Struggling with bulimia nervosa can feel like being trapped in an endless cycle of destructive behavior. Witnessing someone close to you struggling with bulimia can leave you feeling confused, frustrated, and helpless. Like all eating disorders, bulimia comes with a mix of complex physical, mental, and emotional symptoms and side effects that can sometimes feel impossible to address.

The good news is that treatment is out there, and it works. Working with a qualified team — a physician, mental health therapist, and dietitian at minimum — can help you break out of the binge-purge cycle and finally develop a calmer relationship with food.

What is bulimia nervosa?

Bulimia nervosa is an eating disorder characterized by recurrent episodes of binge eating, followed by behaviors aimed at compensating for the overconsumption of food, according to the National Eating Disorders Association (NEDA). These compensatory behaviors may include self-induced vomiting, the misuse of laxatives or diuretics, fasting, or excessive exercise.

People with bulimia nervosa often have a distorted body image and may feel ashamed or guilty about their eating behaviors. They may also engage in secretive binge eating and purging behaviors and may try to hide their actions from others.

Bulimia nervosa can have serious physical and psychological consequences, including electrolyte imbalances, gastrointestinal problems, dental issues, and depression. It is typically treated with a combination of therapy, targeted medical care (and sometimes medication), and nutrition counseling with providers who specialize in eating disorders.

What are the signs and symptoms of bulimia nervosa?

Eating disorders, including bulimia, aren’t totally uniform across the board. Different people might experience slightly different symptoms, or frequency of symptoms. In general, these are the signs and symptoms of bulimia nervosa:

1. Binge eating: Consuming large amounts of food in a short period of time, feeling out of control during the episode, and experiencing shame and guilt afterwards.
2. Purging: Engaging in behaviors to rid the body of calories and prevent weight gain, such as self-induced vomiting, misuse of laxatives, diuretics, or enemas.
3. Excessive exercise: Compensating for binge eating by engaging in excessive exercise.
4. Body image concerns: A preoccupation with body weight and shape, and feeling negatively about one’s appearance.
5. Dieting behaviors: Restricting food intake or following strict diets to compensate for binge eating episodes.
6. Physical symptoms: Frequent vomiting can cause sore throat, swollen salivary glands, and electrolyte imbalances that can lead to muscle weakness, fatigue, and even heart problems.
7. Emotional symptoms: Feeling depressed, anxious, or irritable; having low self-esteem or a distorted self-image.

If you or someone you know is exhibiting these symptoms, it’s important to seek professional help as soon as possible. Even if you don’t meet criteria for bulimia nervosa, the above symptoms are serious and distressing, and you deserve help.

What are the health consequences of bulimia nervosa?

Over time — and in some cases, immediately — bulimia can have a serious impact on someone’s overall health. The combination of malnutrition (due to inadequate energy and/or nutrients) and electrolyte imbalance (due to frequent purging) impacts the body in a myriad of ways, including:

1. Gastrointestinal problems: Frequent vomiting can cause damage to the esophagus, throat, and mouth, leading to inflammation, bleeding, and soreness. It can also cause acid reflux, stomach ulcers, and other gastrointestinal problems.
2. Electrolyte imbalances: Vomiting and laxative abuse can cause imbalances in electrolytes, such as potassium and sodium, which can lead to irregular heartbeat, muscle weakness, seizures, and even death.
3. Nutritional deficiencies: Bulimia nervosa can lead to inadequate intake of nutrients, such as vitamins, minerals, and protein, which can cause anemia, muscle weakness, and bone loss.
4. Mental health problems: Bulimia nervosa is often accompanied by other mental health problems, such as depression, anxiety, and substance abuse.
5. Dental problems: Frequent vomiting can erode the enamel on the teeth, leading to cavities, sensitivity, and discoloration.
6. Reproductive problems: Bulimia nervosa can disrupt menstrual cycles, leading to irregular periods or even amenorrhea (absence of periods). It can also affect fertility.
7. Cardiovascular problems: Bulimia nervosa can lead to low blood pressure, irregular heartbeat, and other cardiovascular problems.

How can nutrition counseling with a dietitian help with bulimia nervosa?

A registered dietitian can play a critical role in the treatment of bulimia nervosa. As a team of eating disorder dietitians, here are some ways we help clients who are recovering:

1. Food-focused counseling: Dietitians aren’t mental health therapists — and you absolutely need a mental health therapist on board for recovery — but our nutrition counseling sessions do include talk therapy around food and eating. We might dig into your beliefs about food and your body, your disordered behaviors and what triggers them, and ways to feel more comfortable in your relationship with food over time.
2. Meal planning: For people with bulimia nervosa, planning meals and snacks can be challenging. A dietitian can help create meal plans that meet the individual’s nutritional needs while also taking into account any dietary restrictions or preferences. The first priority in bulimia recovery is to end purging, so your dietitian will work with you on a meal plan that includes foods that feel safe. Over time, you’ll work with your dietitian to introduce more foods, reduce fear around them, and feel confident eating without bingeing and purging.
3. Monitoring progress: Throughout recovery, dietitians monitor your progress in a variety of ways. We might work with you on gradually increasing your food intake, and we’ll set weight restoration goals if that’s medically necessary. We’ll also help you adjust these goals as needed.
4. Addressing co-occurring health concerns: Many people with bulimia nervosa also have other health concerns, such as nutrient deficiencies or gastrointestinal problems. As dietitians, we can work closely with your medical provider to address these concerns and develop a comprehensive treatment plan.
5. Providing emotional support: Eating disorders are complex and often involve emotional issues. A dietitian can provide emotional support and encouragement throughout the recovery process, helping the individual stay motivated and on track.

Overall, a dietitian is a crucial and valuable member of a multidisciplinary treatment team for bulimia nervosa, providing specialized nutritional care and support for individuals in recovery.

How do you find a dietitian to help you with recovery?

At Ruby Oak Nutrition, we offer eating disorder nutrition counseling for adults and teenagers in Raleigh, North Carolina, and virtually across several states. (To figure out if we work with people in your state, check out the list here.)

If you live in a state where we don’t provide services, rest assured that there are many qualified dietitians in your area! That said, it can be tough to find the right person sometimes. Look for a dietitian who specializes in eating disorders and takes a Health at Every Size® approach. Then, schedule a time to talk with them and see if you get along. 

Depending on how severe your eating disorder is and what your life looks like, you might need inpatient treatment. Two eating disorder treatment center organizations we love are Monte Nido & Affiliates and the Eating Recovery Center. Both have treatment centers across the country. If your outpatient (AKA private practice, someone you see once or twice a week) dietitian or therapist recommends inpatient treatment, they might refer you to one of these treatment centers. If you don’t have outpatient providers and want to refer yourself, you can reach out to the intake team at these treatment centers.

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If you’re struggling with an eating disorder or disordered eating, we can help! We’re a group of dietitians who takes an anti-diet, body-positive, identity-affirming approach to recovery and healing your relationship with food. . Learn more about nutrition counseling, offered in Raleigh, NC, and virtually to clients in several states. Not ready to commit to counseling but want more information about the anti-diet approach? Subscribe to our weekly newsletter.

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