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Bulimia Nervosa


Bulimia is an eating disorder. You binge eat and then vomit, use laxatives, starve yourself, or exercise for hours to prevent weight gain. This behavior happens often, usually at least 2 times a week for several months.


Informed consent

is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.

Psychiatric assessment:

Caregivers will ask if you have a history of psychological trauma, such as physical, sexual, or mental abuse. They will ask if you were given the care that you needed. Caregivers will ask you if you have been a victim of a crime or natural disaster, or if you have a serious injury or disease. They will ask you if you have seen other people being harmed, such as in combat. You will be asked if you drink alcohol or use drugs at present or in the past. Caregivers will ask you if you want to hurt or kill yourself or others. How you answer these questions can help caregivers decide on treatment. To help during treatment, caregivers will ask you about such things as how you feel about it and your hobbies and goals. Caregivers will also ask you about the people in your life who support you.

Vital signs:

Caregivers will check your blood pressure, heart rate, breathing rate, and temperature. They will also ask about your pain. These vital signs give caregivers information about your current health.

Meals and bathroom use:

A caregiver will provide support and supervision as you learn to eat normal, healthy meals. You may be allowed to use the bathroom only when a caregiver is present.


You will meet with a dietitian to talk about nutrition and develop a healthy meal plan. It is important to eat 3 to 5 structured meals a day to reduce the urge to binge. You might need to learn how to prepare healthy food. You might also need to relearn what it feels like when you are hungry and full.

Physical activity:

You will be weighed regularly to find out if you are gaining, losing, or maintaining your weight. Limited amounts of physical activity will be part of your daily routine. A caregiver will help you learn ways other than exercise to relieve stress.


  • Blood test: This will show if you are getting enough iron, calcium, glucose, and other nutrients from food.
  • Telemetry is continuous monitoring of your heart rhythm. Sticky pads placed on your skin connect to an EKG machine that records your heart rhythm.


is a small tube placed in your vein that is used to give you medicine or liquids.


  • Antidepressants: Antidepressants called SSRIs are usually used to treat bulimia. You may need this medicine even if you are not depressed. An SSRI gives your brain more of a chemical called serotonin. Serotonin may help you focus on other things and think less about weight and food.
  • Anticonvulsants: This medicine may help control your mood swings and decrease aggression or irritability.
  • Antinausea medicine: This medicine may be given to calm your stomach and prevent vomiting.
  • Laxatives: Treat constipation with a laxative that contains polyethylene glycol 3350, or use glycerin suppositories. Do not use stimulant laxatives, because they can damage your bowels.
  • Vitamins: You may need vitamin and mineral supplements if your nutrient levels are low because of bulimia.


  • Cognitive behavioral therapy (CBT): A therapist will help you change your thoughts about food, weight gain, and self-worth. You will learn how to identify negative thoughts and beliefs and replace them with positive thoughts and beliefs. CBT also teaches you new ways to cope with events that trigger bulimia.
  • Group therapy, family therapy, or a support group: Group therapy is a meeting with other people who also have bulimia. Family therapy is a meeting with a therapist and your family members. Overeaters Anonymous, Eating Disorders Anonymous, or another support group may help prevent a relapse in the future.


  • Without treatment, bulimia is likely to be a long-term condition. Many of the risks of bulimia can be life-threatening. You can develop congestive heart failure if you use ipecac to make yourself vomit. Vomiting can cause your electrolytes (calcium, sodium, potassium) to be too high or too low, and this could cause your heart to stop. If you have type 1 diabetes and skip insulin to lose weight, you could slip into a coma or even die.
  • The acid in vomit may erode the enamel on your teeth and cause cavities and gum disease. Repeated vomiting can also cause heartburn, acid reflux, and damage to your esophagus. If you abuse laxatives, your bowels could stop working and you could need rectal surgery or a colostomy bag. Your bones could fail to develop fully, and you could have weak bones or bone fractures. You may have a hard time getting pregnant during episodes of severe bulimia, and your risk for miscarriage is higher. Your baby may be born prematurely, at a low birth weight, and with a small head circumference.


You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.