Bulimia

Bulimia is characterized by cycles of binge eating followed by behaviors aimed at preventing weight gain. These compensatory behaviors may include self-induced vomiting, excessive exercise, fasting, or misuse of laxatives or diuretics. Teen girls with bulimia often feel trapped in a cycle of shame and secrecy, eating large amounts of food in a short period of time and then engaging in purging to relieve guilt or fear of weight gain.

While many people associate bulimia with purging through vomiting, not all individuals with bulimia engage in this behavior. Some may compensate by exercising excessively or restricting their food intake afterward. Despite these differences, all forms of bulimia share the same emotional and behavioral patterns—bingeing as a response to emotional distress, followed by compensatory behaviors to manage feelings of shame and guilt and to regain control.

Unlike anorexia nervosa, individuals with bulimia often maintain a body weight within the normal range or slightly above the normal range. This makes the disorder more difficult to recognize, as it may not fit the stereotypical image of an eating disorder.

Bulimia arises from a combination of genetic, psychological, social, and environmental influences. For most teens, it is not one single factor that leads to the disorder, but rather an interplay of many elements that create emotional vulnerability.

Genetics

Genetics may play a role, as research has shown that eating disorders can run in families. A family history of anxiety, depression, or obsessive-compulsive tendencies may increase risk. However, genetics alone cannot explain bulimia. Environmental and cultural pressures often play a significant role in shaping a person’s body image and self-esteem.

Social media and peer environments

Social media and peer environments are particularly powerful influences during adolescence. Constant exposure to edited, filtered images and societal ideals of thinness can lead teens to internalize unrealistic beauty standards. When combined with low self-esteem and impulsivity, a dangerous cycle of self-criticism and body dissatisfaction can ensue.

Emotional and psychological factors

Emotional and psychological factors are also central. Many teens with bulimia struggle to cope with difficult emotions—such as anxiety, sadness, loneliness, or fear—by turning to food for comfort or distraction. Bingeing can provide temporary relief from these feelings, but afterward, guilt and shame often take over, leading to purging behaviors to “undo” the perceived damage.

Family dynamics

Additionally, family dynamics can contribute to the development of bulimia. Teens who experience high expectations, criticism about appearance, or inconsistent emotional support may be at higher risk. Even well-intentioned comments about dieting or weight can reinforce negative beliefs about self-worth being tied to physical appearance.

Because bulimia often occurs in secrecy, it can be difficult for parents to detect. However, there are subtle emotional, behavioral, and physical signs that may indicate your teen is struggling.

Behavioral symptoms often include frequent trips to the bathroom after meals, especially if accompanied by running water or other efforts to conceal vomiting. You may notice disappearing food, hidden food wrappers, or evidence of large amounts of food being consumed quickly. Teens with bulimia may also show signs of rigid dieting or skipping meals, followed by periods of overeating.

Emotional signs are often even more telling. Your teen may express constant dissatisfaction with their body or fear of gaining weight, even if their weight is within a healthy range. They may appear withdrawn, anxious, or irritable—particularly around mealtimes. Mood swings are common, as are feelings of guilt, shame, or low self-esteem.

Physically, signs of bulimia can include swollen cheeks or jaw area (due to inflamed salivary glands), dental problems like enamel erosion, dry mouth, chronic sore throat, or gastrointestinal discomfort. Fatigue, dizziness, and irregular menstrual cycles may also occur. In some cases, parents may notice fluctuations in weight, though they are often less dramatic than those seen in anorexia.

If you suspect your teen may be struggling with bulimia, it is important to seek professional help early. Diagnosis typically involves a combination of medical, psychological, and nutritional assessments.

Arin Bass, MFT, specializes in eating disorders. She will take a detailed history, including eating patterns, emotional symptoms, and physical health. Because many individuals with bulimia hide their behaviors, clinicians are trained to ask sensitive, nonjudgmental questions to uncover the full picture.

She will recommend that you take your child to their physician for a physical examination and lab work to identify complications such as dehydration, electrolyte imbalances, or gastrointestinal damage. The medical consequences that can result from bulimia can be serious, as repeated vomiting can lead to dangerous changes in potassium levels and affect the heart and other organs.

Mental health professionals use diagnostic criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to confirm a diagnosis of bulimia nervosa. This includes evidence of recurrent binge-eating episodes, compensatory behaviors (such as vomiting or fasting), and a self-evaluation that is excessively influenced by body shape or weight.

Beyond diagnosis, evaluation helps uncover underlying emotional and family dynamics that may contribute to the disorder. This understanding is critical for developing an effective treatment plan that supports both the teen and their family.

Parents play a vital role in helping teens recover from bulimia. Creating an environment of empathy, understanding, and open communication is essential. Avoid focusing on weight or appearance; instead, emphasize health, emotional well-being, and balance. Express concern with compassion rather than criticism and reassure your teen that they are not alone.

It is also important to seek professional treatment as soon as possible. Eating disorders can worsen over time and lead to serious health risks if left untreated. Early intervention—particularly with a team that includes therapists, dietitians, and medical providers—can significantly improve outcomes.

Encouraging your teen to attend therapy can be challenging, especially if they are resistant or ashamed. Approach the conversation calmly and privately, expressing love and concern rather than frustration. Reinforce that treatment is a path toward feeling better, not a punishment.

Families can also benefit from participating in therapy themselves, including learning how to communicate more effectively, reduce stress within the household, and support recovery without reinforcing unhealthy behaviors, which can make a tremendous difference.