Bulimia Nervosa (Binge-Purge Disorder)

Bulimia nervosa, commonly known as bulimia or binge-purge disorder, is an eating disorder. In the diagnostic system, it is designated by the code F50.2. It is characterized by recurrent binge eating episodes: In a short period of time, those affected eat very large amounts and experience a sense of losing control. Out of fear of weight gain, they then take countermeasures, usually by inducing vomiting, as well as through strict fasting, excessive exercise, or the misuse of laxatives and diuretics.

Unlike in anorexia, body weight in bulimia is often within the normal range. This makes the disorder difficult to recognize from the outside. Self-esteem and mood depend heavily on body shape and weight. It predominantly affects girls and young women, and onset often occurs in late adolescence.

Bulimia often goes unnoticed. Feelings of shame and guilt after binge eating episodes lead teenagers to keep these episodes secret, sometimes for years. Nevertheless, there are signs that parents can look out for:

• Large amounts of food disappear, and empty packaging turns up in hidden places
• After eating, the child goes to the bathroom with noticeable regularity
• Constant preoccupation with body shape, weight, calories, and diets
• Swollen cheeks, a sore throat, or tooth damage caused by stomach acid
• Mood swings, withdrawal, periods of irritability or low mood

A single observation is not proof in itself. However, it is a good reason to start a conversation—without blame—and seek medical advice. Focus on your child’s well-being rather than on food and numbers.

There is no single cause. Experts believe it results from a combination of several factors. Genetic predisposition plays a role: eating disorders occur more frequently in families where someone has been affected. Strict diets and prolonged starvation can alter metabolism and the brain’s neurotransmitter system, making binge eating more likely.

Added to this are psychological factors such as low self-esteem, high expectations of oneself, and difficulty managing intense emotions. Society’s ideal of thinness, comparisons on social media, and traumatic experiences such as bullying also increase the risk. Important for parents: Bulimia is not a matter of weak willpower, nor is it the result of poor parenting. It is a serious illness for which no single family member is solely responsible.

Bulimia is highly treatable, and many people with the condition make a full recovery. Psychotherapy is the first-line treatment. Cognitive behavioral therapy has been the most extensively studied: It helps break the cycle of dieting, binge eating, and purging, and fosters a more relaxed relationship with food. For children and adolescents, treatment involves the family, for example through family-based therapy. In some cases, medication is used to supplement therapy.

As parents, you can play a big role:

• A calm and supportive atmosphere at the dinner table instead of control and pressure
• Talk about feelings and concerns, not just about food and weight
• Seek support for yourself and pace yourself

Recovery often takes time, and setbacks are part of the process. They are not a sign of failure, but rather part of the journey.

The earlier bulimia is treated, the better the prognosis. The first places to turn to are a pediatrician’s office, an eating disorder counseling center, or a child and adolescent psychiatric practice. In acute emergencies—such as circulatory problems, severe weight loss, or signs of self-harm—prompt medical attention is necessary.

Only a child and adolescent psychiatrist or a medical or psychotherapeutic specialist can provide a definitive diagnosis and appropriate treatment. Support services such as the parent coaching offered by Rückenwind can help relieve your burden and strengthen you during this time. However, they are not a substitute for diagnosis or psychotherapy; rather, they support you alongside the specialists.