The exact cause of bulimia is not known. Some things that may lead to it include:

• Pressure to look a certain way
• Judging self-worth by weight or body shape
• Family problems

Nearly half of teens with bulimia also had signs of anorexia when their eating problems first started.

Most people with bulimia are teenage girls from wealthier families. Bulimia happens in many Western countries. About 4% of all teenage girls in the United States have bulimia.

Teens with bulimia often come from families with a history of eating disorders, physical illnesses or mental health problems like mood disorders or substance abuse. Other mental health issues like anxiety or mood disorders are common in teens with bulimia.

There are two main types of bulimia based on how a person tries to stop gaining weight:

• Purging type: The person often makes themselves throw up or misuses laxatives, diuretics or enemas to get rid of food.
• Non-purging type: The person tries to control weight by fasting (not eating) or exercising too much instead of purging.

Symptoms can be different for each person, but common signs include:

• Normal or low body weight but thinking they are overweight
• Eating a lot of food very quickly (binge eating), often in secret
• Feeling scared they can’t stop eating during binges
• Making themselves throw up in secret
• Exercising too much or not eating to control weight
• Strange eating habits or routines
• Misusing laxatives or other medicines
• Irregular or missing periods
• Feeling anxious
• Feeling unhappy with themselves and their body
• Feeling sad or depressed
• Thinking a lot about food, weight and body shape
• Scars on the back of their fingers from making themselves throw up
• Decaying or damaged teeth from throwing up so often
• Trying very hard to succeed in school or other activities

Bulimia symptoms can look like other health or mental problems. Always talk to your child’s doctor to get the right diagnosis.

Bulimia in teens is usually treated with:

• Individual therapy
• Family therapy
• Behavior changes
• Nutrition help

Treatment depends on your teen and your family’s needs. Therapy often includes learning new ways to think and act. Medicine may help if the teen is feeling anxious or depressed.

Because bulimia can cause health problems, a doctor and a nutritionist should be part of the care team. Parents are also a very important part of treatment and recovery.

Staff in our Adolescent Health and Medicine Program are specially trained to help teens and young adults manage all the health problems they may face — from routine to serious.