Bulimia Nervosa in Adolescents

Bulimia nervosa is an eating disorder in which a person eats excessive amounts of food in a short period of time (binge eating), with a sense of lack of control over eating, and then engages in compensatory behaviors to prevent weight gain, such as vomiting, use of laxatives, diuretics, other medications, fasting or excessive exercise.

Bulimia usually begins in adolescence or young adulthood and is more likely to affect girls than boys.

Children and teenagers with bulimia are usually of normal- or low-body weight. They often take steps to hide their disorder by bingeing and purging in secret. Signs and symptoms of bulimia can vary, but may include:

• Being preoccupied with body image.
• Eating large amounts of high-calorie foods in a short period of time.
• Feeling a total lack of control during binge-eating episodes.
• Forcing oneself to vomit after a binge-eating episode. Some people with bulimia use laxatives, an enema, or diuretic after binge eating.
• Withdrawing from usual friends or activities.
• Frequent trips to the bathroom after eating.
• Exercising to excess.

Physical symptoms of bulimia may include:

• Broken blood vessels in the eyes
• Tooth enamel that is worn away, discolored or pitted
• Swelling of the cheeks or jaw

• Irregular or absent menstrual periods
• Severe dehydration
• Electrolyte imbalances

Bulimia is a complex condition that may involve genetic, biological, behavioral, psychological and social factors.

If you suspect your child or adolescent has an eating disorder, a psychiatrist or qualified mental health professional will take a detailed psychiatric history and will work with your child’s pediatrician to perform laboratory tests and a physical exam to assess medical status.

Eating disorders can affect nearly every organ system in the body, so early treatment is essential. Treatment will depend on your adolescent’s specific eating disorder as well as:

• Age, overall health, and medical history
• Extent of the symptoms
• Tolerance for specific medications or therapies
• Expectations for the course of the condition
• Personal opinion or preference

Goals of treatment are for the person to:

• Resume normal eating habits
• Stop the binge/compensatory behavior cycle
• Reach normal body weight

At Children’s Hospital of Philadelphia (CHOP), our team of behavioral health eating disorder specialists will treat your child using a model we call Systems-Based Family Therapy. Family-centered therapy emphasizes the important role that families play in helping their child recover from an eating disorder and promoting their mental and physical wellness.

An individualized treatment plan will be developed based on your child's and family’s needs. Research has proven the effectiveness of the family-centered approach to treatment, and we are one of the only programs in Pennsylvania to specialize in family treatment for eating disorders.

The beginning phases of the plan will focus on restoring nutrition and stopping eating disorder behaviors such as bingeing and compensatory behaviors. Later phases will focus on ongoing therapy for your child and the family as a whole. The goal is for your child to resume age-appropriate development, in the absence of eating disorder symptoms, with the support of the entire family unit.

Treatment usually progresses over one year, with visits often weekly for the first two to three months, then progressing to a lesser frequency. Relapse prevention sessions often occur during the first year of treatment. We work collaboratively with the Division of Adolescent Medicine, recommending medical appointments at regular intervals. Some patients may require medical stabilization as an inpatient at CHOP before beginning outpatient treatment. This is determined on a case-by-case basis.

Many people with eating disorders recover fully and lead normal, healthy lives with no lingering effects. But in some cases, managing an eating disorder like bulimia nervosa may require ongoing counseling and monitoring.

The Eating Disorder Program in the Department of Child and Adolescent Psychiatry and Behavioral Sciences at CHOP offers comprehensive outpatient services to children and adolescents with anorexia nervosa and bulimia nervosa.

When enrolled in our program, your child will be treated by a dedicated team that includes doctors, nurses and psychosocial staff. Team members have a range of specialties including adolescent medicine, psychiatry, nutrition and social work.