Can bulimia nervosa be prevented?

No one knows any sure way to prevent bulimia nervosa. Adhering to some lifestyle guidelines may reduce the risk of a person developing the disorder, but so many factors may influence the disorder’s development, including genetics, that it’s difficult to know what can prevent it. Nonetheless, a healthy attitude toward eating and self-perceptions about body size and shape are important, as is maintaining good mental health. Education and awareness of eating disorders may help identify problems early and offer the best chance for appropriate treatment and recovery.

Ways to reduce the risk of bulimia nervosa

• Education about and awareness of the disorder and associated risk factors
• Early intervention if risk factors are identified
• Knowledge and maintenance of healthy eating habits
• Cultivation of a positive self-image of the body
• Maintenance of good mental health
• Counseling as needed to identify and resolve areas of conflict and stress
• Balancing school, work, social life, rest, and exercise

Encouraging the at-risk person to develop close relationships with trusted friends, mentors (teachers/coaches), and family where possible could play a significant role in the reduction of risk for bulimia nervosa and other mental health disorders.

Cure, recovery, or remission?

Some controversy surrounds use of the term “cure” for any eating disorder, including bulimia nervosa. Most experts treating eating disorders consider bulimia nervosa, like many other mental health disorders, to be chronic illnesses requiring ongoing surveillance. They prefer the terms “remission” and “recovery” because the risk factors for the behavior may persist and relapse or multiple relapses can occur over an individual’s lifetime.

Nonetheless, treatment for bulimia nervosa can reduce and even halt the hallmark behaviors in many patients, as well as provide the skills and tools needed to recognize and deal with potential triggers for relapse. The amount and type of treatment required to achieve a successful long-term outcome and the chances of relapse vary widely among individuals. Also, the definitions that different clinicians use to define remission may vary. These variations affect the reported remission rates in the medical literature, according to researchers from the University of Toronto, Canada, who studied the impact of different definitions on reported relapse rates. They proposed using standard definitions for partial and full relapses: partial relapse would be two symptom episodes per month for two months (which by DSM-5 standards would be considered a diagnosis of Other Specified Feeding or Eating Disorder); full relapse would be defined as meeting the full DSM-5 diagnostic criteria for the disorder. Thus, from this definition, the implied definition of remission is fewer than two episodes per month.

Published scientific data on remission rates are scarce, since few long-term studies have been done. Nonetheless, available data from several studies show that about half to three-fourths of patients who received treatment for bulimia nervosa and achieved a remission were in remission five years later. For shorter time periods, the remission rates reported in published studies varied more widely. Some clinicians have reported anecdotally that self-recovery is possible, although little scientific evidence from well-conducted studies is available to really determine the effectiveness of self-recovery. Several published studies show that dropout rates were higher for self-help psychological interventions than for other treatment interventions that involved interaction with professionals experienced in treating eating disorders.

What are the positive and negative indications for recovery?

Researchers have identified some indicators that may predict chances for a successful recovery. Individuals who are self-confident, realistic, and goal-oriented and who make early progress in therapy usually respond well to the overall treatment plan. Individuals who begin treatment with a low body mass index, have a history of obesity, and show signs of depression may respond less well to therapy.

Triggers for relapse

Many situations and feelings can trigger bulimic behavior: extreme emotional distress, anxiety, depression, dieting, exposure to certain foods (especially high-sugar or high-fat foods), or sudden dissatisfaction with body image. People with bulimia nervosa have reported extreme mood changes before, during, and after binge eating and purging or nonpurging compensatory behavior. They have also reported feeling depressed or anxious before binge eating and then feeling temporary relief or even euphoria afterward. These feelings are often followed by feelings of guilt, shame, and self-loathing. Then purging or excessive exercise occurs to regain feelings of self-control.

Low self-esteem and fulfilling deep emotional needs can be factors affecting bulimic episodes. Triggers can be something an affected individual really wants and gets, like being named captain of a sports team or achieving a high score on a test…and then a boyfriend or girlfriend says something to undermine that confidence.

Bulimic episodes in male and female athletes participating in sports that focus on aesthetics (such as gymnastics, figure skating, or dance) or weight class (such as rowing or wrestling) might be triggered by the stress of an upcoming competition or performance pressure from coaches or teammates. Military personnel could experience bulimic episodes after post-traumatic flashbacks or combat exposure. In addition to the triggers listed above, bulimic episodes in LGBT individuals could be triggered by rejection or fear of rejection after coming out; harassment or violence at work, school, or in the community; or negative beliefs about themselves due to their sexual orientation or gender identity.