Bulimia Care
Specialized telehealth care for bulimia, for adults and adolescents across Maryland, Washington D.C., Virginia, and Pennsylvania. CBT-E, FBT, DBT, and trauma-informed approaches, with coordinated medical and dental care for the parts of bulimia that don’t show on the outside.
Juniper Blu Collective provides telehealth therapy for bulimia nervosa for adolescents and adults across Maryland, Washington, D.C., Pennsylvania, and Virginia. Our therapists draw on CBT, DBT, attachment-based, and trauma-informed approaches, and we coordinate with your medical providers and dietitian when team-based care makes sense. Bulimia is often hidden for years. Our work is to help you step out of the binge-purge cycle, understand what's been driving it, and build a relationship with food and your body that doesn't run on shame.
- Bulimia nervosa involves recurrent binge eating followed by behaviors meant to "undo" it, and it often happens at an average body weight, which is part of why it stays hidden.
- Dentists and doctors are sometimes the first to notice signs, such as worn tooth enamel or swollen salivary glands (NIMH).
- Research reviews find CBT for eating disorders has the broadest evidence for adults with bulimia, and family-based therapy for adolescents.
- You don't need a diagnosis, or to have stopped the behaviors, before reaching out.
Clinically reviewed by Jamie L. Jones, LCPC, LPC, LCPAT, ATR-BC, C-DBT, TBHP · Last updated: October 2026
If you need support right now:
- National Alliance for Eating Disorders Helpline: 1-866-662-1235 (Monday to Friday, 9am to 7pm ET), staffed by licensed therapists
- 988 Suicide & Crisis Lifeline: call or text 988, or chat at 988lifeline.org (24/7)
- If someone is in immediate danger or having a medical emergency, call 911
This page is about bulimia specifically. For how we work with eating disorders more broadly, including our team and how we coordinate with dietitians and medical providers, visit our Eating Disorder Therapy page.
What Is Bulimia Nervosa?
Bulimia nervosa is a serious but treatable eating disorder marked by recurrent episodes of binge eating, with a sense of losing control, followed by compensatory behaviors meant to "undo" what was eaten. Those behaviors can include self-induced vomiting, laxative or diuretic use, fasting, or excessive exercise. People with bulimia may be at a lower, average, or higher weight (NIMH).
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 it in silence, sometimes even from the 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 tends to protect itself by staying hidden, which is one reason people often live with it for years before getting care. Some of the things it commonly hides:
How often it's really happening
Many people with bulimia underestimate how often the cycle is happening, even to themselves. Naming what's actually going on, without judgment, is often the first step toward changing it.
The full range of compensatory behaviors
Vomiting is what most people picture, but bulimia also includes laxative or diuretic use, fasting between binges, and excessive exercise. Many people don't realize these 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 often something else: trauma, anxiety, depression, perfectionism, attachment wounds, identity stress, or a nervous system that learned the binge-purge cycle was a way to feel something, or to stop feeling something. Lasting change means reaching what's underneath.
How much physical harm is happening
Bulimia carries serious medical risks, including electrolyte imbalances, which can affect the heart, plus dental erosion, dehydration, and digestive problems (NIMH). Many people minimize these to themselves. Medical evaluation is part of safe care, and we coordinate with your medical providers so your body is looked after as healing happens.
The disorder itself
Many people with bulimia haven't told partners, family, friends, or even their primary care doctors. The first time saying it out loud often happens in a therapist's office. If that's where you are, you're not alone.
What Medical Signs Might Your Dentist or Doctor Notice First?
Dentists and primary care physicians are sometimes the first to notice signs of bulimia, because the disorder is so often hidden. If something came up at a routine appointment that you didn't fully understand at the time, this section may explain why.
Signs your dentist might notice
- Worn tooth enamel
- Teeth that are increasingly sensitive or decaying
- Swollen salivary glands in the neck and jaw area
- A chronically sore or inflamed throat
Signs your doctor might notice
- Electrolyte imbalances on routine bloodwork
- Dehydration
- Acid reflux and other digestive problems
- Heart rhythm changes linked to electrolyte imbalance
- Irregular menstrual cycles
Sources: National Institute of Mental Health (NIMH), eating disorders overview; clinical references on bulimia nervosa.
If a dentist or doctor has gently asked you about eating
It's usually because they noticed something. Their job isn't to shame you. It's to help. 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 Is Bulimia Different from Binge Eating Disorder?
Both involve recurrent binge eating with a sense of losing control. The key difference is that bulimia includes compensatory behaviors afterward, and binge eating disorder does not (NIMH).
| Bulimia nervosa | Binge eating disorder | |
|---|---|---|
| Recurrent binge eating | Yes | Yes |
| Compensatory behaviors (purging, fasting, excessive exercise) | Yes, regularly | No |
| Medical risks tied to purging (electrolytes, dental erosion) | Yes | Not from purging; other health effects can occur |
| Therapy with strong research support | CBT for eating disorders (adults); family-based therapy (adolescents) | CBT and other psychotherapies |
Sources: NIMH; Monteleone et al., meta-review of eating disorder treatments, Neuroscience & Biobehavioral Reviews, 2022. Read more on our binge eating page.
How Does Juniper Blu Approach Bulimia Care?
Bulimia care works best when the approach fits what's actually keeping the cycle going, so the work is shaped to you. A 2022 meta-review of eating disorder treatment research found that CBT focused on eating disorders has the broadest evidence for adults with bulimia, and family-based therapy for adolescents (Neuroscience & Biobehavioral Reviews). Depending on what you need, our therapists draw on:
- Cognitive Behavioral Therapy (CBT): interrupting the binge-purge cycle, building regular eating, and working with the thoughts and patterns that keep it going
- Dialectical Behavior Therapy (DBT): especially helpful when bulimia is tied to intense emotions, distress tolerance, or self-harming patterns
- Trauma-informed care: for the many people whose bulimia developed alongside or after difficult experiences
- Attachment-based therapy: for the relational and emotional patterns often underneath the cycle
- Art therapy: for people who benefit from non-verbal ways of working with body image, identity, and difficult emotions
- Neurodivergence-affirming care: for people whose bulimia intersects with autism, ADHD, or sensory differences
If we think a structured CBT-E program or family-based treatment would serve you or your teen better, we'll tell you and talk through next steps together. We coordinate with primary care physicians, psychiatrists, and dietitians when team-based care makes sense, and we encourage regular dental care.
If bulimia is causing serious medical complications, or the cycle is happening many times a day despite outpatient support, a higher level of care such as an intensive outpatient or residential eating disorder program may be the right starting point. We can help you think that through.
Other places to look
Bulimia care is part of our broader Eating Disorder Therapy work. If a related concern fits better, see our Anorexia, Binge Eating, PTSD, or Neurodivergence-Affirming Therapy pages.
What Are the Signs of Bulimia?
Signs of bulimia go beyond the binge-purge behaviors themselves, and many of the most telling ones happen between episodes. These are common signs, not a way to diagnose yourself or someone else.
Behavioral signs:
- Recurrent episodes of eating large amounts of food in a short window
- Frequent trips to the bathroom right after meals
- Hiding food or eating in secret
- Use of laxatives or diuretics
- 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, such as anxiety before and distress after
- A sense of being out of control during binges
- Feeling like body shape and weight are central to self-worth
- Pulling away from people who used to be close
Physical signs:
- Worn tooth enamel, sensitivity, or decay
- Swelling in the neck and jaw area
- Irregular menstrual cycles
- Acid reflux and digestive problems
- Dehydration, dizziness, or fatigue
Not sure what you're noticing fits bulimia? Our guide to recognizing the signs of an eating disorder can help you sort through it.
When Should You Reach Out About Bulimia?
If binge-purge episodes are happening regularly, if you've been hiding it 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 medical signs become severe, and reaching out earlier means less time carrying the physical and emotional strain alone.
You also don't need a formal diagnosis to start. Many people aren't sure whether what they're experiencing fits a category, and the early sessions include sorting that out together.
If you've been carrying this in silence, the relief of finally saying it out loud, with someone who isn't going to judge you, can be a real turning point. We hear this often, and we're not going to recoil.
What to Expect from Bulimia Care
Safety and getting started
Early on, we make sure your body is being looked after. That usually means a check-up with your primary care provider, and we coordinate with your medical team as needed. At the same time, your therapist starts understanding the cycle, your history, and what you want recovery to look like.
Interrupting the binge-purge cycle
This is where the active work of interrupting the cycle happens: building regular, adequate eating to reduce binge urges, learning skills for handling distress without purging, and planning for high-risk moments. For teens, parents are often involved in a supportive role. The cycle doesn't usually stop overnight, and that's expected.
Working with what's underneath
As the cycle quiets, the work shifts to what's been driving it: trauma, attachment patterns, perfectionism, identity, anxiety, depression, or body image. This is often the longest phase, and it's where lasting change is built.
Staying steady
Bulimia can flare during stress, transitions, or hard life moments. The final phase consolidates skills, plans for setbacks, and helps you reclaim the parts of life bulimia has narrowed. Many people continue with less frequent sessions for ongoing support.
Therapists Who Work with Bulimia
The therapists below work with eating disorders, including bulimia. To meet our full team, visit the Eating Disorder Therapy page.
Jamie L. Jones
Founder · LCPC, LPC, LCPAT, ATR-BC, C-DBT, TBHP
Eating Disorder and Body Image Specialist who founded Juniper Blu in 2013 to support people navigating eating disorders and self-harming behaviors. 17+ years of clinical experience. Sees adolescents and adults in Maryland, Washington, D.C., Pennsylvania, and Virginia.
View full bio →
Michelle R. Scudero
LCSW (MD, D.C., PA)
Training in eating disorders across the lifespan, including adolescents, adults, and individuals with special needs, with a background in medical social work. Licensed in Maryland, Washington, D.C., and Pennsylvania.
View full bio →
Malca R. Gottlieb
LICSW (D.C.) · LCSW-C (MD) · C-DBT
EMDR-trained, offering relationship-centered psychotherapy for eating disorders, particularly when the cycle is intertwined with trauma, attachment wounds, or self-harming patterns. Works across the lifespan in Maryland and Washington, D.C.
View full bio →
Megan M. Herbets
LPC (D.C.) · LCPC (MD)
Eating disorder treatment training combined with advanced DBT, ACT, IFS, and psychodynamic psychotherapy. Works with adolescents and adults on the binge-purge cycle and the body image and emotional patterns underneath. Maryland and Washington, D.C.
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Batya H. Erickson
LGPC (MD, D.C.) · NCC
Works through the lens of attachment theory with people navigating eating disorders, with attention to the emotional and relational patterns underneath the cycle. Draws on DBT, mindfulness-based therapy, and solution-focused approaches.
View full bio →
Stacey C. Cooperman
LGPC (MD, D.C.) · NCC
Certified Trauma Professional, Certified Mindfulness-Informed Professional, and Certified Grief-Informed Professional who works with eating disorders and the trauma, anxiety, and depression that often sit underneath. Bilingual in English and French.
View full bio →Payment & Where We Work
We see people by secure telehealth across Maryland, Washington, D.C., Pennsylvania, and Virginia. In Pennsylvania, bulimia care is with Jamie L. Jones or Michelle R. Scudero; in Virginia, with Jamie L. Jones. See our Maryland, Washington, D.C., Pennsylvania, and Virginia pages for more.
We offer concierge support to help you make the most of your out-of-network benefits. We do not accept Medicaid or Medicare at this time. Visit our Payment Options page for full details.
Bulimia-Specific Questions
A few questions that come up specifically about bulimia care. For broader questions about telehealth and getting started, see our Eating Disorder Therapy page.
You're not alone. Many people carry bulimia in silence for years 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 getting a sense of whether it's the right fit. You set the pace.
No. Many people start therapy while still in the middle of the cycle, and that's expected. The early work is about understanding what's been happening, building trust with your therapist, and getting medically checked. Interrupting the binge-purge cycle is the work of treatment, not a requirement for starting it.
Both involve recurrent binge eating with a sense of losing control. Bulimia also includes regular compensatory behaviors, such as purging, fasting, or excessive exercise, meant to "undo" the binges, and binge eating disorder does not. Because of that, the medical risks differ, and CBT has strong research support for both.
A medical check-up is strongly recommended. Bulimia can cause electrolyte imbalances, dehydration, and dental erosion, so a baseline evaluation with your primary care provider is part of safe outpatient care, and regular dental care helps too. With your consent, we coordinate with your medical providers as part of treatment.
Because bulimia isn't a willpower problem. The cycle is often held in place by something underneath, such as trauma, anxiety, depression, attachment patterns, or a nervous system that learned the cycle was a way to cope. Therapy looks at what's keeping the cycle going, not only the behavior itself.
Yes. Jamie L. Jones, Michelle R. Scudero, Malca R. Gottlieb, Megan M. Herbets, Batya H. Erickson, and Stacey C. Cooperman work with adolescents. Parents are often involved in a supportive role. Research supports family-based therapy for adolescents with bulimia, and if we think a dedicated family-based program would serve your teen better, we'll talk that through with you.
It varies with how long bulimia has been present, its medical impact, and what else is going on, such as trauma or anxiety. Your therapist will talk through a realistic plan early on. Recovery isn't linear, and many people continue with less frequent sessions for ongoing support.
Yes. People with bulimia may be at a lower, average, or higher weight, which is one reason it stays hidden so long. Body size is not a reliable indicator of bulimia or of how serious it is.
Visit our contact page or call (202) 244-0818. Some of our therapists have openings for online therapy right now, while others are booking from a waitlist. We'll talk through what you're experiencing and help you find a therapist who fits, with no pressure to commit.
If you need support right now:
- National Alliance for Eating Disorders Helpline: 1-866-662-1235 (Monday to Friday, 9am to 7pm ET)
- 988 Suicide & Crisis Lifeline: call or text 988 (24/7)
- Medical emergency: call 911
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.
Now welcoming new patients. Some of our therapists have openings for online therapy right now, while others are booking from a waitlist. Reach out and we'll match you with a therapist who has availability, or add you to the waitlist for a specific therapist.
Connect With Usor call (202) 244-0818
This page is for general education and is not a substitute for individualized care. Reading it does not create a therapist–patient relationship. If you're in crisis, call or text 988 or call 911.