Bulimia Care
We provide specialized telehealth care for bulimia nervosa across Maryland, DC, and Pennsylvania. Our team works with adults and adolescents using CBT-E, DBT, FBT for teens, and trauma-informed approaches, alongside coordinated medical and dental care. Bulimia is one of the most secretive eating disorders, often hidden for years. Our work is to help you stop the binge-purge cycle, address what's been driving it, and rebuild a relationship with food and your body that doesn't run on shame.
This page is about bulimia specifically. For more on how we work with eating disorders generally (our team, our philosophy, and how we coordinate care with dietitians and medical providers), visit our Eating Disorder Therapy page.
Bulimia Care at Juniper Blu
Bulimia nervosa is a serious but treatable eating disorder marked by recurrent episodes of binge eating followed by compensatory behaviors meant to "undo" what was eaten. Those compensatory behaviors can include self-induced vomiting, laxative use, diuretics, fasting, or excessive exercise.
One of the most painful things about bulimia is how hidden it usually is. The behaviors happen privately, the body often looks "normal" from the outside, and people with bulimia frequently spend years carrying the disorder in silence. By the time most people reach out for help, they've already worked extraordinarily hard to keep the disorder hidden, sometimes from people closest to them. We get that. Our work isn't to add to the shame. It's to help you step out of the cycle.
What Bulimia Hides
Bulimia is one of the most secretive eating disorders, and that secrecy is a feature, not a bug. The disorder protects itself by staying hidden, which is one of the reasons people with bulimia often live with it for years before getting care. Some of the things bulimia commonly hides:
How frequent the behaviors really are
Most people with bulimia underestimate (or hide) how often binge-purge episodes are happening, even from themselves. Once tracking starts in therapy, the actual frequency can be a relief, not because it's good news, but because naming the truth is often the first step toward changing it.
The full range of compensatory behaviors
Vomiting is what most people picture, but bulimia involves a broader set of behaviors: laxative use, diuretic use, fasting between binges, and excessive exercise. Many people only recognize the vomiting as "really" bulimia and don't realize the other behaviors are part of the same disorder. They are.
What's driving the cycle
Bulimia is rarely just about food. Underneath the cycle there's usually something else: trauma, anxiety, depression, perfectionism, attachment wounds, identity stress, or a nervous system that learned long ago that the binge-purge cycle was a way to feel something, or to stop feeling something. Real recovery means reaching what's underneath.
How much physical harm is happening
Bulimia carries serious medical risks, including electrolyte imbalances, dental erosion, heart complications, and GI damage. Many people minimize these to themselves to keep the disorder going. Honest medical evaluation is part of treatment, and we coordinate with medical providers to make sure the body is being looked after as healing happens.
The disorder itself
Many people with bulimia don't tell their partners, families, friends, or even their primary care doctors. The first time saying it out loud often happens in a therapist's office, sometimes years into living with the disorder. If that's where you are, you're not alone.
Medical Signs Your Dentist or Doctor Might Notice First
Because bulimia is so often hidden, medical providers (especially dentists and primary care physicians) are sometimes the first to notice something is wrong. If you've been told something during a routine appointment that you didn't fully understand at the time, this section may explain why.
Signs your dentist might notice
- Erosion of tooth enamel, especially on the back of the front teeth
- Increased dental sensitivity
- Cavities that develop unusually fast
- Receding gums
- Inflammation of the salivary glands
- Dry mouth
Signs your doctor might notice
- Electrolyte imbalances on routine bloodwork
- Calluses or scarring on the knuckles (Russell's sign)
- Swollen cheeks or jaw area
- Irregular heartbeat or low blood pressure
- Disrupted menstrual cycles
- GI complaints, including reflux, bloating, and constipation
- Dehydration
If a medical provider has gently asked you about eating
It's usually because they noticed something. Their job isn't to shame you. It's to help. If you've been hiding the disorder and a dentist or doctor has flagged something, that conversation is hard, but it's also an opportunity. We work alongside medical providers as part of coordinated care, and you don't have to figure out the next step alone.
How We Approach Bulimia Care
Bulimia responds well to treatment when the approach matches what's actually driving the cycle. Every person we work with is different, so the work is shaped to who you are and what's been happening. Depending on what you need, our therapists draw on:
- Cognitive Behavioral Therapy for Eating Disorders (CBT-E): the most well-researched first-line treatment for bulimia in adults, focused on interrupting the binge-purge cycle, regularizing eating, and addressing the thoughts and patterns that maintain the disorder
- Family-Based Treatment (FBT): evidence-based outpatient treatment for adolescent bulimia, with parents as active partners in early-phase recovery
- Dialectical Behavior Therapy (DBT): particularly useful when bulimia is tied to emotion regulation, distress tolerance, or self-harming patterns
- Trauma-informed care: for the many people whose bulimia developed alongside or after traumatic experiences
- Attachment-based therapy: for the relational and emotional patterns often underneath the cycle
- Art therapy: for clients who benefit from non-verbal processing of body image, identity, and difficult emotions
- Neurodivergence-affirming care: for clients whose bulimia intersects with autism, ADHD, or sensory differences
Bulimia almost always benefits from coordinated medical and dental care alongside therapy, and we work closely with primary care physicians, dietitians, dentists, and psychiatrists when team-based care makes sense.
Other places to look
Bulimia care is part of our broader Eating Disorder Therapy work. It also overlaps often with other concerns. If you want to read about how we work with a related condition, our Anorexia, Binge Eating, PTSD, or Neurodivergence-Affirming Therapy pages might be useful.
Signs of Bulimia
Bulimia signs go far beyond the binge-purge behaviors themselves. Many of the most telling signs happen between episodes.
Behavioral signs:
- Recurrent episodes of eating large amounts of food in a short window
- Frequent trips to the bathroom after meals
- Evidence of vomiting (smell, sound, or evidence in trash)
- Hoarding or hiding food
- Use of laxatives, diuretics, or diet pills
- Excessive or compulsive exercise
- Periods of restriction or fasting between binges
- Avoiding social events that involve food
Emotional and cognitive signs:
- Intense shame or secrecy around food and body
- Persistent preoccupation with weight, body, or food
- Mood changes around eating (anxiety before, distress after)
- Sense of being out of control during binges
- Feeling like food and body shape are central to self-worth
- Withdrawal from people who used to be close
Physical signs:
- Tooth erosion, sensitivity, or unusual cavities
- Swelling of the cheeks or jaw
- Calluses on the knuckles (Russell's sign)
- Disrupted menstrual cycles
- GI issues, including reflux, bloating, and constipation
- Dehydration, dizziness, or fatigue
- Irregular heartbeat or low blood pressure
When to Reach Out
If binge-purge episodes are happening regularly, if you've been hiding the disorder for a long time, or if you've tried to stop and the cycle keeps coming back, those are reasons enough to reach out. You don't need to wait until the medical signs become severe. Outpatient bulimia treatment works best when it starts early, before the disorder has caused more medical harm.
You also don't need a formal diagnosis to start. Many people who reach out aren't sure whether what they're experiencing fits a category. The early sessions of therapy include sorting that out together.
If you've been carrying this in silence, please know: the relief of finally being able to say it out loud, with someone who isn't going to judge or recoil, is often the first real shift in recovery. We hear this work all the time. We're not going to recoil.
What to Expect from Bulimia Care
Safety & assessment
Before we go deep, we make sure you're medically safe. That means coordinating with your medical team to evaluate vitals, electrolytes, dental health, and any medical concerns from purging behaviors. We also start understanding the cycle, your history, and what you want recovery to look like.
Stopping the binge-purge cycle
This is where the active work of interrupting the cycle happens. Building consistent, adequate eating to reduce binge urges. Skills for handling distress without purging. Planning for high-risk moments. For adolescents, FBT phase 1 puts parents in a supportive role around food. The cycle doesn't usually stop overnight, and that's expected.
Underlying work
As the cycle quiets, treatment shifts to what's been driving it: trauma, attachment patterns, perfectionism, identity, anxiety, depression, body image. This is usually the longest phase, and it's where lasting recovery is built. Without this work, bulimia tends to come back.
Recovery consolidation
Bulimia can have flare-ups during stress, transitions, or difficult life moments. The final phase consolidates skills, plans for setbacks, and helps you reclaim the parts of life the disorder has narrowed. Many of the people we work with continue with less frequent sessions to stay grounded long-term.
Wondering if what you're experiencing might be an eating disorder? Our broader guide can help you sort through it: recognizing the signs of an eating disorder.
Therapists Who Work with Bulimia
The clinicians below all have specific training and experience with bulimia and disordered eating. To meet our full team, including therapists who work across our other service areas, visit the Eating Disorder Therapy page.
Jamie L. Jones
Founder · LCPAT, LCPC, ATR-BC
Eating Disorder and Body Image Specialist who founded Juniper Blu in 2013 specifically to support people navigating eating disorders and self-harming behaviors. 17+ years of work with adults and adolescents around bulimia, the binge-purge cycle, and the secrecy and shame underneath it.
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Batya H. Erickson
Licensed Graduate Professional Counselor
Works through the lens of attachment theory to support people with bulimia, with attention to the emotional and relational patterns underneath the cycle. Draws on DBT, mindfulness-based therapy, and solution-focused approaches.
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Stacey C. Cooperman
Licensed Graduate Professional Counselor
Certified Trauma, Mindfulness, and Grief-Informed Professional with specialized training in bulimia and the trauma, anxiety, and depression that often sit underneath the cycle. Bilingual in English and French.
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Malca R. Gottlieb
Licensed Independent Clinical Social Worker
C-DBT certified and EMDR-trained, offering relationship-centered psychotherapy for bulimia, particularly when the cycle is intertwined with trauma, attachment wounds, or self-harming patterns. Works across the lifespan.
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Megan M. Herbets
Licensed Professional Counselor
Specialized eating disorder treatment training combined with advanced DBT, ACT, IFS, and psychodynamic psychotherapy. Works with adolescents and adults to interrupt the binge-purge cycle and address the body image and emotional patterns underneath.
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Michelle R. Scudero
Licensed Clinical Social Worker
Specialized training in eating disorders across the lifespan, including children, adolescents, adults, and individuals with special needs. Licensed in Maryland, DC, and Pennsylvania.
View full bio →Insurance, Cost & Where We Work
We see people via secure telehealth across Maryland, Washington DC, and Pennsylvania. We accept CareFirst directly, and for other insurance plans we offer concierge support to help you get the most out of your out-of-network benefits, including most PPO, HMO, POS, and federal plans.
For full details on insurance, payment, telehealth delivery, and the specific areas we serve, visit our Eating Disorder Therapy page or our Insurance & Payment Options page.
Bulimia Specific Questions
A few questions that come up specifically about bulimia care. For broader questions about insurance, telehealth, getting started, and our process more generally, those live on our Eating Disorder Therapy page.
You're not alone in this, and almost everyone we work with has spent years carrying bulimia in silence before reaching out. The first session isn't about disclosing everything at once. It's about meeting your therapist, sharing what you're comfortable sharing, and starting to feel out whether this is the right fit. You set the pace, and nothing has to come out before you're ready. The relief of finally being able to say it out loud, with someone who isn't going to judge or recoil, is often the first real shift.
No. Many people start therapy still in the middle of the cycle, and that's expected. The early work isn't about stopping immediately. It's about understanding what's been happening, building safety with your therapist, and getting medically evaluated. Stopping the binge-purge cycle is the work of treatment, not a prerequisite for starting it.
Both involve recurrent binge eating. The difference is that bulimia includes regular compensatory behaviors (vomiting, laxatives, fasting, excessive exercise) meant to "undo" the binges, while binge eating disorder doesn't. The medical risks differ as a result, and the treatment approach often differs as well, though both respond to CBT-E and trauma-informed care.
Strongly recommended, yes. Bulimia has real medical risks (electrolyte imbalances, heart complications, dental erosion, GI damage), and a baseline medical evaluation is part of safe outpatient care. We'll coordinate with your medical and dental providers as part of the treatment process. If you don't currently have a primary care provider or dentist, we can help you find one.
Because bulimia isn't a willpower problem. It's a cycle that's usually being kept in place by something underneath: trauma, anxiety, depression, attachment patterns, identity stress, or a nervous system that learned the cycle was a way to cope. Stopping the behavior on your own without addressing what's driving it usually just delays the next episode. Therapy works differently because it reaches what's underneath, not just the surface behavior.
Yes. Family-Based Treatment (FBT) for adolescent bulimia has been adapted successfully for telehealth, and several of our therapists work with teens and their families this way. Treatment usually involves the adolescent and parents together for parts of sessions, with parents taking a supportive role around food during early-phase recovery.
CBT-E for bulimia typically runs 20 sessions over four to five months. Many people benefit from longer treatment, particularly when bulimia intersects with trauma, anxiety, or attachment work. Recovery isn't linear. Bulimia can have flare-ups during stress, transitions, or difficult life events, and many of the people we work with continue with less frequent sessions to stay grounded long-term.
Yes. People with bulimia often have bodies that look "normal" from the outside, which is one of the reasons the disorder stays hidden so long. Body size is not a reliable indicator of bulimia. The medical and psychological severity of the disorder isn't determined by what your body looks like.
Start Bulimia Care with Juniper Blu Collective
If you've been carrying this in silence, you don't have to keep figuring it out alone. Reach out today and we'll talk through what specialized care could look like for you.
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