- Marked changes in mood and emotions
- Suicidal thoughts and behaviors*
- Medical problems associated with bulimia, such as kidney problems, a ruptured stomach or esophagus, or arrhythmia (abnormal heartbeat)
*Suicidal thoughts or behaviors should never be ignored. Don’t assume your teen is just being “dramatic” or manipulative. The risk of suicide is particularly high for individuals suffering from bulimia or anorexia.
It’s not uncommon for teens, especially females, to occasionally worry about their weight and go on a diet. However, don’t automatically assume it’s just a passing phase or that your teen is merely caught up in the latest trendy diet.
Knowing the First Steps to Take
If you have reason to suspect your teen is suffering from bulimia, the first steps to take towards handling the situation are:
1 – Talk to your teen. Let your child know that you are genuinely concerned regarding the behaviors you’ve been observing, that you want to help in any way you can, and that you’re there if he or she wants to talk.
Individuals with eating disorders often adamantly deny them, so don’t be surprised if your teen denies having any problems. He or she may become defensive, accusing you of overreacting or being overly protective. Avoid judgment, criticism, and shaming of any kind, as those generally make things worse. If your teen opens up and confirms your worst fears, strive to remain calm.
2 – Set up an appointment for an evaluation. Your teen’s pediatrician or your family doctor can do an initial evaluation, including a physical examination to rule out any underlying medical issues that may be playing a role in your teen’s disordered eating.
With eating disorders like bulimia, however, it’s essential that you have your teen evaluated by a psychologist or psychiatrist as soon as possible. Look for one who not only specializes in treating children and adolescents, but who also has substantial experience in treating eating disorders. Your family doctor may be able to give you a referral or recommendation.
3 – Get your teen into treatment. Since eating disorders become increasingly difficult to treat effectively as time goes on, early intervention is crucial.
Treatment for bulimia may involve a multifaceted approach that includes:
- Individual psychotherapy or “talk therapy” – Psychotherapy can help your teen understand what’s driving his or her disordered eating, including the underlying issues and the dangerously self-destructive nature of bulimia. Some of the most effective types of psychotherapy for bulimia are:
- Cognitive Behavioral Therapy
- Dialectical Behavior Therapy
- Interpersonal Therapy
- Family therapy – Family therapy is frequently a necessary component of successful treatment for bulimia and other eating disorders. It addresses the dysfunctional family dynamics that may be contributing to and even reinforcing the problem.
- Nutritional Counseling – to help develop healthy and nutritional eating habits, and to help reach and maintain a healthy weight
- Medical Care – to monitor and address the many health problems that bulimia can cause
- Medication – Prozac (fluoxetine) is the only medication currently approved by the FDA for the treatment of bulimia. It’s an SSRI (selective serotonin reuptake inhibitor) often used to treat depression and anxiety. Medications may also be prescribed to alleviate symptoms of other psychiatric disorders that often co-occur with bulimia.
- Dual diagnosis treatment – This is indicated when there’s a co-occurring substance use disorder. It may be provided as part of an outpatient or residential eating disorder treatment program.
- Residential treatment (see below)
- Hospitalization (see below)
Supporting and Encouraging Your Child
Bulimia nervosa can be an extremely challenging disorder for your teen to manage and, hopefully, overcome. Following are several ways you can encourage and support him or her:
- Learn everything you can about bulimia. This will enable you to have more empathy for and understanding about what your teen is experiencing and why it can be so difficult to stop
- Be willing to consider and address any unhealthy issues you have regarding food, weight, and body image. Model healthy eating and self-acceptance. If you’re frequently dieting or complaining about your own weight, you’re likely reinforcing your teen’s struggle. Also, be careful not to criticize the weight or appearance of other people as well.
- Never minimize or shame your teen’s struggle with his or her weight, eating behaviors, or body image
- Foster your teen’s self-esteem as much as possible, and do so without associating self-worth with appearance or weight
- Don’t judge or criticize what your teen is going through. From the outside looking in, and can be difficult to understand the irrational thinking and unusual behaviors of someone with bulimia
- Strive to be patient and understanding, without enabling your teen’s unhealthy behaviors
- Pay attention to your teen’s eating behaviors, exercise habits, body image, and moods. This will help you spot the warning signs of a relapse. It will also allow you to help your teen more effectively manage his or her eating disorder by recognizing potential triggers and patterns
- Actively participate in your teen’s treatment
- Avoid getting into power struggles with your teen, especially over food and other things directly related to his or her eating disorder
- Respect your teen’s privacy and dignity; your neighbors, relatives, and friends don’t need to know about your teen’s battle with bulimia
- Talk to your teen in a respectful manner; avoid nagging, shaming, or lecturing
What to Do When Things Escalate
Eating disorders are challenging and complex, and the course they take can be unpredictable. Since many individuals with bulimia nervosa also struggle with moderate to severe depression, there’s a considerable risk of suicidal thoughts and behaviors. Also, because of the serious and potentially fatal health risks associated with bulimia, a medical emergency may occur if any seemingly mild to moderate health concerns aren’t monitored closely and addressed in a timely manner.
If your teen is becoming increasingly depressed, actively suicidal, engaging in self-harm, physically weak, or exhibiting any type of psychiatric or medical distress, immediate steps must be taken to ensure his or her safety and wellbeing. This usually requires a visit to the nearest ER. Hospitalization may be necessary to stabilize any medical issues, keep your teen safe from self-harm, and / or get serious depressive symptoms under control.
Don’t hesitate to reach out for help. You can:
- Contact your child’s treatment provider asap
- Enlist the help of a close family member or friend for support or assistance
- Call an emergency hotline
- Take your child to the nearest hospital emergency room (if you can do so safely)
- Call 911
When Individual Therapy isn’t Enough
It’s not uncommon for eating disorders like bulimia and anorexia to require more intensive treatment than individual therapy can provide. Additional treatment is likely necessary if your teen is:
- Refusing to abide by his or her therapist’s treatment recommendations
- Frequently sabotaging any progress made in therapy
- Experiencing severe depression, anxiety, or other psychiatric symptoms that require a higher level of treatment
- Actively suicidal – threatening or planning suicide, and / or engaging in suicide gestures or attempts
- Developing or experiencing serious or potentially life-threatening medical problems as a result of the bulimia
then it’s time to consider a more intensive level of treatment. This may involve:
- Intensive outpatient treatment (IOP) / Psychiatric day treatment
- Residential treatment
- Inpatient psychiatric or medical hospitalization
Intensive outpatient treatment or psychiatric day treatment can vary in terms of the amount of time spent in treatment and how many times a week your teen is required to go. These programs are often the next step up from regular outpatient treatment.
Residential treatment requires having your teen stay at a non-hospital treatment facility that specializes in treating adolescents with eating disorders and other mental health disorders. Residential treatment typically lasts between 30 to 180 days, depending on the severity of symptoms and your child’s rate of progress. There are many residential treatment centers throughout the country that specialize in adolescent eating disorders.
Inpatient psychiatric or medical hospitalization is the highest and most intensive level of treatment for adolescents with bulimia. Medical staff is on hand to monitor patients 24/7, and treatment may last for a few days to several weeks. This is usually necessary for severe or advanced cases of bulimia with serious medical complications, or if there is imminent risk of suicide or self-harm.
Each of these intensive levels of treatment typically provides daily or bi-weekly visits with a psychiatrist and various types of daily therapy.
Taking Care of Yourself
Eating disorders impact the entire family. As a parent, you may struggle with feelings of guilt, fear, and helplessness. That’s why taking care of yourself needs to be a priority. Your teen will be looking to you for emotional support and guidance as he or she focuses on healing. You won’t be able to offer those things if you’re burned out.
Several things you can do to help maintain your sanity and bolster your own emotional well-being include:
- Connecting with a support group (online or in-person). Local hospitals and your local NAMI chapter may be able to provide resources
- Finding support through family, friends, a church, and / or a therapist
- Finding healthy ways to manage your stress, such as yoga, meditation, and regular exercise
- Making time for yourself
Bulimia nervosa can be effectively treated. Time, patience, and a lot of love and support from you can play a key role in helping your teen recover from his or her battle with this challenging eating disorder.
