Bulimia Nervosa: Symptoms, Causes, and Treatment Options

Bulimia nervosa is a serious and treatable eating disorder characterized by recurrent episodes of binge eating followed by compensatory behaviors to prevent weight gain.

Bulimia affects both physical and emotional health and can lead to significant medical complications if left untreated.

We will address what bulimia nervosa is, its symptoms and causes, how it is diagnosed, and the treatment and support options available at Rittenhouse Psychiatric Associates.

What is Bulimia Nervosa?

Bulimia Nervosa is a behavioral disorder characterized recurrent episodes of binge eating. To make the diagnosis of Bulimia Nervosa, there must be recurrent and inappropriate compensatory behaviors that occur to prevent weight gain from the episodes of binge eating. These behaviors may include self-induced vomiting, misuse of laxatives, diuretics or weight loss medications, fasting or excessive exercise. The binge eating and compensatory behaviors must occur on average, once per week for at least 3 months. Individuals with Bulimia Nervosa often evaluate themselves based on their body shape and weight. This condition can cause the individual to have a great deal of emotional distress, and it can also cause significant physical ailments and medical problems.

Symptoms of Bulimia Nervosa

Bulimia nervosa presents with behavioral, emotional, and physical symptoms that often overlap and reinforce one another. These symptoms can vary in severity but typically interfere with relationships, work or school performance, and overall quality of life.

Behavioral Symptoms of Bulimia Nervosa

• Recurrent episodes of binge eating large amounts of food in a short time
• Self-induced vomiting after eating
• Misuse of laxatives, diuretics, or weight loss medications
• Fasting between binge episodes
• Excessive or compulsive exercise
• Eating in secret or hiding food
• Avoiding meals with others

Psychological and Emotional Symptoms of Bulimia Nervosa

• Intense shame or guilt after eating
• Fear of weight gain
• Low self-esteem
• Anxiety or depression
• Sensitivity to comments about food or appearance
• Feeling out of control around food
• Preoccupation with body image and weight

Physical Symptoms of Bulimia Nervosa

• Fatigue and weakness
• Sore throat or swollen salivary glands
• Acid reflux
• Tooth decay and gum disease
• Gastrointestinal discomfort
• Bloating or constipation
• Dehydration
• Weight fluctuations

Causes and Risk Factors of Bulimia Nervosa

Bulimia nervosa is believed to develop through a combination of biological, psychological, and social influences rather than a single cause.

Biological and Genetic Risk Factors

Genetic vulnerability plays a role in the development of eating disorders, and individuals with a family history of bulimia or related conditions may be at higher risk. Differences in brain chemistry related to impulse control, reward processing, and emotional regulation may also contribute to disordered eating behaviors.

Psychological and Emotional Triggers

Psychological factors such as trauma, chronic stress, anxiety, and depression can increase vulnerability to bulimia nervosa. Perfectionism, emotional sensitivity, and difficulty managing distressing emotions are also commonly associated with the disorder.

Social and Environmental Factors

Social pressures related to appearance, dieting culture, and body stigma can reinforce unhealthy relationships with food. Bulimia often emerges during periods of transition, such as adolescence or early adulthood, when identity and self-image are still developing.

How Bulimia Nervosa Is Diagnosed

Diagnosis of bulimia nervosa requires a comprehensive psychiatric and medical evaluation conducted by a qualified healthcare professional.

Diagnostic Tools and Medical Assessments

Assessment typically includes a clinical interview, review of DSM-5-TR criteria, and standardized screening questionnaires. Medical evaluation may involve physical examination and laboratory testing to assess for dehydration, electrolyte imbalances, and other complications.

Evaluation also includes screening for co-occurring mental health conditions such as anxiety disorders, depression, or substance use disorders.

Medical Risks and Complications of Bulimia Nervosa

Bulimia nervosa can lead to serious medical complications, particularly when purging behaviors occur frequently. Repeated vomiting and laxative misuse may cause dehydration and electrolyte imbalances, which increase the risk of seizures and cardiac arrhythmias.

Other complications include damage to the esophagus, acid reflux, gastrointestinal problems, dental erosion, gum disease, enlarged salivary glands, pancreatitis, and hormonal changes that may affect fertility. Early treatment significantly reduces the risk of long-term medical harm.

Treatment for Bulimia Nervosa

Treatment for bulimia nervosa is individualized and often involves a multidisciplinary care team addressing both psychological and physical health.

Psychological Therapies for Bulimia Nervosa

Evidence-based psychotherapy, particularly cognitive behavioral therapy (CBT) and exposure-based approaches, is central to bulimia nervosa treatment. These therapies help individuals identify emotional triggers, challenge distorted beliefs about food and body image, and reduce binge-purge behaviors.

Medication Options for Bulimia Nervosa

Medication may be used as part of a comprehensive treatment plan. Certain antidepressants, including selective serotonin reuptake inhibitors (SSRIs), have been shown to reduce binge-purge symptoms in some individuals. Medication decisions are based on medical history and individual needs.

Multidisciplinary Care for Bulimia Nervosa

Care may involve psychiatrists, psychologists, primary care physicians, dietitians, family therapists, and social workers. Treatment plans address both mental and physical health.

In-Office and Virtual Bulimia Nervosa Treatment

Rittenhouse Psychiatric Associates offers both in-office and virtual psychiatric appointments for the evaluation and treatment of bulimia nervosa, making care accessible and flexible.

Dr. Tracy Kuniega-Pietrzak, Director of Eating Disorder Services, offers in-office visits in Baltimore and virtually throughout CA, DE, DC, FL, MD, NJ, NY and PA.

Why Choose Rittenhouse Psychiatric Associates for Bulimia Nervosa Treatment?

Rittenhouse Psychiatric Associates provides evidence-based care for eating disorders, including bulimia nervosa. Our team includes board-certified psychiatrists, psychiatric nurse practitioners, and licensed therapists experienced in treating complex and co-occurring psychiatric conditions.

Tracy Kuniega, MD serves as the Director of Eating Disorder Treatment at RPA and offers in-office appointments in Baltimore, MD and virtual visits for patients throughout PA, NJ, DE, MD, DC, and additional states.

Conclusion: Seeking Help for Bulimia Nervosa

Bulimia nervosa is a serious but treatable condition. With early recognition, comprehensive evaluation, and evidence-based care, lasting recovery is possible.

If you recognize symptoms in yourself or someone you care about, Rittenhouse Psychiatric Associates is here to help. Our experienced providers offer compassionate, individualized treatment plans that address both the emotional and physical aspects of bulimia nervosa.

Schedule an appointment today to take the first step toward healing and long-term wellness.