Navigating Bulimia Recovery with a Registered Dietitian

Eating disorders are dangerous mental illnesses that can cause lasting physical and mental complications for those who suffer. Of the eating disorders, bulimia can be one of the most challenging to overcome, as those who are struggling often suffer in silence. It’s important to assess your, or your loved one’s, risk of developing bulimia and the warning signs and symptoms so you can receive prompt treatment. Bulimia recovery is possible with the right support and a specialized eating disorder dietitian by your side.

What is bulimia?

Bulimia nervosa is a serious and life-threatening eating disorder that involves both bingeing and purging behaviors. Bulimia differs from binge eating in that those with binge eating disorder do not purge after eating. Purge behaviors can look different for different individuals. Often purging involves vomiting, but can also include abusing laxatives or diuretics to rid the body of food and calories in an attempt to lose weight.

What causes bulimia?

Bulimia, like other eating disorders, is not caused by any one thing. There are several environmental, psychological, and physical factors that put someone at a greater risk of developing an eating disorder. 

You are more likely to develop bulimia if you:

• Have a family history of eating disorders or other mental illness
• Grew up around family that frequently dieted
• Have a history of trauma or abuse
• Experienced food insecurity
• Grew up in a home with little emotional support
• Were teased or bullied about your weight as a child
• Were put on diets or engaged in dieting at a young age
• Struggle with substance abuse or addiction
• Struggle with low self esteem or self worth
• Have been diagnosed with anxiety, depression, OCD, ADHD, or other mental illness

Signs and symptoms of bulimia

You cannot tell whether or not someone has bulimia just by looking at them. The average age of onset for bulimia is 18, and is five times more common in women than in men. However, people of all ages, sizes, sexual identities, and socioeconomic backgrounds can struggle with bulimia.

Changes in food thoughts and behaviors:

• Feeling preoccupied by thoughts of food
• Disappearing immediately after eating
• Spending a lot of time in the bathroom
• Purging via vomiting, laxatives, or diuretics
• Eating in secret and hoarding food
• Avoiding social eating and choosing to eat alone
• Finding reasons to skip meals
• Eating either too little or too much at a meal
• Going a long time without eating followed by bingeing
• Feeling a loss of control during binges
• Scheduling times to binge and purge in private
• Feeling distressed if unable to purge after eating
• Intense feelings of guilt, shame, embarrassment, or disgust following bingeing and purging

Changes in physical health or appearance:

• Swollen salivary glands
• Callused or bleeding knuckles from self-induced vomiting
• Tooth decay or bad breath
• Heartburn, cramping, bloating, diarrhea or constipation
• Weight loss
• Fatigue
• Dry hair, skin, or nails
• Amenorrhea
• Heart palpitations
• Dizziness or fainting

Changes in exercise thoughts and behaviors, like:

• Feeling compelled to exercise to make up for eating
• Adopting a new, highly regimented routine
• Exercising despite being injured
• Feeling extremely guilty for skipping a workout

Changes in body image thoughts and behaviors, like:

• Constantly fearing weight gain
• Feeling preoccupied by your reflection in mirrors
• Body checking or pinching/pulling on different parts of your body
• Weighing yourself multiple times a day or week
• Obsessively checking for changes on your body
• Thinking of yourself as fat when others tell you you’re too thin
• Feeling unhappy with your appearance no matter your weight

Diagnosis of bulimia

If you are concerned that you or a loved one is struggling with bulimia, it is important to seek help immediately from an eating disorder specialist like a doctor, therapist, or registered dietitian. Your doctor will be able to draw labs to assess if you are in immediate danger of electrolyte imbalances from purging or at risk of refeeding syndrome upon starting treatment. A registered dietitian can assess your thoughts and behaviors with a nutrition behavior screening. 

Medical complications of bulimia

Bulimia, like all eating disorders, can be extremely dangerous if not treated. Constant purging via vomiting or laxative use puts undue strain on your digestive tract and can cause deadly electrolyte imbalances. Here are some of the long term complications associated with bulimia:

• Stomach rupture
• Esophageal tears
• Tooth decay/loss
• Heart arrhythmias
• Amenorrhea
• Dehydration
• Kidney disfunction
• Colon damage
• Low libido
• Depression, anxiety, OCD
• Suicidal ideations

Bulimia recovery with a registered dietitian

Bulimia recovery starts by assembling a team of eating disorder specialized professionals including a registered dietitian, a therapist, a doctor, and a psychiatrist. Your support team can help you determine what level of care would best suit your physical and emotional needs.

Your registered dietitian will support you in learning how to nourish your body and decrease disordered eating behaviors. Here are a few things you can expect in your bulimia recovery with a registered dietitian:

Making an eating plan

You can think of your meal plan as your “medicine” in recovery– it is designed to nourish both your body and your mind so you can tackle bulimia recovery with strength and confidence. Your eating plan will focus on eating regular meals that meet your body’s needs. Eating more and eating more frequently may sound scary at first! Your dietitian will be there to support you as you confront your food fears.

Breaking the restrict-binge cycle

Many people with bulimia view bingeing as the “problem” that needs to be fixed. In reality, the bingeing is only a symptom. Often, bingeing is a response to eating too little, which can leave you feeling ravenous and vulnerable to overeating. By eating more, and eating more regularly, you will find your hunger and cravings to be much more manageable.

Challenging black and white thinking

The eating disorder prefers to think in absolutes, like believing that food is either all “good” or all “bad.” This black and white thinking makes it difficult to achieve peace and balance with food, and contributes to feelings of guilt and shame around eating. The truth is, all foods can fit into a healthy diet, and there is no such thing as “junk” or “bad” food.

Finding alternative emotional coping strategies

Bingeing is not always in response to hunger alone. Bingeing may serve an emotional purpose as well, like a way to avoid, distract, or comfort yourself. It’s normal and ok to use food to feel better, but it should not be the only tool in your emotional coping skills toolbox. Finding alternative methods to feel better is an important aspect of bulimia recovery. 

Practicing body respect

Body image can be challenging in bulimia recovery. Adopting the practice of body respect can be a helpful way to move away from body loathing. Body respect involves accepting your body for what it is in the moment and acknowledging that you don’t have to love everything about the way you look to take care of your body.

Learning how to eat intuitively

Intuitive eating is the practice of listening to your body’s hunger, fullness, and satisfaction cues when eating. Intuitive eating is focused on self care and nourishment, not weight loss. Intuitive eating can be a long term goal of bulimia recovery.

Next steps

If you are ready to pursue bulimia recovery, or to help a loved one recover from bulimia, reach out to one of our expert eating disorder dietitians today. Early intervention is key– those who get help sooner rather than later have better treatment outcomes. We can help you end the purging cycle, nourish your body, and heal your relationship with food for good.