Once your child enters a treatment program, your work continues. Some forms of therapy require your participation, and others ask you to stay behind the scenes.
Know that your child needs you, no matter what kind of therapy is required. You can be a massive influence in your child’s recovery.
When Does Bulimia Start?
Researchers say most people with bulimia are diagnosed at age 18.  But for many people, the problem begins much earlier.
Doctors use a formal, technical set of guidelines to determine who does and does not have bulimia. Typically, people must demonstrate repeated episodes of the following:
- Bingeing: The person eats a large amount of food in a short time while feeling unable to stop. “Large” is subjective, but it usually means the person eats twice or three times as much in a binge as that person would eat in a typical meal.
- Purging: The person uses vomiting, laxatives, or exercise to remove the calories ingested in the purge.
Sometimes, teenagers have just some of these symptoms. Researchers say these teenagers have out-of-control eating episodes but don’t eat what an outsider would consider a “large” amount. 
A teenager like this has signs of bulimia. But it might not be enough to qualify the teen for a formal diagnosis.
Parents who spot these very early signs can get their children help when it matters most. Addressing a new habit can mean stopping it before it has the potential to cause long-term damage.
Recognize the Signs of Bulimia
While people with bulimia often want to lose weight, they may be at a normal weight or even overweight. They may also work hard to keep their habits a secret. For these reasons, bulimia can be hard to detect.  But it’s not impossible.
Your teen might do the following: 
- Hoard food: Stashes of snacks tucked away in secret places could indicate bulimia. You may also find empty wrappers, soiled dishes, or missing leftovers hidden around your home.
- Visit the restroom: After eating, your child will spend a long time in the bathroom purging. Some people run the water tap while purging to cover up the sound.
- Diet often: Your child may talk about wanting to lose weight, or the child might exercise excessively or quickly.
Bulimic episodes can wax and wane. For example, during stressful periods (when your child has a test or faces a significant relationship problem), your child may binge and purge a lot. But when the issues fade, your child may seem healthy once more.
If you think your child is struggling with bulimia, act on it. Some parents think they can’t address the problem until their children are very sick. But the sooner children get help, the better they can move into a healthy future.
How to Help Someone With Bulimia: Discuss the Topic
Bulimia thrives in silence. Your child may try hard to keep the issue a secret, and they may never come to you to talk about it. But you can have a gentle, honest chat that helps your child understand that you care and want to help.
Learn all you can about bulimia and how it’s treated before you start talking. Your child may have questions, and the more you know, the better.
As you talk, remember to do the following: 
- Be honest. Tell your child you’d like to discuss bulimia. Don’t tiptoe around the topic or open with a discussion of weight or appearance.
- Focus on yourself. Sentences that start with “You” can seem aggressive. Look for ways to put your observations first. For example, don’t say, “You always throw up, and it’s a sign of bulimia.” Instead, try, “I’ve noticed that you visit the bathroom during family dinners, and I am worried about bulimia.”
- Stay calm. Your child may deny what you’ve seen or get upset. Denial is part of the disease. Don’t react with anger.
You may need to talk about bulimia more than once. Some teenagers need time to process and think before they’re willing to act. Stick with it. Remind your child that the problem is too serious to ignore.
When to Get Professional Help
You’ve talked about bulimia with your child, and you’ve reached an understanding. Your child will admit that bulimia is a problem, and you are ready to facilitate the next steps. It’s time to work with professionals.
Most children and teenagers can recover from problems like bulimia.  But they often need comprehensive programs that include the following:
- Medical care, including nutritional support
You can start treatment by talking to your child’s doctor. But you may need to work with your insurance company to find an eating disorder treatment program covered by your plan.
Finding care can be stressful, and sometimes, doctors can help. Your child’s pediatrician can work with your insurance company to find the right program. If you’re overwhelmed by this important choice, don’t be afraid to ask for help.
The Role of Parents in Bulimia Recovery
When your child enrolls in eating disorder treatment, therapists, counselors, doctors, and nutritionists will take over. But you’ll still have a role to play. For example, some treatment models require parents to be integral parts of the treatment team.
These are some of the interventions your child’s treatment team might suggest:
Family-Based Treatment (FBT) for Bulimia
In this treatment model, parents sit at the center. The child works with a therapist, but the family reinforces those lessons at home. Again, the focus is recovery, not what caused bulimia or disordered eating.
FBT moves through three phases: 
- Parents are in charge. The parent cooks meals, supervises eating, and ensures the teen can’t purge.
- The teen takes over. When the acute symptoms have improved and the teen is eating a variety of foods regularly, parents step back.
- The family relaxes. Treatment winds down.
Relationship issues can trigger disordered eating, and this form of therapy aims to repair the damage. Your teen works with a therapist to identify troubling trends and resolve them. 
Sometimes, parents attend therapy sessions to help facilitate the work. And sometimes, they just support the child’s learning and development, even as their relationship changes.
Cognitive Behavioral Therapy (CBT)
During CBT, your child has private sessions with a counselor, and you’re rarely invited. But your child may have homework, including lessons that involve talking to you and changing your relationship. Your role is to support your child through these changes.
Surround Your Child With Support
You have a role to play even if you never attend a therapy session with your child. Ensure that your home is a safe recovery space by doing the following:
- Don’t discuss weight or appearance, including your own.
- Cook healthful meals that feature a variety of foods.
- Stay open and relaxed if your child wants to discuss therapy, but don’t push for details.
- Remind your child how proud you are.
If your child takes medications during recovery (and many do), ensure that doses are taken right on time and your child gets refills as needed. It’s a small step you can take to show your child you’re actively involved.
Many parents feel guilty and blame themselves for a child’s eating disorder.  Your feelings are valid, and you’re worthy of help.
Schedule counseling sessions to help you process what’s happening to your child. You’ll support your child better when you’re calm and focused.
- Eating Disorders. (n.d.). National Institute of Mental Health. Retrieved August 11, 2022.
- Hail L, Le Grange D. (2018). Bulimia nervosa in adolescents: prevalence and treatment challenges. Adolescent Health, Medicine, and Therapeutics; 9:11-16.
- Bulimia Nervosa. (2019). Raising Children Network. Retrieved August 11, 2022.
- For Parents: Eating Disorders in Teens. (2020). American Academy of Family Physicians. (2020, June 16). Retrieved August 11, 2022.
- Advice for Parents: Eating Disorders. (2022). NHS. Retrieved August 11, 2022.
- Eating Disorders in Teens. (2018). American Academy of Child and Adolescent Psychiatry. Retrieved August 11, 2022.
- Family-Based Treatment for Bulimia Nervosa. (n.d.). American Psychological Association. Retrieved August 11, 2022.
- Interpersonal Psychotherapy for Bulimia Nervosa. (n.d.). American Psychological Association. Retrieved August 11, 2022.
- Coelho, J.S., Suen, J., Marshall, S. et al. (2021). Parental experiences with their child’s eating disorder treatment journey. Journal of Eating Disorders; 9(92).