Bulimia in Teenagers: Symptoms, Mental Health Effects, and Teenage Bulimia Recovery Options
Bulimia nervosa is an eating disorder that often develops during adolescence and is recognized in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).
This type of eating disorder is characterized by cycles of binging and purging, prolonged fasting, and excessive exercise in order to control weight and body image. Yet, bulimia is sometimes known as the “hidden” eating disorder due to people’s attempts to keep it secret. Plus, people with it often maintain a body weight in the normal range.
Bulimia can seriously affect a teenager’s mental and physical health, and unfortunately, can even be life-threatening on occasion. Therefore, recognizing the signs of bulimia and understanding its treatment options is often vital for recovery.
If you suspect that a teen has bulimia or another form of eating disorder, professional support is strongly advised. Eating disorders rarely go away on their own and can, in fact, worsen without treatment.
This page can work as a useful guide for understanding bulimia in teenagers, as it covers:
- How to understand bulimia in teens
- Bulimia symptoms in teenagers
- Mental health effects of bulimia in youth
- Long-term physical health risks of bulimia in teens
- Teenage bulimia treatment options
- Where to find professional support
Understanding Bulimia Nervosa in Teens
Bulimia in adolescents involves a repetitive cycle of binge eating followed by compensatory behaviors that include vomiting, intense and excessive exercise, or inappropriate use of laxatives or diuretics.¹
According to the National Institute of Mental Health,¹ nearly 1.5% of adolescents in the United States are affected by bulimia nervosa. Research also shows that the number of teen girls with eating disorders is more than twice as prevalent as in males. However, teen boys and young male adults make up approximately 20–25% of people with diagnosable eating disorders.² Yet, they are often underdiagnosed due to stigma and lack of awareness around eating disorders in males.
In bulimia, self-worth is overly associated with body weight and image. Therefore, if a teen perceives their image in dissatisfactory ways, they may feel compelled to make choices that they believe will help give them a sense of control.
Understandably, bulimia can cause intense distress for both a teen and their caregivers. Caregivers may also feel frustrated and lack understanding about how to help. Understanding the causes and risk factors may help instill compassion and a better awareness of how to support their child.
Risk Factors for Bulimia in Teens
There isn’t one singular cause of bulimia, which might exasperate some parents and caregivers. But yet it doesn’t just appear out of “thin air.” Instead, it’s often the result of biological, environmental, and psychological factors.
- Biological factors: Research suggests that a family history of eating disorders may be a risk factor for someone developing bulimia. In fact, there are even higher rates of bulimia in identical twins in comparison to fraternal ones.8 Another potential biological factor may be an imbalance in the neurotransmitters dopamine and serotonin, as these are strongly linked to mood.
- Environmental pressures: Social media, being bombarded with cultural ideals of thinness, and constant peer comparison may also be risk factors for bulimia. These pressures can create a comparison effect, leading to low self-esteem when a teen believes they don’t “live up” to standards.
- Personality traits: Perfectionism, impulsivity, and high anxiety can also contribute to bulimia. For example, the unattainably high standards associated with perfectionism can lead to a sense of failure and dissatisfaction with body image. Plus, impulsivity may cause a loss of control over binge-purge cycles.
- Trauma and stress: Experiences of bullying, abuse, or significant life changes – especially early in life – are also commonly associated with the binge-purge cycle of bulimia.9
When caregivers and professionals can see the whole picture, bulimia in teenagers is often better understood. This often allows families to respond with empathy rather than judgment or panic. More importantly, when teens build awareness around what bulimia is and why they’re facing it, they can recognize that this struggle is not their fault, reducing shame and stigma.
The next important step in understanding bulimia in teens and seeking the right support is recognizing the signs, which we address next.
Bulimia Symptoms in Teens: What to Look For
Recognizing bulimia symptoms in teens can be difficult since many of the behaviors are secretive.³ In fact, parents and friends may only notice subtle shifts in a teen’s behavior and eating patterns before realizing the seriousness of the disorder. However, bulimia symptoms in teens can be easier to spot when people know what to look for.
We’ve broken down the potential bulimia warning signs teens may show into the following behavioral, physical, and emotional components to help increase understanding.
Behavioral Signs of Bulimia:
- Frequent trips to the bathroom after meals
- Running the tap or the shower while in the bathroom
- Aversion to conversations around weight or eating patterns
- Talking about dissatisfaction with weight or body shape
- Hidden food stashes or empty food wrappers
- Rigid food rituals, such as avoiding eating in public
- Fasting periods or excessive exercise
Physical Symptoms:
- Dizziness or fainting spells
- Swelling of the cheeks or the jaw area from swollen salivary glands
- Sore throat and dental enamel erosion
- Fluctuations in weight that don’t reflect consistent eating habits
- Calluses on knuckles from induced vomiting (Russell’s sign)
- Stomach pain and bloating
- Dry skin or brittle nails
- Menstrual irregularities in girls
- Hair thinning and falling
Emotional Signs:
- Low self-esteem and self-worth, especially around body image and weight
- Social withdrawal or avoiding family meals.
- Intense guilt, shame, or secrecy around hiding food or evidence of eating
- Irritability and mood swings.
- Difficulty concentrating in school and keeping up with regular activities.
Experts recommend that any pattern of bingeing and purging, even if occasional, should be taken seriously. Therefore, spotting these bulimia warning signs early could prompt you to seek professional support and encourage your teen on their path to recovery.
Mental Health Effects of Bulimia in Youth
Conditions such as these can cause teens to feel out of control and hopeless, so they may use food as a coping mechanism to drown out or “numb” emotional pain. Further, due to the intense guilt and shame they may feel after a binge, they typically attempt to compensate for their actions and regain control by purging.
As mentioned previously, teens with bulimia may have an imbalance in dopamine and serotonin, which can contribute to bulimia. However, the binge-purge cycle can reinforce this imbalance, creating highs and lows similar to those experienced with addiction.
Further mental health impacts of teenage bulimia may include:
Obsessive thoughts about food and weight take over their daily life- Decline in school performance and engagement as they struggle to focus or keep up
- Increased irritability and conflict with family, especially when questioned about food
- Isolation from friends and withdrawal from social activities, hobbies and special interests
If left untreated, bulimia in teens can set the stage for lifelong struggles with mood and anxiety disorders and other health complications. The earlier treatment begins, the better the chances of a complete recovery.
Long-Term Physical Health Risks for Teens With Bulimia
Along with the emotional and mental health effects teens face, the long-term effects of bulimia on their bodies can be highly serious – and even life-threatening. These effects come down to how the repeated binge-purge cycle can cause disruption and imbalance to vital bodily functions, potentially leading to:⁴
- Cardiac complications: Electrolyte imbalances can cause irregular heartbeat or sudden cardiac arrest
- Gastrointestinal damage: Chronic vomiting may lead to stomach ulcers, ruptures, or digestive disorders.
- Dental erosion: Stomach acid weakens enamel over time and damages gums
- Reproductive health issues: Hormonal disruption can delay puberty or affect fertility later in life
- Bone density loss: Malnutrition increases the risk of fractures and osteoporosis
- Kidney damage: Frequent dehydration puts strain on renal function
Due to the high rates of morbidity in bulimia, seeking professional support for a teen is typically essential. Recovery is not just about restoring healthy eating habits but about preventing permanent physical and emotional damage.
Teenage Bulimia Treatment Options
Evidence-based bulimia treatment programs for teenagers combine medical, nutritional, and psychological care.⁷ Finding the right plan for your teen is important, as it should take into account their medical and psychological state.
The following is a breakdown of the treatment process for teens with bulimia.
Stages of Care for Teens With Bulimia
The first stage in any treatment plan for bulimia is making an appointment with a doctor. During their assessment, the doctor will ask a teen and their parents questions about their eating habits and any compensatory behaviors that may exist. After this, they may make a referral to a mental health professional who specializes in eating disorders.
Yet, first, they’ll check a teen’s vitals, such as heart rate, weight, blood pressure, and temperature, to ensure that they’re physically healthy. They may also look for physical signs of bulimia, such as dental erosion, swollen salivary glands, or Russell’s sign (scarring on the knuckles).
A doctor or mental health professional may also make arrangements for the following treatment approaches to be in place alongside therapy.
Supportive approaches for treating teenage bulimia:
- Nutritional counseling to rebuild healthy eating patterns
- Ongoing medical monitoring for measuring heart, kidney, and digestive health
- Group therapy with peers to reduce feelings of hopelessness, confusion, or isolation
- Skills-based workshops focusing on body image, stress, and coping strategies
Parents play a crucial role in family support for bulimia teenagers, helping reinforce healthy routines and providing emotional stability at home. Therefore, treatment success often depends on both professional care and consistent family involvement.
Therapy Options for Teenage Bulimia
The following evidence-based therapy options for treating bulimia in teens can be delivered in an outpatient setting or residential format, depending on a teen’s symptoms and needs:
- Enhanced cognitive behavioral therapy (CBT-E): Shown to reduce binge-purge episodes by restructuring harmful thought patterns⁵
- Family-based therapy (FBT): Involves parents directly, putting them in control to help the teen establish normal eating patterns. Over time, the control is slowly given back to the teen as they recover
- Dialectical behavior therapy (DBT): Helps teens regulate intense emotions, reduce impulsive behavior, and build coping skills when facing challenging situations and triggers.
If a teen’s physical health is at risk, or their symptoms are too severe to manage in a home-based environment, a mental health professional may recommend one of the following:
- Residential bulimia treatment: Provides structured environments where therapy, nutrition, and academics are supported
- Inpatient bulimia treatment: Suitable for cases where the need for medical stability is urgent or there is a risk of suicidal ideation.
Practical Tips for Parents Coping With Teenage Bulimia
While the professional support should be at the center of an eating disorder recovery plan, teens with bulimia also need an environment of trust and consistency at home. In fact, research shows that teens recovering from bulimia relapse less when families are actively engaged in therapy and recovery plans.⁶
Aside from being actively involved in their treatment plan, you can also support your child’s recovery by:
- Staying calm: Avoid blaming or judging and making negative comments about food or weight
- Promoting open conversation: Let your teen know you’re available to actively listen
- Model balanced eating: Show healthy habits without making food the central topic of every conversation
- Encourage professional help: Reinforce that seeking treatment is a sign of strength and help them practice skills learned in therapy at home
- Create a structured routine: Consistent meal times and family support reduce opportunities for binge-purge cycles
- Monitor online activity: Be aware of “pro-eating-disorder trends” and harmful social media content
Mission Prep: Professional Support for Teenage Mental Health
Teens with bulimia nervosa face complex challenges that can affect their physical health, emotional well-being, and growth. It’s not simply something they can be talked or scolded out of with a strict routine or discipline. As a parent, you may feel distressed and overwhelmed about how to help your child, but you don’t have to face this challenge alone.
At Mission Prep, we don’t directly treat eating disorders, but we can target the issues that can lead to them. We can also offer mental health resources, education, and guidance on where to seek specialized care for your teens and families affected by bulimia.
Our programs focus on resilience, emotional regulation, and healthy coping strategies that complement recovery. We also connect families with trusted information and community support so that no one has to navigate bulimia alone.
Healing takes time, patience, and professional guidance, but recovery gives your teen the chance to reclaim their health, well-being, and confidence. Contact our team today to learn more about how we can help.
FAQs About Bulimia in Teenagers
While we hope this guide helped you better understand teenage bulimia, you may, understandably, still have some concerns or burning questions. For this reason, we’ve provided some responses to FAQs to help clarify the topic further.
Is Bulimia Just About Wanting to Be Thin?
No. While a symptom of bulimia is an over-concern with body weight and tying self-worth to body image, it’s a mental health disorder with biological, psychological, and social roots. Therefore, the binge-purge cycle becomes a coping mechanism for overwhelming emotions.
Can a Teen “Grow Out of” Bulimia?
Without treatment, bulimia usually worsens over time. Therefore, early intervention is vital and improves the chances of recovery.
What’s the Difference Between Bulimia and Anorexia?
Anorexia is marked by restrictive eating and significant weight loss, while bulimia involves cycles of bingeing and purging and, often, weight in the typical range. Some teens may experience both patterns.
Can Bulimia Be Treated Without Inpatient Care?
Many adolescents respond well to outpatient therapy, especially when families are involved. However, severe cases may require inpatient bulimia treatment or residential care.
How Can Parents Encourage Recovery?
Offer consistent support, express reassurance without focusing on weight, and encourage therapy by framing it as a way for them to feel better mentally and physically. You can also be actively involved in their therapy.
Does Bulimia Only Affect Girls?
No. While girls are more often diagnosed, male, non-binary, and trans teens can also struggle with bulimia. However, cultural stigma means these cases may be overlooked and underdiagnosed.
Can Bulimia Recovery Be Long-Lasting?
Yes. With comprehensive treatment and ongoing support, many teens achieve full recovery and go on to lead healthy lives. Relapses may happen, but they can be managed with the right coping skills and professional support.
References
- National Institute of Mental Health. (2022). Eating Disorders. https://www.nimh.nih.gov/health/topics/eating-disorders
- PolicyLab. (2024, February 28). Eating disorders affect boys and men too: Research and policy need to catch up. Children’s Hospital of Philadelphia https://policylab.chop.edu/blog/eating-disorders-affect-boys-and-men-too-research-and-policy-need-catch
- Stice, E., Marti, C. N., & Rohde, P. (2013). Prevalence, incidence, impairment, and course of eating disorders in a community sample of young women. Journal of Abnormal Psychology, 122(2), 445–457. https://doi.org/10.1037/a0030679
- Mehler, P. S., & Brown, C. (2015). Anorexia nervosa – medical complications. Journal of Eating Disorders, 3(11). https://doi.org/10.1186/s40337-015-0040-8
- Fairburn, C. G. (2008). Cognitive Behavior Therapy and Eating Disorders. New York: Guilford Press
- Le Grange, D., Lock, J., Agras, W. S., Bryson, S. W., & Jo, B. (2014). Randomized clinical trial of family-based treatment and cognitive-behavioral therapy for adolescent bulimia nervosa. Journal of the American Academy of Child & Adolescent Psychiatry, 53(11), 1162–1172. https://doi.org/10.1016/j.jaac.2014.08.00
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing
- Barakat, S., McLean, S. A., Bryant, E., et al. (2023). Risk factors for eating disorders: Findings from a rapid review. Journal of Eating Disorders, 11(1), 1–31. https://doi.org/10.1186/s40337-022-00717-4
- Vidaña, A. G., Forbush, K. T., Barnhart, E. L., Mildrum Chana, S., Chapa, D. A., Richson, B., & Thomeczek, M. L. (2020). Impact of trauma in childhood and adulthood on eating-disorder symptoms. Eating Behaviors, 39, 101426. https://doi.org/10.1016/j.eatbeh.2020.101426
