Help for bulimia nervosa

Bulimia nervosa - Diagnosis and treatment


If your primary care provider suspects you have bulimia, he or she will typically:

  • Talk to you about your eating habits, weight-loss methods and physical symptoms
  • Do a physical exam
  • Request blood and urine tests
  • Request a test that can identify problems with your heart (electrocardiogram)
  • Perform a psychological evaluation, including a discussion of your attitude toward your body and weight
  • Use the criteria for bulimia listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association

Your primary care provider may also request additional tests to help pinpoint a diagnosis, rule out medical causes for weight changes and check for any related complications.

More Information

  • Electrocardiogram (ECG or EKG)
  • Urinalysis
  • X-ray


When you have bulimia, you may need several types of treatment, although combining psychotherapy with antidepressants may be the most effective for overcoming the disorder.

Treatment generally involves a team approach that includes you, your family, your primary care provider, a mental health professional and a dietitian experienced in treating eating disorders. You may have a case manager to coordinate your care.

Here's a look at bulimia treatment options and considerations.


Psychotherapy, also known as talk therapy or psychological counseling, involves discussing your bulimia and related issues with a mental health professional. Evidence indicates that these types of psychotherapy help improve symptoms of bulimia:

  • Cognitive behavioral therapy to help you normalize your eating patterns and identify unhealthy, negative beliefs and behaviors and replace them with healthy, positive ones
  • Family-based treatment to help parents intervene to stop their teenager's unhealthy eating behaviors, to help the teen regain control over his or her eating, and to help the family deal with problems that bulimia can have on the teen's development and the family
  • Interpersonal psychotherapy, which addresses difficulties in your close relationships, helping to improve your communication and problem-solving skills

Ask your mental health professional which psychotherapy he or she will use and what evidence exists that shows it's beneficial in treating bulimia.


Antidepressants may help reduce the symptoms of bulimia when used along with psychotherapy. The only antidepressant specifically approved by the Food and Drug Administration to treat bulimia is fluoxetine (Prozac), a type of selective serotonin reuptake inhibitor (SSRI), which may help even if you're not depressed.

Nutrition education

Dietitians can design an eating plan to help you achieve healthy eating habits to avoid hunger and cravings and to provide good nutrition. Eating regularly and not restricting your food intake is important in overcoming bulimia.


Bulimia can usually be treated outside of the hospital. But if symptoms are severe, with serious health complications, you may need treatment in a hospital. Some eating disorder programs may offer day treatment rather than inpatient hospitalization.

Treatment challenges in bulimia

Although most people with bulimia do recover, some find that symptoms don't go away entirely. Periods of bingeing and purging may come and go through the years, depending on your life circumstances, such as recurrence during times of high stress.

If you find yourself back in the binge-purge cycle, follow-up sessions with your primary care provider, dietitian and/or mental health professional may help you weather the crisis before your eating disorder spirals out of control again. Learning positive ways to cope, creating healthy relationships and managing stress can help prevent a relapse.

If you've had an eating disorder in the past and you notice your symptoms returning, seek help from your medical team immediately.

More Information

  • Cognitive behavioral therapy
  • Family therapy
  • Psychotherapy

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Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition.

Lifestyle and home remedies

In addition to professional treatment, follow these self-care tips:

  • Stick to your treatment plan. Don't skip therapy sessions and try not to stray from meal plans, even if they make you uncomfortable.
  • Learn about bulimia. Education about your condition can empower you and motivate you to stick to your treatment plan.
  • Get the right nutrition. If you aren't eating well or you're frequently purging, it's likely your body isn't getting all of the nutrients it needs. Talk to your primary care provider or dietitian about appropriate vitamin and mineral supplements. However, getting most of your vitamins and minerals from food is typically recommended.
  • Stay in touch. Don't isolate yourself from caring family members and friends who want to see you get healthy. Understand that they have your best interests at heart and that nurturing, caring relationships are healthy for you.
  • Be kind to yourself. Resist urges to weigh yourself or check yourself in the mirror frequently. These may do nothing but fuel your drive to maintain unhealthy habits.
  • Be cautious with exercise. Talk to your primary care provider about what kind of physical activity, if any, is appropriate for you, especially if you exercise excessively to burn off post-binge calories.

Alternative medicine

Dietary supplements and herbal products designed to suppress the appetite or aid in weight loss may be abused by people with eating disorders. Weight-loss supplements or herbs can have serious side effects and dangerously interact with other medications.

Weight-loss and other dietary supplements don't need approval by the Food and Drug Administration (FDA) to go on the market. And natural doesn't always mean safe. If you choose to use dietary supplements or herbs, discuss the potential risks with your primary care provider.

Coping and support

You may find it difficult to cope with bulimia when you're hit with mixed messages by the media, culture, coaches, family, and maybe your own friends or peers. So how do you cope with a disease that can be deadly when you're also getting messages that being thin is a sign of success?

  • Remind yourself what a healthy weight is for your body.
  • Resist the urge to diet or skip meals, which can trigger binge eating.
  • Don't visit websites that advocate or glorify eating disorders.
  • Identify troublesome situations that trigger thoughts or behaviors that may contribute to your bulimia, and develop a plan to deal with them.
  • Have a plan in place to cope with the emotional distress of setbacks.
  • Look for positive role models who can help boost your self-esteem.
  • Find pleasurable activities and hobbies that can help distract you from thoughts about bingeing and purging.
  • Build up your self-esteem by forgiving yourself, focusing on the positive, and giving yourself credit and encouragement.

Get support

If you have bulimia, you and your family may find support groups helpful for encouragement, hope and advice on coping. Group members can truly understand what you're going through because they've been there. Ask your doctor if he or she knows of a group in your area.

Coping advice for parents

If you're the parent of someone with bulimia, you may blame yourself for your child's eating disorder. But eating disorders have many causes, and parenting style is not considered a cause. It's best to focus on how you can help your child now.

Here are some suggestions:

  • Ask your child what you can do to help. For example, ask if your teenager would like you to plan family activities after meals to reduce the temptation to purge.
  • Listen. Allow your child to express feelings.
  • Schedule regular family mealtimes. Eating at routine times is important to help reduce binge eating.
  • Let your teenager know any concerns you have. But do this without placing blame.

Remember that eating disorders affect the whole family, and you need to take care of yourself, too. If you feel that you aren't coping well with your teen's bulimia, you might benefit from professional counseling. Or ask your child's primary care provider about support groups for parents of children with eating disorders.

Preparing for your appointment

Here's some information to help you get ready for your appointment, and what to expect from your health care team. Ask a family member or friend to go with you, if possible, to help you remember key points and give a fuller picture of the situation.

What you can do

Before your appointment, make a list of:

  • Your symptoms, even those that may seem unrelated to the reason for your appointment
  • Key personal information, including any major stresses or recent life changes
  • All medications, vitamins, herbal products, over-the-counter medications or other supplements you're taking, and their dosages
  • Questions to ask your doctor, so you can make the most of your time together

Some questions to ask your primary care provider or mental health professional include:

  • What kinds of tests do I need? Do these tests require any special preparation?
  • What treatments are available, and which do you recommend?
  • Is there a generic alternative to the medicine you're prescribing for me?
  • How will treatment affect my weight?
  • Are there any brochures or other printed material I can have? What websites do you recommend?

Don't hesitate to ask other questions during your appointment.

What to expect from your doctor

Your primary care provider or mental health professional will likely ask you a number of questions. He or she may ask:

  • How long have you been worried about your weight?
  • Do you think about food often?
  • Do you ever eat in secret?
  • Have you ever vomited because you were uncomfortably full?
  • Have you ever taken medications for weight loss?
  • Do you exercise? If so, how often?
  • Have you found any other ways to lose weight?
  • Are you having any physical symptoms?
  • Have any of your family members ever had symptoms of an eating disorder, or have any been diagnosed with an eating disorder?

Your primary care provider or mental health professional will ask additional questions based on your responses, symptoms and needs. Preparing and anticipating questions will help you make the most of your appointment time.

By Mayo Clinic Staff


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Bulimia Nervosa Treatment - Medications, Therapies, Self-Care, and Specialists

Written by WebMD Editorial Contributors

What Is the Treatment for Bulimia?

The primary treatment for bulimia often combines psychotherapy, antidepressants, and nutritional counseling.

It is helpful to find a psychologist or psychiatrist experienced in dealing with eating disorders. The same is true for nutritional counseling, whether the patient sees the family doctor or another health professional.

Clinics that specialize in eating disorders can often provide psychiatrists, psychotherapists, and nutritionists. All therapists involved should work in close cooperation with one another.

Psychotherapy and Bulimia

Psychological treatments for bulimia may involve individual, family, or group psychotherapy. Behavior or cognitive therapies are often prescribed, as well. Behavior therapy focuses on altering habits (such as bingeing and purging). Sessions are usually devoted to analyzing the behavior and devising ways to change it, and the patient follows specific instructions between sessions.

Cognitive therapy focuses on exploring and countering the negative thoughts that underlie destructive habits. Individual or group psychotherapy focuses on the underlying emotional experiences and relationships that have contributed to the bulimia.

Medications for Bulimia

Antidepressants, such as selective serotonin reuptake inhibitors (SSRIs) -- including Celexa, Lexapro, Prozac, and Zoloft -- in combination with psychological therapies, are now a mainstay in bulimia therapy. The antidepressant Wellbutrin, popular in part because of its especially low risk for causing weight gain, is usually avoided because it can increase the risk for seizures in patients with electrolyte abnormalities from vomiting.

Alternative Choices for Bulimia

Most alternative therapies for bulimia do not address the root causes of the disorder, but they can be helpful in relieving some of the physical distress resulting from it. If you want to include this type of treatment in your recovery, it is important to consult practitioners who are experienced in dealing with eating disorders. And be sure to tell your doctors and therapists about any complementary therapy you receive, such as acupuncture or biofeedback.

Bulimia and Mind/Body Medicine

Body exercises such as yoga, tai chi, qigong, and dance can help bulimics with their problems of body image. Reprogramming mental processes to gain control over the binge-and-purge cycles is another approach. Either hypnotherapy or EEG biofeedback may help. If you seek help here, be sure to ask hypnotherapists or biofeedback practitioners about their experience in treating eating disorders. And again, tell your doctor and other therapists about the care you get.

Nutrition and Diet's Role in Bulimia Treatment

A nutrient-dense, sugar-free diet may help reduce binge eating. Also, eliminate alcohol, caffeine, flavor enhancers, most salt, and cigarettes. Eat a balanced diet, supplemented daily with vitamin C (1,000 milligrams), vitamin B complex (50 milligrams), and a multivitamin/multimineral supplement.

Remember that treatment probably will include some retraining on how you think about food, eating, and your body. Treatment may be needed over a long period to try to win control over the binge-purge habits.

Help with bulimia, psychological assistance, treatment of bulimia by a psychiatrist (psychotherapist)

Bulimia is a form of eating disorder in which nervous overeating is replaced by attempts to cleanse the body of food. It is a psychiatric illness, usually a stage or variant of anorexia nervosa, but may be a syndrome in some other mental illnesses. In any case, the help of a psychiatrist is required. Patients often try to hide the manifestations and symptoms of the disease, which is why they do not get an appointment with a psychotherapist for the treatment of bulimia for years. nine0003


  • Disease description
  • Signs of disease
  • Impaired health
  • Sequelae of disease
  • What help can a specialist offer?
  • What is psychological therapy like
  • The importance of group sessions with a psychotherapist
  • Indications for inpatient treatment

As a rule, food becomes a simple pleasure. In fact, patients simply "seize" their problems and difficulties. But after breakdowns, they feel guilty and try in every possible way to minimize the consequences, so a psychiatrist should deal with the treatment. nine0003

Description of the disease

In bulimia, after eating a large amount of food, a person induces vomiting. Also, various medicines can be used - laxatives, diuretics and other drugs. Psychotherapists note that the disease is most common among adolescents, especially girls.

Signs of illness

Bulimia is a type of mental disorder with the following symptoms:

  • overeating with inability to control oneself or stop; nine0010
  • avoidance of joint meals with other people;
  • absorption of the daily norm or even more food in a short period of time;
  • attempts to hide food so that it is always at hand;
  • regular diets - including those with very tight calorie control, tormenting physical exercises;
  • maintaining or even losing weight;
  • induction of vomiting - with disturbed eating behavior this is usually hidden, but you can guess from weaning to the restroom immediately after dinner; nine0010
  • feeling unwell - constant weakness, drowsiness, fatigue;
  • low self-esteem and critical statements about their appearance;
  • mood swings, depression.

Impairment of health

For a long time, eating disorders may go unnoticed by others. Especially if the patient is hiding and does not turn to a psychologist about bulimia. After a few years, regular overeating and inducing vomiting leads to the development of symptoms associated with general health. In particular, a stomach ulcer and pancreatitis, kidney dysfunction, critical days may disappear, arrhythmia may appear, blood pressure may rise or fall. nine0003

Doctors also note the appearance of inflammatory processes in the oral cavity, erosion of the enamel. Over time, teeth may begin to fall out. No less dangerous for the body and a violation of the water-salt balance.

Consequences of the disease

If you have an eating disorder, you need the help of a psychiatrist, otherwise the symptoms get worse. Initially, vomiting may be induced once a week. But over time, artificial emptying of the stomach occurs every day, and sometimes several times. nine0003

Bulimia is accompanied by poor self-control and dissatisfaction with appearance, sometimes aggravated by a serious depressive state. Sometimes hospitalization may be required to save the patient's life.

If disturbed eating behavior is ignored, then complications such as gastritis, flatulence, liver disease, diabetes mellitus, infertility, hypothyroidism develop due to overeating and vomiting. Often, these diseases cannot be completely cured, so the patient will have to follow a diet all the time or take regular maintenance drugs. nine0003

How a psychiatrist can help with bulimia

For any eating disorder, see a psychiatrist as soon as possible. Adults and adolescents with this condition do not seek help, and bulimia can become rampant. Therefore, relatives can go to tricks and offer an appointment on any other issue.

A psychiatrist can:

  • diagnose bulimia and identify other mental problems that may have caused binge eating; nine0010
  • to determine why signs of eating disorders appeared to help recognize bulimia - the doctor is able to open the patient's eyes to the problem, motivate him to start treatment;
  • prescribe the optimal complex therapy - we are talking about the combination of psychotherapy with drug therapy and other methods.

What psychological therapy is like

Psychotherapists most often use cognitive behavioral therapy to combat bulimia. The method allows you to adjust the way of thinking and behavior of the patient. The doctor also teaches to recognize the approach of severe hunger, to cope with thoughts about food. nine0003

Interpersonal therapy is effective for people with bulimia due to depression. During the treatment of bulimia, the psychotherapist raises problems related to socialization, communication with loved ones, and teaches ways to overcome conflicts.

Psychiatrists often recommend family therapy. It can be used alone or in combination with other methods. The therapist will be able to eliminate resentment and other misunderstandings with relatives. In addition, the psychologist teaches parents and spouses how to properly support the patient. Thanks to this, the treatment is faster and less likely to relapse. nine0003

The importance of group sessions with a psychotherapist

Most often, a psychotherapist recommends coping with bulimia through individual and group sessions. Personal consultation with a psychologist for bulimia is necessary to work out personal problems, raise self-esteem.

Group classes allow you to:

  • get support – it is also provided by a psychotherapist, but understanding people with similar difficulties gives strength not to give up;
  • deal with guilt about relapses - bulimia often does not go away immediately, it is important to see that moments of weakness are normal and this is part of the treatment; nine0010
  • find motivation - psychologists note that uniting with others for a common goal gives confidence, strengthens willpower.

Indications for inpatient treatment

Experts note that inpatient treatment gives better results because external control helps to develop new eating habits and behavior in stressful situations. In addition, it is easier to combine different types of therapy.

A psychiatrist may insist on hospitalization if the patient is physically debilitated, has a history of failure in outpatient care, lacks willpower, has serious family problems, or is addicted to medication, alcohol, or drugs. Also, you can not do without a hospital if the disease is accompanied by suicidal behavior, social isolation or other mental disorders. nine0003

At the Eating Disorders Research Center in Moscow, psychologists and psychotherapists specialize in the treatment of bulimia. We use only modern and proven methods, we provide resuscitation care for patients in serious condition.

Author: Sineutskaya Ekaterina Olegovna

Head of the inpatient department of the Center for Insomnia,

psychiatrist, psychotherapist, narcologist.

Psychological care for bulimia | Mindful Eating

How to get rid of bulimia

about Bulimia

Bulimia in Greek means “bull hunger”.

Specialists define bulimia as one of the eating disorders, the main manifestations of which are frequent bouts of uncontrolled binge eating and compensatory behavior after it (however, these are far from all the criteria!) . nine0003

On our website you can find out all the most important things about bulimia in one place . Starting from the question of modern criteria, ending with how to get rid of bulimia.


The following are the current signs of bulimia nervosa based on the DSM-V (Diagnostic and Statistical Manual of Mental Disorders). Why this guide is the most modern and recognized in the world community of psychologists, psychotherapists and psychiatrists - read here

Thus, bulimia can be diagnosed if a person has ALL of the following signs:

Gluttony is characterized by two points:

  • The amount of food in a discrete period of time (often no more than 2 hours) is significantly higher than what others could eat in the same period of time and under the same conditions.
  • nine0009 Feeling of lack of control during a bout of binge eating (for example, feeling that a person cannot stop eating or control what and how much they eat)

B. Recurrent inappropriate compensatory behaviors to prevent weight gain : Self-induced vomiting, abuse of laxatives, diuretics or other drugs, fasting or excessive exercise.

C. Overeating and unacceptable compensatory behavior both occur, on average, at least once a week for three months.

D. Self-esteem strongly depends on body shape and weight .

E. The disorder is absent only during the manifestation of anorexia nervosa .

It is very important to understand that if you have any one or more of these signs, this does not mean at all that you have bulimia nervosa.

To make such a diagnosis, you need to have all 5 signs of bulimia .

Only in this case it is appropriate to ask how to get rid of bulimia.

So if you, for example, after eating sometimes induce vomiting or use laxatives, but you do not have regular bouts of binge eating, then you do not have bulimia either. If you periodically overeat to the point of pain in the stomach, but never after that resort to means of compensation (vomiting, laxatives, etc.), you cannot be diagnosed with bulimia. nine0003

On the other hand, if you have found all of these signs of bulimia, then this should be taken very carefully. Because if this is really bulimia, then it has very serious consequences. And weight gain in this case is far from the worst option.

Consequences of bulimia

Physiological consequences of bulimia:
  • amenorrhea or interruption in the menstrual cycles
  • Violations of the water-salt balance
  • Often significant or irreversible loss of tooth enamel
  • Often caries
  • Enlarged salivary glands
  • Stool problems due to use of laxatives
  • Serious cardiac and skeletal myopathies due to frequent consumption of ipecac syrup aimed at inducing vomiting.
  • Rare rupture of the esophagus, stomach, cardiac arrhythmia
  • In addition to the physiological consequences of bulimia, there are also psychological ones:
    • Constant food alarm
    • Feelings of guilt and shame for their bouts of binge eating
    • The need to constantly hide from others one's compensatory behavior (especially vomiting)
    • Decreased self-esteem due to awareness of the abnormality of one's eating behavior and the inability to do anything about it
    • Difficulties in enjoying food

    Naturally, when a person is faced with such serious consequences of bulimia, the question begins to sound in his head more and more often: how to get rid of this serious eating disorder? nine0003


    Let's immediately dispel one of the most common myths that bulimia can be overcome on its own at home.

    Unfortunately, in 99% of cases this is not the case.

    There are many problems that an ordinary person can deal with on their own. But mental disorders are not among them, and bulimia, according to the official definition of DSM-V, is a mental disorder. And although I personally don’t really like this interpretation, because it seems to label a person as “mentally ill”, but on the other hand, this emphasizes the seriousness of the problem. With bulimia, the psyche does not work as normal. And eating habits are very disturbed. This is very important to consider when treating bulimia. nine0003

    And the longer a person tries to cope with this on their own with the help of diets, physical activity, fasting, the more severe the consequences of bulimia will be.

    Therefore, the question "how to get rid of bulimia" must first be answered - "with the help of a specialist."

    Which specialist?

    - Either a psychiatrist with an additional specialization in psychotherapy and nutrition, and even better in the field of eating disorders

    - Either a psychologist or psychotherapist with an additional specialization in the treatment of eating disorders

    How to beat bulimia with the help of qualified specialist help?

    I will tell you how I work with this disorder.

    You are booking a 30-minute online diagnostic consultation that I provide at no extra charge.

    The objectives of such a consultation are to clarify the diagnosis of bulimia, get to know each other personally, ask each other all the questions you are interested in, determine the seriousness of the current condition and, ultimately, agree on the form and content of further work (or not agree if we do not approach each other, which is also quite normal). nine0003

    We draw up a verbal therapeutic contract for the entire duration of the work. It includes psychological, organizational and financial issues. In particular, one of the important issues is the duration of the course of psychological consultations when working with bulimia.

    In most cases this is a minimum of 6 months.

    We are starting to work in regular Skype consultations, usually once a week (sometimes more often, but not less often).

    At the first stage of work we examine your personal life history and the causes of bulimia.

    At the second stage we create conditions under which these causes can be eliminated.

    At the third stage we form skills that will help you solve current life problems in a different way, without resorting to gluttony and compensatory behavior.

    At the fourth stage, you consolidate your knowledge and hone new skills , learn to overcome breakdowns (when you want to return to old habits).

    At the fifth stage, if necessary, we work through those psychological problems that will emerge in parallel with bulimia in order to increase satisfaction in key areas of your life.

    The division into stages, of course, is rather conditional, and does not mean that they go strictly one after the other.

    Therefore, I do not treat bulimia in the medical sense of the word, but I do a course of psychological counseling / psychotherapy for people suffering from bulimia. nine0003

    Who am I?

    My name is Sergey Leonov , I am a psychologist with 13 years of experience, including the last 11 years specializing in the field of psychotherapy of eating disorders, teaching mindful eating and weight management.

    Details about me can be found here.

    And if it is important for you to read customer reviews, then they are here.


    Some clients who come to me for help say at the outset that they don't believe there is a cure for bulimia (or another eating disorder).

    I am deeply convinced that almost any psychological problem can be solved, including bulimia.

    The only question is how a person does it. And, if he has chosen an adequate way, is he ready to spend enough time and effort to start a life without bulimia. nine0003

    What is life without bulimia?

    Calm and comfortable relationship with food. When you eat, when you want, what you want and how much you want, and at the same time - you feel good and comfortable.

    The ability to enjoy food instead of constant shame or guilt. And food is supposed to be enjoyable.

    Respectful and calm attitude to one's weight and appearance. When your internal sensations of your body and the external reflection in the mirror completely suit you. nine0003

    The ability to lead a more active lifestyle, without being shackled by constant chains of compensatory behavior and thoughts about food.

    An opportunity to start loving yourself. Moreover, love is not in some abstract philosophical sense, but in a very concrete one. Say more pleasant words to yourself, praise yourself, be proud of yourself, consider yourself worthy of love, attention, recognition, accept yourself with all your features, be interesting to yourself.

    All this is possible! nine0135

    It's just a question of when you decide to start living without bulimia!

    If you are already on the verge of making such a decision, but have some doubts about whether I can help you, then here are some reasons in favor of the fact that most likely I can help.

    What are the advantages of working with me?

    Work from anywhere in the world.

    Since we work online, it doesn't matter what country you live in. The main thing is that you have stable Internet access. I have clients both in my native Yekaterinburg and other Russian cities, as well as in Kazakhstan, England, Austria, Germany and other countries. nine0003

    Convenient schedule.

    We agree on the time of consultations, taking into account your wishes. It can be weekdays or weekends, morning, afternoon or evening.

    Free initial consultation.

    Where you can find out if I am the right specialist for you.

    Responsible attitude to one's work.

    I love what I do, and at the same time, it is always important for me that the client gets the result. Therefore, I strive to invest in work 100%. I always expect the same from my clients.

    Learn more