Bulimia nervosa: pre-teens and teenagers

About bulimia nervosa

Bulimia nervosa is an eating disorder and a serious mental health condition.

If someone has bulimia nervosa, they can’t stop themselves from eating. They eat very large amounts of food in short periods of time. Then they do things like vomiting to get rid of the food. Their self-esteem depends on body shape and weight.

Pre-teens, teenagers and all people with bulimia nervosa need a lot of support from family and health care professionals to recover.

Signs and symptoms of bulimia nervosa

People with bulimia nervosa are often within a healthy weight range for their height. Sometimes they’re overweight. And it’s common for them to try to keep their condition a secret. This means that bulimia nervosa can be hard to spot.

General signs and symptoms
These include:

binge-eating – eating more food than most people would eat in a short period of time
eating only small amounts when eating with others
frequent changes in weight (weight gain or weight loss)
purging after eating – this might include vomiting, taking laxatives or diuretics, or using enemas
fasting or dieting
excessive exercising
having negative thoughts and feelings about body weight, body shape and food.

If someone has bulimia nervosa, they might also:

talk a lot about body weight and body shape
go to the toilet after meals a lot
feel out of control, guilty or ashamed about the binge-eating.

And if someone in your household has bulimia nervosa, you might notice food going missing from the fridge or pantry.

Physical signs and symptoms
These include:

dehydration
fatigue
swollen or puffy cheeks because of enlarged salivary glands
discoloured or damaged teeth or gums
redness or sores on the knuckles and backs of the hands
frequent changes in weight (weight gain or weight loss)
loss of menstrual periods or irregular menstrual periods.

The long-term complications of bulimia nervosa can be severe. They include:

damage to the teeth, gums, mouth and oesophagus
osteoporosis
problems with the heart and kidneys
low self-esteem
depression or anxiety
a higher risk of suicide.

Medical help: when to get it for pre-teens and teenagers with bulimia nervosa

If you notice that your child’s eating habits have changed, or you see a change in their mood and behaviour in relation to food, you need to talk with your child and your GP as soon as you can.

It might be a difficult conversation with your child. Try to stay calm and non-judgmental. Focus on your child’s health and wellbeing, not your child’s weight and appearance.

If you’re not sure how to talk with your child about these issues, you could ask your GP or a mental health professional for help. You can also contact the Butterfly Foundation by calling the free national helpline on 1800 334 673, or using the Butterfly Foundation webchat.

Early assessment and help from a health professional can stop problem eating turning into an eating disorder. It might be easier to get your child to see a health professional now. If you step in early, you might be able to save your child from intensive treatment and a very long recovery time.

Diagnosing bulimia nervosa in pre-teens and teenagers

If your GP thinks your child might have bulimia nervosa, the GP will do a full physical examination. This might include things like a blood test, a urine test or an ECG. The GP will also talk with your child about eating behaviour, habits and thoughts.

The GP might then refer your child to a specialist service to confirm the bulimia nervosa and recommend appropriate treatment.

Treatments, therapies and supports for pre-teens and teenagers with bulimia nervosa

There’s no single treatment for bulimia nervosa.

Treatment involves a team of health professionals with expertise in different areas. They’ll prescribe or suggest a treatment plan that’s specific to your child’s needs. The plan will depend on things like:

your child’s age
the kind of bulimia nervosa your child has
the causes, severity and stage of your child’s bulimia nervosa.

The plan will include regular visits to your child’s GP and a dietitian who specialises in eating disorders. It’s also likely to include some or all of the following.

Psychological therapy
This is a common way to treat bulimia nervosa. It can include family sessions, one-on-one sessions with your child, or group-based sessions. This treatment aims to help you and your child understand the eating disorder and how it affects your lives. It also aims to help your child:

manage their emotions
get back to normal eating
work on things like binge-eating, purging and over-exercising
build self-esteem
feel more comfortable in their body
re-engage with family, friends and social activities.

Medicines
Selective serotonin reuptake inhibitors (SSRIs) are antidepressant medicines that are sometimes used to treat bulimia nervosa. The most commonly prescribed SSRI for bulimia nervosa is fluoxetine (Prozac).

If your child has depression or anxiety as well as bulimia nervosa, there are some medicines that might help with these other conditions.

Hospital
Your child might need to go to hospital to be treated for the physical effects of bulimia nervosa. This will depend on your child’s weight, symptoms and other health issues.

Hospital treatment usually focuses on supporting people to eat at regular mealtimes and eat normally again. It might also involve close supervision to prevent purging and over-exercising. People might get fluids and medicines for dehydration and electrolyte imbalances.

With treatment, people can recover from bulimia nervosa, but it’s also possible for them to get sick again. If you notice that your child is showing the symptoms of bulimia nervosa again, see your doctor as soon as possible.

Causes of bulimia nervosa

There’s no single cause of bulimia nervosa. But there are some factors that can put pre-teens and teenagers at higher risk for bulimia nervosa.

These risk factors include:

low self-esteem
concerns about weight and body image
a history of trauma or abuse
depression or social anxiety
childhood obesity and early developmental maturation
gender – girls are at higher risk than boys
dieting
a family history of bulimia nervosa.

Although bulimia nervosa has no known cause, we do know that it isn’t your fault as a parent. If your child has bulimia nervosa, your love and support will be very important in helping your child get better.