When I reached out to Equip Lead Peer Mentor Makailah Dowell to learn about her experience with bulimia treatment and recovery, she was preparing to have her annual upper endoscopy, a procedure to examine the upper portion of the GI tract. For patients with a history of bingeing and purging, this procedure is a necessity to help detect throat cancer—a disease that those with a history of bulimia are at high risk of developing.

“I wish someone had had this conversation with me,” Dowell says. “This procedure is for someone like myself who had bulimia and, most importantly, had purging symptoms for a very, very long time—undiagnosed and untreated. Untreated bulimia creates a life full of barriers, regret, and health risks.”

Thankfully, Dowell was able to eventually receive a diagnosis and get effective bulimia treatment, but it was a journey. Now on the other side of recovery, Dowell looks back on her days of struggling with undiagnosed bulimia and wishes she’d known more about the disease, how it could affect her life, and how to get help. Here’s what everyone should know about bulimia treatment: what to expect, how it works, and why it’s critical.

What are the risks of untreated bulimia?

The complications associated with bulimia can be devastating, ranging from stomach rupture, heart problems, and dental erosion to depression, anxiety, suicidal behavior, and death. “Untreated bulimia can result in some very serious consequences, both physically and mentally,” says Angela Celio Doyle, PhD, VP of Behavioral Health Care at Equip.

According to Doyle, some of the biggest physical risks of untreated bulimia include:

• Electrolyte imbalances, which disrupt your heart rhythm and, in severe cases, could lead to heart failure
• Strain on the digestive system due to purging. Frequent vomiting can damage the esophagus, lead to severe acid reflux, and even cause the esophagus to rupture.
• Significant dental problems due to stomach acid eroding tooth enamel

In Dowell’s case, it was actually her dental problems that led her to get an official diagnosis. “It took a long time but finally, it was my dentist who saw the damage to my oral health and called out my eating disorder in the dental office,” she says. “They said, ‘this is a problem—what’s going on?’ I could feel the tears in my eyes form as I processed the reality in front of me. My eating disorder was harming me in ways I did not understand.”

In addition to these physical repercussions, bulimia also has consequences for psychological health. “Bulimia is often linked with anxiety and depression, and if left untreated, these issues can spiral,” she says. “There’s also the constant preoccupation with food and body image, which can lead to isolation from friends and family. And in some cases, the psychological stress can even lead to self-harm or thoughts of suicide.”

Untreated bulimia can also cause significant harm in areas of life beyond just mental and physical health. “Socially, bulimia can create a lot of strain in relationships,” Doyle says. “The secrecy, guilt, and shame often associated with the disorder can make it hard to connect with others, and this isolation can make everything feel even more overwhelming. It can also impact your work or school life, as the physical and mental exhaustion takes its toll.”

The long-term health consequences of bulimia

The long-term health consequences of bulimia can be severe and irreversible, which is why early intervention and evidence-based treatment are so crucial. “In the long run, untreated bulimia can lead to chronic health issues, like heart disease and digestive problems, and can even increase the risk of early death,” Doyle says. “And for people thinking about starting a family someday, bulimia can affect fertility and lead to complications during pregnancy.”

The good news is, evidence-based treatment vastly increases the odds of permanent recovery. One study found that after receiving treatment for bulimia, the majority of study participants remained in recovery at a 22-year follow-up. Additional research has shown that in adolescents, family-based therapy (FBT) doubled the success rates for bulimia treatment compared to other forms of treatment.

“This is why treatment is so essential,” Doyle says. “With the right support, including therapy, medical care, and nutritional counseling, it’s possible to break free from the cycle of bulimia and start the journey towards recovery. Early intervention can prevent many of these risks and help you regain control of your health and well-being.”

The main treatment options for bulimia

Like other eating disorders, effective bulimia treatment involves working with a multidisciplinary team of experts, but the specific types of treatment used varies depending on the individual patient. “When it comes to treating bulimia, there are several effective options that can really make a difference,” Doyle says, offering a quick rundown of the main treatment approaches:

• Cognitive behavioral therapy (CBT): “CBT is often the go-to treatment for bulimia,” Doyle says. “It focuses on changing the negative thought patterns and behaviors that drive the disorder. With CBT, you’ll work on identifying and challenging distorted beliefs about food, body image, and self-worth. It also helps you develop healthier coping mechanisms and gradually reduces the urge to binge and purge.”
• Family-based treatment (FBT): “FBT, also known as the Maudsley approach, is particularly effective for younger individuals and young adults,” Doyle says. “It involves the family in the recovery process, empowering parents to take an active role in supporting their child’s return to healthy eating behaviors. FBT helps the whole family understand the disorder and work together to create a supportive environment for recovery.”
• Dialectical behavior therapy (DBT): “DBT is great for people who struggle with intense emotions and impulsivity, which are often linked to bulimia,” Doyle says. “This therapy teaches skills like mindfulness, emotional regulation, and distress tolerance. The goal is to help you manage your emotions in a healthier way, reducing the need to turn to harmful behaviors like bingeing or purging.”
• Nutritional counseling: “Working with a dietitian who specializes in eating disorders can be incredibly helpful,” Doyle says. “They can guide you toward a balanced diet and help you understand how to nourish your body properly. Nutritional counseling often goes hand-in-hand with therapy, helping you rebuild a healthy relationship with food.”
• Medication: “In some cases, medication can be part of the treatment plan,” Doyle says. “Antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs), are sometimes prescribed to help manage the underlying depression or anxiety that often accompanies bulimia. While medication alone isn’t a cure, it can be a useful tool alongside therapy.”
• Support groups: “Connecting with others who are going through similar experiences can be really empowering,” Doyle says. “Support groups offer a sense of community and provide a space to share challenges and successes. They can be a great complement to individual therapy.”

“Each of these approaches offers something unique, and often, a combination of approaches is used to create a comprehensive treatment plan,” Doyle says. “The key is finding the right mix that works for you, with the support of a skilled treatment team.”

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What role can medication play in bulimia treatment?

As Doyle mentions, medication may be an appropriate part of bulimia treatment in some cases. “Medication can play a supportive role in treating bulimia, especially when it comes to managing some of the underlying issues like depression or anxiety that often go hand-in-hand with the disorder,” she says. “While medication isn’t usually the primary treatment for bulimia, it can be a helpful addition to therapy.”

A few of the most common medications used in bulimia treatment include:

• SSRIs: “The most commonly prescribed type of medication for bulimia is SSRIs, with fluoxetine (Prozac) being the most well-known,” Doyle says. “SSRIs help to increase serotonin levels in the brain, which can improve mood and reduce the frequency of binge-eating and purging episodes. They’re particularly useful if you’re dealing with co-occurring depression or anxiety, which can make bulimia even harder to manage.”
• Other antidepressants: “Sometimes, other types of antidepressants might be prescribed if SSRIs aren’t effective or if there are other factors to consider,” Doyle says. “For example, tricyclic antidepressants or MAO inhibitors are sometimes used, but these come with more potential side effects, so they’re less common.”
• Mood stabilizers and antipsychotics: “In some cases, if bulimia is accompanied by severe mood swings or other mental health conditions, mood stabilizers or atypical antipsychotics might be considered,” Doyle says. “These medications can help regulate emotions and reduce impulsivity, which can be beneficial in managing bulimia.”

While medication can make a huge difference for some patients, it isn’t a one-size-fits-all solution and typically is just one piece in the larger recovery puzzle. “Overall, medication can help take the edge off the emotional and psychological symptoms that fuel bulimia, making it easier for you to engage in therapy and focus on recovery,” Doyle says. “It’s important to remember that medication is usually just one part of a comprehensive treatment plan that includes therapy, nutritional counseling, and support from healthcare providers.”

The role of nutritional support in bulimia treatment

Nutritional counseling is an essential component of bulimia treatment. “Nutritional health restoration is a really key part of bulimia treatment,” Doyle says. “Since bulimia often involves unhealthy eating patterns like bingeing and purging, your body can end up missing out on essential nutrients, which can lead to a whole host of physical issues. Working on restoring your nutritional health is about getting your body back to a healthy, balanced state so you can start feeling better physically, which also supports your mental recovery.”

While dietitians may specialize in a variety of specific areas, those specializing in eating disorders are familiar with the nuances of these illnesses and have robust knowledge and experience in working through nutritional and therapeutic challenges. “A registered dietitian who specializes in eating disorders is a vital part of the treatment team,” Doyle says. “They can help you develop a realistic and sustainable eating plan that meets your body’s needs. The goal is not for them to tell you what to eat—a dietitian will help you rebuild a positive relationship with food.”

As Doyle points out, there are a variety of services a dietitian can provide in the recovery process, including education and emotional support. “They guide you through normalizing eating patterns, addressing nutrient deficiencies, relearning hunger and fullness cues, and overcoming fear foods,” she says. “Ultimately, restoring your nutritional health is about giving your body the fuel it needs to heal and thrive.”

The role of support groups in bulimia treatment

While bulimia treatment will look different for everyone, support groups are often hugely beneficial. “Support groups can be a really valuable part of recovery from bulimia,” Doyle says. “They offer a sense of community and understanding that can be hard to find elsewhere, especially when you’re dealing with something as challenging as an eating disorder.”

Support groups may look different and offer different benefits depending on where they take place and how they are led, but in general, they exist to provide space for patients (and sometimes loved ones) to share their experiences, hear from others on similar journeys, and gain new perspectives.

“Just knowing that you’re not alone—that other people truly get what you’re going through—can be incredibly comforting and empowering,” Doyle says. “There are support groups led by peers who have recovered or are in recovery themselves and the focus is on mutual support and shared experiences. There are also support groups facilitated by a mental health professional and might include more structured activities or topics. They can be a great option if you’re looking for something that combines peer support with expert guidance.”

Dowell says that in her case, support groups were life-changing. “To hear of others partaking in the same behaviors as me and having the same strong urges made me realize that: A) I wasn’t alone, and B) There was a possibility of recovery,” she says. “For the longest time, I thought I would live a life full of loss of control, bad behaviors, and even worse health outcomes. When I realized others were getting diagnosed and helped, I knew I needed the same thing. I deserved it.”

Long-term strategies for maintaining bulimia recovery and preventing relapse

“Maintaining recovery from bulimia and preventing relapse is an ongoing process, but with the right strategies in place, it’s definitely achievable,” Doyle says. “Seeking help for bulimia can feel really tough, especially when there’s so much shame tied to it. It’s important for people to know that there is nothing to be ashamed of.”

Although bulimia has been shown to affect more women than men (3% versus 1%), anyone of any gender can develop the illness, and those identifying as male may have a particularly difficult time seeking help. “For men, it can be especially hard to talk about, because there’s often this idea that eating disorders are a ‘women’s issue,’ but that’s just not true,” Doyle says. “Men’s struggles are just as valid. By taking that step to seek help, they’re not only taking control of their life, but they are also breaking down those barriers and showing others that it’s okay to ask for support. It's important to remember that bulimia doesn’t discriminate—it can affect anyone, regardless of gender, age, or race—and reaching out for help is a sign of strength, not weakness.”

Here are some long-term strategies that can help support recovery:

• Build a support system. “Having a solid support network is crucial,” Doyle says. “This might include staying connected with your therapist, attending support groups, and leaning on family or friends who understand your journey. These people can offer encouragement, accountability, and a listening ear when things get tough.”
• Practice regular self-care: “Prioritizing self-care is key to maintaining recovery,” Doyle says. “This means making time for activities that help you relax and recharge, whether that’s healthy movement, hobbies, or simply taking a moment to breathe. Self-care helps reduce stress and keeps you grounded, which can prevent triggers from taking over.”
• Implement regular, healthy eating patterns. “Continuing to follow a balanced eating plan is important,” Doyle says. “Working with a dietitian can help you keep your eating habits on track and ensure you’re nourishing your body properly.”
• Proactively address triggers. “Through therapy and increasingly over time, people get better at recognizing what triggers the urge to binge or purge,” Doyle says. “Whether it’s stress, certain situations, or emotional challenges, being aware of these triggers allows people to manage them before they lead to a setback. Having a plan in place for how to cope with triggers can make a big difference.”
• Be willing to return to therapy. “Even after making significant progress and ‘finishing’ therapy at one time in your life, sometimes returning to therapy can be really beneficial,” Doyle says. “It gives you a space to explore any new challenges that come up and keeps you focused on maintaining your recovery. Some people find that periodic check-ins with their therapist help them stay on track.”
• Set realistic goals. “It’s important to set realistic, achievable goals,” Doyle says. “Recovery isn’t about being perfect; it’s about progress. Celebrating small victories and being kind to yourself if you stumble along the way can help you stay motivated and keep moving forward.”

For those who may fear judgment or stigma because of their illness, Doyle reiterates the strength it takes to ask for support. “There’s nothing to be ashamed of in seeking help,” she says. “It’s one of the bravest things people can do, and it opens the door to a healthier, happier future.”

Dowell says that learning to ask for support has enabled her to remain steadfast in her recovery, and she advises those struggling to do the same. “Be open to asking for help, again and again,” Dowell says. “One thing that makes my recovery extremely strong is the fact that I’ve put my ego to the side. If I am not doing well, I will call my therapist, family, friends, everyone. I will get the help I need before jumping full-blown into a relapse. By becoming self-actualized, I had to realize that I may not handle life perfectly and need to be open to the reality of asking for help, rather than pretending recovery was ironclad.”

If you or a loved one are struggling with bulimia, know that lasting recovery is possible. Don’t wait to reach out for help—schedule a call with our team today to talk through your concerns and treatment options.