Bulimia nervosa: what it looks like and how to act

Think bingeing and purging is just a phase? Bulimia nervosa is an eating disorder that harms your body and mind. People with bulimia cycle between eating large amounts in a short time and trying to cancel it out—by vomiting, laxatives, extreme exercise, or fasting. It’s driven by fear of weight gain and a need to control shame or stress. The sooner you recognize it, the safer the recovery process will be.

Recognize the signs

Bulimia can hide in plain sight. Look for repeated episodes of eating unusually large amounts, feeling out of control during meals, and then using quick fixes to avoid weight gain. Other clues: frequent trips to the bathroom after eating, sore throat, chipped or sensitive teeth, swollen salivary glands, and fluctuating weight. Emotionally, watch for obsessive worry about body shape, secretive eating, low mood, or intense guilt after meals. If a loved one seems withdrawn or constantly skips social meals, that may also be a hint.

Bulimia isn’t only about weight. Physical signs include dehydration, irregular heartbeats, fainting, stomach pain, and electrolyte issues like low potassium. These can lead to dangerous heart problems. For someone using laxatives or diuretics, chronic constipation or kidney trouble can appear. Don’t ignore fainting, chest pain, or seizures—those are emergencies.

Treatment and next steps

Treatment works best when it combines therapy, medical checks, and nutrition help. Cognitive Behavioral Therapy (CBT) is the main proven talk therapy—it helps change the cycle of bingeing and purging and the thoughts that feed it. Sometimes therapists use Dialectical Behavior Therapy (DBT) or interpersonal therapy depending on what’s behind the behavior. A registered dietitian teaches regular eating patterns and helps reduce extreme dieting that triggers binges.

Medication can help, too. Fluoxetine (an SSRI) is often prescribed to reduce binge-purge behavior and lift mood. Medical monitoring matters: blood tests, dental checks, and heart monitoring can catch complications early. For severe cases with dangerous weight changes, ongoing medical problems, or suicidal thoughts, a short hospital or residential stay may be needed to stabilize health and safety.

What can you do today? If you suspect bulimia in yourself or someone else, talk to a primary care doctor or mental health professional. If you feel unsafe—experiencing fainting, chest pain, fast heartbeat, or thoughts of harming yourself—get emergency care now. Join a support group or contact hotlines for immediate guidance. Recovery takes time and often includes setbacks, but steady treatment and support make lasting change possible.

If you want, we can point to resources, support groups, or help you prepare questions for your doctor. You don’t have to handle this alone.