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The Relationship Between Bulimia and Addiction

Eating disorders and addiction often co-occur with one another. One of the most common eating disorders to co-occur with substance use disorders is known as bulimia nervosa. 

According to the National Eating Disorders Association, “Bulimia nervosa is a serious, potentially life-threatening eating disorder characterized by a cycle of binging and compensatory behaviors such as self-induced vomiting designed to undo or compensate for the effects of binge eating.”[1]

But what does bulimia have to do with addiction? 

While the two disorders do not sound connected, addiction and bulimia share common behaviors and characteristics. Both conditions are characterized by compulsions, obsessive preoccupation, ritualistic behaviors, and social isolation. 

The relationship between bulimia and addiction can be complicated. Many risk factors are known to cause bulimia and substance use disorders to co-occur. 

What Causes Bulimia and Addiction to Co-Occur?

Bulimia and addiction are both complex mental health conditions with many contributing risk factors. According to research, up to 70% of adults with bulimia nervosa also struggle with a substance use disorder.[2]

Most individuals suffering from this comorbidity have reported abusing drugs or alcohol to stimulate weight loss. Oftentimes, they are abusing stimulants, diet pills, or laxatives to achieve their “ideal weight” stemming from the body dysmorphia that their bulimia is causing.

On the other hand, many individuals with bulimia nervosa abuse drugs to cope with negative feelings and emotions. People with bulimia struggle with severe depression, feelings of self-loathing, and guilt or shame surrounding their struggles with bulimia. To top it all off, people with bulimia have a hard time healthily expressing their emotions- leading to substance abuse.

What are the Signs of Bulimia?

The signs of bulimia can be difficult to recognize. While many people believe the misconception that people with eating disorders must be underweight, this is far from the truth. People with bulimia may be overweight, underweight, or at a healthy weight. 

Individuals need to be aware of the symptoms of bulimia. When bulimia and substance use disorder co-occurs, oftentimes the bulimia is left unspotted. This can lead to a future addiction relapse and a worsening of the individual’s eating disorder. 

The common signs and symptoms of bulimia nervosa include:

  • Scrapes or calluses on knuckles 
  • Severe dehydration 
  • Swollen face 
  • Gastrointestinal problems
  • Sensitive or decaying teeth
  • Dry mouth or bad breath 
  • Absence of menstruation or irregular cycles 
  • Depression
  • Poor self-esteem 
  • Anxiety and mood swings 
  • Living in constant fear of gaining weight

Bulimia nervosa causes an array of behavioral changes as well. Individuals struggling with bulimia may withdraw from social activities, engage in excessive exercise, or always visit the bathroom after a meal. 

How are Bulimia and Addiction Treated?

Bulimia and substance use disorder can be difficult to treat, as both conditions are characterized by social isolation, secrecy, and denial. This can cause individuals to avoid receiving professional help, leading to a worsening of both conditions. However, it is important to remember that it is never too late to receive treatment. 

The best way to treat addiction and bulimia is to attend a dual diagnosis addiction treatment center. Finding one that specializes in eating disorders will provide individuals with the highest levels of care and support. 

Behavioral Therapies

Thankfully, there is a form of therapy that is proven effective for treating both addiction and bulimia. Cognitive-behavioral therapy (CBT) is the most popular treatment approach for a variety of mental health disorders, including addiction and bulimia nervosa.

For addiction, CBT teaches patients how to identify their negative thought patterns, feelings, and actions. Once they are identified, patients learn how to replace them with positive coping mechanisms. This prevents patients from relapsing when they experience a trigger or a craving.

When it comes to bulimia nervosa, CBT helps patients disrupt the cycle of binging and purging by identifying the triggers and causes of this behavior. The patient will work closely with their therapist to find creative positive coping mechanisms that help them abstain from binging and purging. 


Oftentimes, medications are used in the treatment of bulimia. Because guilt, anxiety, and depression are often leading factors in an individual’s compulsion to binge and purge, antidepressant medication has been found helpful. 

The following serotonin reuptake inhibitors are commonly used during bulimia nervosa treatment:

  • Fluoxetine (Prozac)
  • Paroxetine (Paxil)
  • Fluvoxamine (Luvox or Fevarin)
  • Sertraline (Zoloft)

Thankfully, the anti-depressants used to treat bulimia nervosa are also helpful for addiction treatment. Because addiction causes the same feelings of guilt, depression, and anxiety, these medications work as a dual-diagnosis treatment. 

Nutritional Counseling

Because people with bulimia often fail to consume proper daily nutrients, nutritional counseling is a vital aspect of bulimia and addiction treatment. 

According to the National Eating Disorder Association, nutritional counseling for bulimia includes the following:[3]

  • Stabilization of weight through decreasing the cycles of binging and compensation.
  • A development of neutrality toward food through re-developing intuitive understandings of hunger, fullness, and satiety.
  • Re-establishment of blood-sugar levels through portion re-distribution 
  • Regulation and maintenance of potassium levels

Attend a Top-Rated Eating Disorders and Addiction Treatment Center

If you or a loved one suffer from a co-occurring eating disorder and addiction, you are not alone. This comorbidity is extremely common, especially among teen girls and young women. 

Even further, bulimia nervosa is the most common eating disorder to exist alongside addiction. Bulimia causes feelings of shame and guilt, causing individuals to isolate and withdraw socially. It can also make them reluctant to seek help. 

If you are experiencing these feelings, Mandala Healing Center is here to help. 

We understand how difficult it is to ask for help, but attending professional dual diagnosis treatment will allow you to live the life you deserve. Contact us today for more information on our eating disorders and addiction treatment program