Bulimia Nervosa

What Is Bulimia Nervosa?

Bulimia nervosa (often just called bulimia) is an eating disorder where someone gets caught in a cycle of binge eating followed by attempts to “make up” for it, like self-induced vomiting, over-exercising, or using laxatives.

During a binge, a person may quickly eat large amounts of food, often feeling out of control. Afterward, they may feel guilty, ashamed, or afraid of gaining weight, which leads to compensating behaviors.

Unlike some other eating disorders, people with bulimia nervosa often have a body weight that seems normal or healthy, making it harder to notice.

But even if someone looks fine on the outside, bulimia can cause serious health issues, like dehydration, digestive problems, and emotional struggles. Getting professional help is essential because bulimia can be life-threatening without proper care and treatment.

Eating Disorder Overview

An eating disorder is a mental illness that can cause a person to be preoccupied with their weight, food intake, and body shape. As a result, it forms an unhealthy relationship between food and body image.

Eating disorders are more than just about weight loss or gaining weight—they are about how a person feels about themselves and their body.

Bulimia nervosa is one type of eating disorder that involves bingeing and purging.

Bulimics use binging (eating large amounts of food at once) and purging (vomiting or using laxatives after eating) to control their weight or prevent weight gain. They may also engage in excessive exercise or fasting to compensate for binging.

Bulimia VS Anorexia Nervosa

Bulimia and anorexia nervosa have a lot of similarities. Both disorders involve a significant distortion of body image, food and weight concerns, and an obsession with dieting.

However, there are some key differences between bulimia and anorexia:

• Eating Behaviors: In bulimia nervosa, a person eats large amounts of food, often high in calories, and then tries to prevent weight gain through behaviors like purging. In anorexia nervosa, a person avoids eating or eats very little, leading to extreme weight loss and malnutrition.
• Body Weight and Self-Image: People with bulimia usually try to maintain an average body weight. Alternatively, people with anorexia often have a distorted body image, believing they’re overweight even when they’re dangerously underweight.
• Purging Behaviors: People with bulimia cycle between overeating and purging, while people with anorexia mainly restrict their food intake but may sometimes engage in binge-purge episodes.
• Medical Complications: Both disorders can cause serious health problems, but anorexia has a higher mortality rate than bulimia.

Symptoms of Bulimia Nervosa

Bulimia nervosa is a severe mental health condition that affects people physically, mentally, and emotionally.

While these symptoms are not exclusive to bulimia nervosa, they are common among those who suffer from the illness. People who experience them should seek help from a licensed therapist or physician.

Physical Symptoms of Bulimia Nervosa

Bulimia nervosa can lead to a range of physical symptoms, many of which result from repeated purging and the strain placed on the body. These symptoms can significantly impact a person’s overall health and well-being.

Common physical symptoms of bulimia include:

• Dental problems: Acid from vomiting wears down tooth enamel, causing cavities and sensitivity.
• Swollen salivary glands: Frequent vomiting can cause swelling, making it hard to chew or speak.
• Dehydration: Fluid loss due to vomiting and laxative use can cause dry mouth, skin, and low blood pressure.
• Laxative dependency: Overuse of laxatives, enemas, or diuretics can damage the digestive system and lead to dependency.
• Diarrhea: Excessive laxative or diuretic use can result in chronic diarrhea, which exacerbates dehydration.
• Vomiting-related injuries: Self-induced vomiting can cause knuckle calluses (“Russell’s sign”) and sore throat.
• Electrolyte imbalance: Repeated purging disrupts the body’s minerals, increasing the risk of heart issues.
• Dizziness and fainting: Dehydration and nutrient loss can lead to lightheadedness and fainting spells.
• Heart problems: Purging can strain the heart, causing an irregular heartbeat or, in severe cases, heart failure.
• Gastrointestinal distress: Repeated purging may lead to stomach pain, bloating, and constipation.
• Frequent bathroom trips: Individuals with bulimia often excuse themselves after meals to purge.
• Muscle weakness: Lack of nutrients can cause fatigue, muscle cramps, and overall weakness.
• Dry skin and brittle nails: Malnutrition and dehydration can lead to dry, flaky skin and weakened nails.
• Acid reflux: Persistent vomiting can lead to acid reflux and damage to the esophagus.

Mental and Emotional Symptoms

People with bulimia nervosa often experience intense emotional struggles that contribute to and reinforce their disordered eating habits. These emotional symptoms can be just as damaging as the physical ones, affecting mental health and everyday life.

Living with bulimia nervosa involves more than physical challenges—it also creates a cycle of negative thoughts and feelings that can make recovery seem overwhelming.

Common emotional side effects of bulimia can include:

• Distorted body image: Believing they are overweight even when they’re not or thinking certain body parts are too large despite being a healthy size.
• Low self-esteem: Struggling with negative self-worth and poor body image, often doubting compliments or positive feedback from others.
• Fear of weight gain: Experiencing an intense fear of gaining weight, leading to purging after small amounts of food or over-exercising.
• Depression and anxiety: Feeling depressed or anxious, often due to hiding binge and purge behaviors or worrying about weight changes.
• Social isolation: Withdrawing from friends and family out of shame or avoiding social situations involving food.
• Loss of control: Unable to stop eating during a binge, even when not physically hungry.
• Guilt and shame: Experiencing intense guilt after bingeing and purging can reinforce the cycle of disordered eating.

What Causes Bulimia?

Bulimia affects people of all ages, races, and genders. However, some people are more likely to develop it than others.

Risk factors for developing bulimia include:

• History of dieting: Regular dieting or restrictive eating can increase the risk of bingeing and purging behaviors.
• Body dissatisfaction: Feeling unhappy with body shape or weight can lead to disordered eating to “fix” perceived flaws.
• Low self-esteem: A negative self-image and feelings of inadequacy can contribute to the development of bulimia.
• Perfectionism: Holding oneself to impossible standards can lead to cycles of guilt and shame when those expectations aren’t met.
• Trauma or abuse: Past experiences of trauma, abuse, or neglect can increase vulnerability to eating disorders as a way to cope.
• Mental health conditions: Anxiety, depression, and obsessive-compulsive tendencies often co-occur with bulimia nervosa.
• Family history: Having a close family member with an eating disorder or mental health condition can increase the likelihood of developing bulimia.
• Societal pressures: Cultural messages that promote thinness as the ideal body type can lead to unhealthy eating behaviors.
• Involvement in certain activities: Participation in activities where body weight and appearance are emphasized, such as gymnastics, dance, or wrestling, can increase the risk.
• Peer pressure: Social environments that focus on appearance or dieting can encourage disordered eating behaviors.
• Bullying or teasing: Experiencing bullying, especially about weight or appearance, can contribute to body image issues and lead to disordered eating as a coping mechanism.

Understanding these risk factors can help with early identification and prevention efforts, especially for those who may be vulnerable to developing bulimia nervosa.

Bulimia Data and Statistics

• According to the Bulimia Project, approximately 0.3% of the U.S. population is affected by bulimia nervosa, with the disorder being five times more common in women than in men.
• The National Eating Disorders Association (NEDA) estimates that 1% of young women and 0.1% of young men will have bulimia nervosa at some point in their lifetime.
• NEDA also reports that eating disorders (including bulimia nervosa) have the second highest mortality rate of all mental health disorders, surpassed only by opioid addiction.

Diagnosis and Treatment

Bulimia is a severe mental illness that can cause a tremendous amount of damage to the body and mind. It is important to understand the symptoms and signs of bulimia and how it is diagnosed and treated.

How Is Bulimia Diagnosed?

Bulimia nervosa is diagnosed by a healthcare professional through a combination of physical assessments, medical history, and psychological evaluations.

The diagnosis typically involves:

• Binge-purge cycle: Identifying episodes of binge eating followed by behaviors like vomiting or laxative use.
• Frequency: Tracking frequency of episodes. (Episodes must occur at least once a week for three months to meet diagnostic criteria.)
• Mental health evaluation: Assessing thoughts about body image, weight, and self-worth.
• Physical examination: Checking for physical signs of bulimia, such as dental erosion, dehydration, and electrolyte imbalances.

A thorough diagnosis helps ensure the person receives appropriate treatment to address the disorder’s emotional and physical aspects.

Therapy for Bulimia Treatment

After diagnosing someone with bulimia nervosa, doctors then move on to treatment options for this disorder. Most people with bulimia nervosa require psychotherapy sessions with a therapist specializing in eating disorders and medical care.

Common therapy styles used in treating bulimia include:

• Cognitive Behavioral Therapy (CBT): Focuses on identifying and changing negative thought patterns and behaviors related to body image, food, and self-worth.
• Dialectical Behavior Therapy (DBT): Helps individuals develop distress tolerance, emotional regulation, and coping strategies to reduce bingeing and purging behaviors.
• Interpersonal Therapy (IPT) Focuses on improving relationships and communication and addressing life events or conflicts that may contribute to disordered eating.
• Family-based therapy (FBT): This approach, often used with adolescents, involves family members in the recovery process to provide support and structure around eating habits.
• Nutritional Counseling: Provides education on healthy eating habits and helps individuals rebuild a positive relationship with food.
• Group Therapy: Offers peer support and helps individuals connect with others who have similar experiences, fostering a sense of community and shared understanding.
• Psychodynamic Therapy: Explores underlying emotional conflicts and past experiences that may contribute to disordered eating.
• Medication-Assisted Therapy: In some cases, medications like antidepressants may be prescribed to help manage co-occurring anxiety or depression.

Medical Care

Medical care usually plays a crucial role in treating bulimia nervosa, especially when the disorder leads to severe physical health complications.

In some cases, people may require intensive care or hospitalization to address urgent medical concerns related to the disorder.

Hospitalization may be necessary if a person is experiencing life-threatening symptoms, such as severe dehydration, electrolyte imbalances, or heart irregularities. These complications can arise due to frequent purging, extreme malnutrition, or prolonged laxative misuse.

In a hospital or intensive care setting, a specialized team of doctors, nurses, and dietitians monitors vital signs, provides IV fluids to rehydrate the body, and corrects any nutrient or electrolyte imbalances.

The medical team also addresses co-occurring issues, such as gastrointestinal damage, kidney problems, or cardiac complications.

Once the immediate health concerns are managed, the focus typically shifts to long-term recovery, which includes ongoing therapy, nutritional rehabilitation, and emotional support.

How Friends and Family Members Can Help

Bulimia can be a tricky thing for a loved one to deal with. It’s not something that happens overnight and doesn’t just disappear.

Bulimia is an illness; like any mental illness, it takes time and patience to get better. You can support your loved one by being there for them and helping them through this difficult time.

If you’re worried about a loved one who might be struggling with bulimia, here are some important things to keep in mind:

Do:

• Talk about it. You might be afraid of bringing up the topic of bulimia, but don’t worry—it’s not taboo! You’re doing your loved one a favor by being open with them about what’s going on in their lives, whether it’s good or bad news. (Remember to be considerate of their feelings)
• Be supportive. Listen without judgment if your loved one wants to talk about their feelings. Let them know you’re there for them and that they don’t have to do this alone.
• Help them find treatment. If your loved one is ready to seek help but doesn’t know how or where to start, offer to help them look for treatment options in your area.
• Encourage healthy eating habits. Ensure your loved one eats enough food at each meal so they don’t feel like they have to purge after overeating—this may help prevent them from engaging in unhealthy compensatory behaviors.
• Be a good listener. Listen to them when they tell you they’re struggling with their eating habits or how they feel about food and their body.
• Show interest. Ask if there’s anything more you can do to help them feel less alone or anxious during this difficult time.
• Be a friend. Offer company when they’re feeling down (or just bored) so that they won’t resort to binge eating to cope.

Don’t:

• Don’t judge. Bulimia is not a choice; it is a serious mental illness.
• Don’t make comments about weight, eating, or dieting. Eating disorders are very sensitive topics for people, and it’s important to avoid saying anything that seems negative.
• Don’t force them into treatment, but let them know you’re there for them and care about their well-being—even if it means keeping certain information private until they’re ready to share it with others.
• Don’t make comments that imply they are at fault or need help because of their choices. Instead, talk about how much you love and want them healthy—this will go a long way!
• Don’t give up on them if they relapse—it happens, but keep trying different approaches until something works!

It’s also important to understand that one cannot recover from bulimia overnight or even in a few weeks. Eating disorders are complex and require much work and support from loved ones and the person with the disorder to treat successfully.

Get Help for Bulimia Nervosa

If you or a loved one is struggling with bulimia nervosa, there’s no need to keep it a secret. Help is available for you.

You can talk to your doctor or healthcare professional about available treatment options. You can also check out SAMHSA’s online treatment locator or call 1-800-662-HELP (4357) to find a treatment facility near you.

Written by

Jessica Miller

Editorial Director

Jessica Miller is the Editorial Director of Addiction Help. Jessica graduated from the University of South Florida (USF) with an English degree and combines her writing expertise and passion for helping others to deliver reliable information to those impacted by addiction. Informed by her personal journey to recovery and support of loved ones in sobriety, Jessica's empathetic and authentic approach resonates deeply with the Addiction Help community.

Reviewed by

• Fact-Checked
• Editor

Kent S. Hoffman, D.O.

Founder & Chief Medical Officer

Kent S. Hoffman, D.O. has been an expert in addiction medicine for more than 15 years. In addition to managing a successful family medical practice, Dr. Hoffman is board certified in addiction medicine by the American Osteopathic Academy of Addiction Medicine (AOAAM). Dr. Hoffman has successfully treated hundreds of patients battling addiction. Dr. Hoffman is the Co-Founder and Chief Medical Officer of AddictionHelp.com and ensures the website’s medical content and messaging quality.