So, who’s most at risk for developing bulimia?

• Those with a family history. Children with a close relative who has had an eating disorder are at higher risk.

• Certain personality traits. Traits like perfectionism, impulsivity, and difficulty managing distress can all increase vulnerability. Many kids with bulimia struggle with intense emotions, anxiety being the most common, and try to avoid or control those emotions with disordered eating behaviors.

• Athletes and dancers. While sports like gymnastics, figure skating, and wrestling are well-known risk areas, any sport can raise the risk—especially in performance-focused or body-conscious environments.

What is binge eating?

Binge eating is defined as eating an unusually large amount of food in a short period of time—typically much more than what most people would eat during a typical meal. While the specifics can vary, an example might be eating an entire package of cookies followed by a full pint of ice cream.

It’s important to know that binge eating doesn’t always involve what we think of as “junk food.” People with bulimia may binge on any type of food—sometimes it’s chips and sweets, other times it might be dinner leftovers, carrot sticks with dip, or whatever is available at the moment.

In many cases, the person may not even enjoy the food they’re eating during a binge. It’s less about the type of food, and more about the loss of control that happens during the binge episode.

So why do people binge eat? The most common reasons include:

• Physical hunger due to restriction or undereating.

• A desire to feel unrestrained after periods of strict control.

• Emotional numbing—using food to disconnect from anxiety, sadness, shame, or overwhelm.

For many individuals with bulimia, binge eating is a way to cope with emotional pain—but it’s often followed by guilt, shame, and the urge to purge. Understanding the “why” behind the behavior is key to helping your child heal.

What is purging?

Purging is any behavior used to “cancel out” the calories consumed during a binge. These behaviors may happen immediately after a binge, several hours later, or even the next day. While purging can take many forms, the common thread is that the person is trying to relieve physical discomfort, avoid weight gain, or escape the emotional distress that follows a binge.

Common purging behaviors include:

• Self-induced vomiting - Forcing oneself to throw up, often within a few hours of a binge.

• Laxative use - Taking stimulant laxatives in pill, powder, or tea form. These may be used the same day or the day after a binge.

• Exercise - Engaging in intense cardio or other physical activity with the goal of “burning off” the calories consumed. This often happens the day after a binge, as people frequently feel physically unwell right afterward.

• Fasting - Skipping meals or eating as little as possible after a binge. Fasting periods can last for hours—or in some cases, days.

• Diuretics - Also known as water pills, these medications increase urination to reduce water weight. Though they don’t have a long-term impact on weight, they can provide the sense of emptiness people with eating disorders often crave.

Most people who purge are driven by two core motives:

1. To prevent weight gain and regain a sense of control or “emptiness.”

2. To relieve the shame, guilt, or emotional overwhelm that follows a binge.

Unfortunately, purging doesn’t break the cycle—it deepens it. Because hunger and restriction often trigger future binges, many individuals find themselves trapped in a repeating restrict–binge–purge loop that becomes harder to escape over time.

Bulimia Myths

Bulimia is often misunderstood, especially by those who haven’t had direct experience with eating disorders. These misconceptions can make it harder for parents to recognize the signs—or to understand the seriousness of what their child is going through. Below are some of the most common myths about bulimia nervosa, along with the facts every parent should know.

Medical complications of bulimia:

The physical consequences of bulimia can be serious—even life-threatening—and often go unnoticed until significant damage has occurred. Here are some of the most common medical complications to be aware of.

• Electrolyte imbalances - Purging behaviors such as vomiting and laxative use can disrupt the body’s balance of electrolytes like potassium, magnesium, and sodium. These imbalances can cause dangerous symptoms including severe muscle cramps, heart palpitations, arrhythmias, and long-term kidney damage.

• Pseudo-Barrter syndrome - A complication of chronic purging that leads to severe fluid and electrolyte shifts, increasing the risk of kidney damage and other systemic issues.

• Kidney problems - Frequent dehydration from purging can lead to kidney pain, kidney stones, and, over time, chronic kidney disease.

• Dental erosion - Repeated exposure to stomach acid from vomiting can wear down tooth enamel, leading to tooth sensitivity, cavities, and other dental problems.

• Periodontal disease - Inflammation of the gums, often worsened by poor nutrition and acid exposure, can result in jaw pain, gum recession, infections, and eventual tooth loss.

• Swollen cheeks or puffy face - Frequent vomiting can cause swelling in the salivary glands, giving the cheeks a noticeably puffy appearance.

• Chronic acid reflux - Repeated purging can weaken the muscles at the base of the esophagus, leading to ongoing heartburn and acid reflux.

• Barrett’s esophagus - A serious, pre-cancerous condition caused by repeated exposure of the esophagus to stomach acid, increasing the risk of esophageal cancer.

• Cathartic colon syndrome - Severe constipation caused by the loss of muscle tone and slow peristalsis (muscle contractions) in the colon due to damage from long-term stimulant laxative abuse.

• Atherosclerosis & Coronary artery disease - Chronic malnutrition and electrolyte disruption can contribute to the thickening or hardening of arteries, increasing the risk of heart attack or stroke.

How would I know if my child has bulimia?

If you’re worried your child may be struggling with bulimia, there are both physical and behavioral signs to look out for. It’s important to keep in mind that eating disorders don’t always look the same—some children may show many warning signs, while others might only show a few.

What makes bulimia especially difficult to detect is that many of its symptoms can be hidden, minimized, or explained away. Even the most attentive and caring parents can miss the early signs, simply because binging and purging are not behaviors your child will likely practice out in the open.

Behavioral signs

Eating disorders often thrive in secrecy, so many of these behaviors are subtle or easy to miss. Here are some of the more common behavioral signs that may indicate your child is struggling with bulimia:

• Hiding or hoarding food in unusual places. Common hiding spots include under the bed, in the bedside table or dresser, or in the closet.

• Large amounts of food go missing in a short amount of time—for example, a full box of snacks disappearing overnight.

• Finding empty wrappers or containers hidden in bedrooms, backpacks, or other unusual places. Most people who binge eat feel ashamed and hide the evidence left behind after their binge.

• Avoiding eating around others or appearing anxious during meals, especially in social settings.

• Regularly going to the bathroom immediately after eating, often staying in there for an extended time.

• Sudden changes in eating habits, such as cutting out entire food groups, skipping meals, or adopting a restrictive diet (e.g., suddenly becoming vegan or vegetarian without other context).

• Wearing baggy or oversized clothing—particularly if your child previously preferred more fitted clothes. This can be a way to hide body changes or discomfort with appearance.

• Erratic eating patterns, such as eating very little one day and a large amount the next.

• Reporting that they feel fat, don’t like their appearance, or need to lose weight.

• A sudden increase in exercise, especially if it's rigid, excessive, or framed as a way to "make up for" eating.

• Engaging in body-checking behaviors, such as frequently looking in mirrors, touching areas like the stomach or hips, or closely examining photos of themselves. These actions are often attempts to monitor weight or shape.

Emotional signs

In addition to changes in behavior, bulimia brings new negative emotions and emotional responses. These can show up in ways that may look like general teen distress, making it easy to initially disregard these signs as teenaged moodiness.

• Isolating from friends and family

• Pulling away from previously enjoyed groups or activities.

• Increased anxiety or emotional distress, especially around food, appearance, or performance.

• Low self-esteem or frequent self-criticism, including comments that they’re “not good enough” or “a failure.”

• Feelings of guilt or shame after eating, particularly after eating foods perceived as “bad” or high in calories.

• Symptoms of depression, such as sadness, irritability, or emotional withdrawal.

• Communicates a strong fear of failure, or belief that they’ve failed as a person.

• A strong fear of social rejection or abandonment—even when there’s no obvious reason for it, such as bullying, conflict with friends, or recent experiences of exclusion.

How do you treat bulimia?

Bulimia, like all eating disorders, is best treated through a multidisciplinary approach that includes mental health counseling, nutritional support, medical monitoring, and, when appropriate, psychiatric care. This collaborative model is often referred to as a “treatment team.” The gold standard for outpatient care typically includes, at minimum, a therapist and a dietitian who work closely together to coordinate recovery. Depending on the individual’s needs, additional providers—such as a medical doctor or psychiatrist—may also be involved. Most importantly, all members of the treatment team should be specialists in eating disorders. Well-meaning providers without specialized training can delay recovery and even cause accidental harm.

• Therapist: The therapist plays a central role in your child’s eating disorder treatment team. Their job is to help your child understand why the eating disorder developed, what maintains it, and how to manage the emotional challenges that come with recovery. Therapists work with clients to build skills for coping with anxiety, increasing distress tolerance, managing depression, and addressing the underlying fears—like rejection, isolation, or not being “enough”—that often drive disordered behaviors.

  That intense anxiety your child feels after eating? The therapist helps them learn how to manage it. The fear of being judged or abandoned? The therapist helps them explore and heal those wounds over time. Of all the providers on the team, the therapist is often the one your child will work with the longest, providing a consistent space for emotional growth and support throughout recovery.

• Dietitian: The dietitian on your child’s treatment team plays a crucial role in restoring physical health and supporting a more balanced relationship with food. Their job is to provide accurate, evidence-based nutrition education, correct common myths about dieting or “healthy” eating, and create a structured meal plan tailored to your child’s needs.

  Unlike general dietitians, eating disorder dietitians are trained to work through the emotional side of eating. They spend time exploring your child’s fears around food and weight gain—and help them take gradual steps toward a more flexible and nourishing relationship with food. Because of their expertise in nutrition and the effects of malnutrition on the body, dietitians are also skilled at recognizing early signs of medical instability and will refer to a physician when additional care is needed.

• Medical Providers: Whether it’s a medical doctor, nurse practitioner, or physician assistant, a medical provider becomes an essential part of the treatment team when an eating disorder begins to impact a child’s physical health. These providers monitor key medical indicators—such as lab work, vital signs, and growth patterns—to assess for signs of medical instability. In addition to regular monitoring, they may prescribe medications that support recovery.

  For example, gastrointestinal discomfort is common in eating disorder recovery, and a provider can offer treatments to ease those symptoms and make eating feel more manageable. While medical providers can prescribe basic psychiatric medications, like antidepressants, they will often refer to a psychiatrist for more complex medication needs. It is ideal for your child’s medical provider to have specific training in eating disorders, as many medical complications can be subtle—and easily overlooked by providers without this expertise.

• Psychiatrist: A psychiatrist is a medical doctor who specializes in mental health and is responsible for managing psychiatric medications, such as antidepressants, anti-anxiety medications, or mood stabilizers. Appointments with a psychiatrist may feel similar to therapy sessions, but they tend to focus more on symptom monitoring and medication management. Psychiatrists usually meet with patients less frequently than therapists—often every few weeks or months—to assess progress and make any necessary adjustments to medications.

  While it’s ideal to work with a psychiatrist who has some understanding of eating disorders, they don’t necessarily need to be a specialist. As long as they have a basic awareness of how eating disorders work, they can safely and effectively support your child’s mental health needs without interfering with the overall recovery process.

Treatment approaches

Bulimia treatment should be tailored to the individual, as no single approach works for everyone. Some of the most commonly used evidence-based treatments include:

• Cognitive Behavioral Therapy (CBT): CBT helps individuals identify and challenge unhelpful thoughts and behaviors related to food, body image, and self-worth. It’s especially effective for older teens and adults who can reflect on their thought patterns and motivations.

• Family-Based Treatment (FBT): Also known as the Maudsley Method, FBT is a structured, three-phase approach that empowers parents to take an active role in their child’s recovery. It focuses on early weight restoration and has strong evidence supporting its effectiveness, particularly for adolescents still living at home.

• Dialectical Behavior Therapy (DBT): A modern, skills-based approach that helps individuals learn to regulate their emotions, cope with distress, and practice mindfulness. One of its core concepts, Radical Acceptance, encourages people to acknowledge difficult thoughts or feelings without judgment. DBT can be especially helpful in eating disorder treatment, as many individuals struggle to manage overwhelming emotions or tolerate distress without turning to disordered behaviors.

• Acceptance and Commitment Therapy (ACT): Pronounced like the word “act”—is a modern therapeutic approach that helps individuals respond to difficult thoughts and emotions without turning to self-destructive behaviors. A core goal of ACT is to help people build a values-based life, meaning they learn to make choices aligned with what truly matters to them, even in the presence of emotional pain. For those in eating disorder recovery, ACT can be a powerful tool for reconnecting with purpose and developing healthier, more flexible ways of coping.

The path to recovery:

Full recovery from bulimia is possible—but it often takes time, and the process isn’t always linear. Setbacks will occur, which is why continued support is so important. Long-term recovery typically includes ongoing therapy, nutrition counseling, regular medical check-ins, and community connection through support groups or group therapy. For many adolescents with bulimia, participation in a higher level of care treatment program may be necessary. Every recovery journey is unique. With patience, persistence, and the support of a skilled care team, healing is not only possible—it’s within reach.