What Is Bulimia Nervosa? Symptoms, Causes, Diagnosis, Treatment, and Prevention Everyday Health MenuNewslettersSearch Bulimia

What Is Bulimia Symptoms Causes Diagnosis Treatment and Prevention

By Julie Lynn MarksMedically Reviewed by Allison Young, MDReviewed: October 13, 2020Medically ReviewedMany people with bulimia use self-induced vomiting as a way to purge calories.iStockBulimia is a serious eating disorder that involves both bingeing and purging. “Bingeing” means you eat a large amount of food in a short period of time. “Purging” is an unhealthy way to rid your body of those extra calories. (1) People with bulimia sometimes make themselves vomit to eliminate the calories they consume. But that isn’t the only way to purge. They may also follow a strict diet, fast, exercise excessively, or use laxatives, pills, or enemas. The harmful cycle of bingeing and purging can affect both physical and mental health. (2) The bingeing and purging cycle isn’t even an effective way to lose weight. Indeed, many people with bulimia actually gain weight over time. Your body starts absorbing calories from the moment you put food in your mouth. If you vomit right after a very large meal, you typically eliminate less than 50 percent of the calories you consumed. Laxatives get rid of 10 percent of the calories you eat. While purging may make you weigh less temporarily, it’s most likely water loss and not true weight loss. (2)

Signs and Symptoms of Bulimia

Signs and symptoms of bulimia can vary from person to person. Some common red flags include: (1,2)Eating large amounts of food in isolationBeing unable to control how much you eatVomiting after mealsUsing laxatives, diuretics, enemas, or other pills after eating when they’re not neededExercising or dieting excessivelyExperiencing frequent weight changesSuffering from fainting or dizziness spellsDisplaying physical changes caused by vomiting, such as bad breath, damaged teeth, swelling around the cheeks, broken blood vessels in the eyes, or calluses on the knuckles (from gagging)Feeling constipated or bloatedFeeling tiredExperiencing menstrual period changesEngaging in repetitive, secretive, or antisocial behaviors related to foodBeing intensely concerned with body weightUsing dietary supplements incorrectly

Causes and Risk Factors of Bulimia

Doctors aren’t sure exactly what causes bulimia. Your genes, family history, mental health status, life experiences, self-esteem, and other factors may all play a role. (3) Scientists are also studying whether certain chemical changes in the brain, such as changing levels of serotonin, may affect a person’s risk of developing eating disorders like bulimia. (3) Some factors may make you more likely to develop bulimia. These include: (1,2)Having a poor body image or low self-esteemExperiencing stressful life changesHaving a history of substance abuseBeing diagnosed with depression, anxiety, or another mental health disorderExperiencing trauma or abuse or suffering from post-traumatic stress disorder (PTSD)

How Is Bulimia Diagnosed

Your physician will likely use the criteria listed in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to diagnose your condition. Among the criteria in the DSM-5 are: (4)Recurrent episodes of binge eatingRecurrent inappropriate behavior designed to prevent weight gain, including using vomiting, laxatives, diuretics, or other medicationBehavior occurs, on average, at least once a week for three months

When to See a Doctor About Your Condition

If you think you have bulimia, it’s important to be honest with your doctor about your eating habits and weight loss methods. This eating disorder can cause dangerous effects on your body if it’s not treated. Your healthcare provider may want to perform a physical exam, a blood or urine test, and a psychological evaluation. (3) You may also need to have a blood test (including a particular blood test called a basic metabolic panel) or an electrocardiogram (ECG) to see if the repeated bingeing and purging episodes have affected certain organs in your body. (3) A good first step is to consult your primary care physician. He or she can then refer you to a more specialized doctor. Additionally, the National Eating Disorders Association offers a toll-free hotline at 800-931-2237. (2)

Prognosis of Bulimia

Many people with bulimia will improve with the right treatment, but some may get better and then relapse again. Studies show about 50 percent of those battling bulimia will completely recover with treatment, 30 percent will experience a partial recovery, and between 10 percent and 20 percent will still have symptoms. (5)

Duration of Bulimia

The duration of bulimia varies from person to person. While roughly half of patients will fully recover from the condition within 10 years, others won’t. For many, bulimia is a lifelong struggle. Symptoms may come and go or be constant. (6)

Treatment and Medication Options for Bulimia

Several options are available to help people with bulimia. Sometimes these approaches are used together for better results. Common treatments include: (1,4)Psychotherapy Different forms of therapy and counseling can improve symptoms of bulimia. Talking to a mental health professional may help you identify your unhealthy behaviors and come up with ways to eliminate them. Sometimes family members are encouraged to participate in therapy sessions.Nutritional counseling A dietitian can help you develop a healthy eating plan.Hospitalization If your condition is severe, you may need to be hospitalized until you get better. You may relapse after treatment, but the good news is you can recover from bulimia. After proper treatment, most girls and women are able to eat and exercise in healthy ways. (3)

Medication Options

Antidepressant medications can be used along with therapy. The U.S. Food and Drug Administration (FDA) has approved Prozac (fluoxetine), which is a selective serotonin reuptake inhibitor (SSRI), to treat bulimia in adults. (1,3)

Alternative and Complementary Therapies

Some people with bulimia look to alternative therapies to help ease their symptoms and lower their stress levels. Common approaches include: (7)AcupunctureMassageMeditation, tai chi, or yoga

Prevention of Bulimia

While there’s no surefire way to prevent bulimia, adopting healthy habits and seeking professional help early on can improve the outlook for you or someone you know who’s battling bulimia. Here are some tips: (1,8)Try to avoid talking about your weight.Be mindful of your triggers and steer clear of them; examples may include social media or fashion magazines, certain interactions with highly critical people in your life, etc. It is different for everyone, but it is important to be mindful if certain experiences lead you to be more likely to binge or purge.Focus less on your weight and more on maintaining a healthy lifestyle.Avoid unhealthy weight-control measures, such as fasting, laxatives, or supplements.Talk to your doctor if you have any early signs or symptoms of bulimia.Seek treatment for underlying conditions, such as depression.Ask a loved one for support.Educate yourself about unrealistic body expectations portrayed by the media.Talk to friends or family members if you think they have food issues.

Complications of Bulimia

Bulimia can have dangerous effects on your body. In certain cases, the eating disorder can even lead to death. Some risks that can develop from bulimia include: (1,9)Severe dehydrationElectrolyte imbalances, which can lead to heart or kidney failureStomach damage or ulcersIrregular periods (in women)Tooth decayChronic sore throatIndigestion, heartburn, or acid refluxConstipation, diarrhea, or other problems with bowel movementsOsteoporosisInfertility in men and women

Research and Statistics Who Has Bulimia

Anyone can suffer from bulimia. It does, however, tend to affect more women than men. Up to 2 percent of women have this eating disorder. (3) Girls and younger women are more likely to have bulimia than older women. Women usually develop bulimia around age 18 or 19. Still, researchers are finding that eating disorders are beginning to affect more older members of the population. According to a study cited by the U.S. Department of Health and Human Services, 13 percent of women over age 50 had some disordered eating pattern. (3)

BIPOC and Bulimia

Historically, eating disorders have been portrayed as a problem affecting young, heterosexual, white women. In fact they affect people of all races and ethnicities. (10)

Black and Hispanic Americans and Bulimia

A study published in 2011 found that Black teenagers were 50 percent more likely than white teens to exhibit symptoms of bulimia. In another study, researchers found Hispanic adolescents were significantly more apt to suffer from bulimia compared with non-Hispanics. Experts say eating disorders may be partially due to environmental stressors, such as abuse, poverty, or racism. Because women from the Black, Indigenous, and People of Color (BIPOC) communities are exposed to more of these stressors, they may be more susceptible to disorders like bulimia. (10)

Related Conditions and Causes of Bulimia

Sometimes people with bulimia have other eating disorders or medical problems. Conditions that may be related to bulimia include: (7,11)Anorexia This disorder involves extreme calorie restriction.Exercise bulimia People with this condition use physical activity along with other means, such as vomiting and diarrhea, to “pay” for overeating.Rumination disorder It involves repeatedly regurgitating food after eating, but it’s not caused by an eating disorder.Binge-eating disorder This means you regularly eat too much and feel a lack of control over your eating, but you don’t try to purge the food.Depression This mental health disorder is characterized by a depressed mood or loss of interest in activities.PTSD This condition happens when a person has a reaction to a traumatizing or upsetting event.

Resources We Love

Your journey with bulimia will require lots of support and resources. Here are Everyday Health’s top recommended organizations, articles, and websites with the information and support you may need.

Favorite Organizations for Essential Bulimia Info

National Eating Disorders Association (NEDA) NEDA is the largest nonprofit organization dedicated to supporting individuals and families affected by eating disorders. They provide information and support to build a community of hope. We especially love their online screening tool, which can help you determine if you need to seek professional help. The Alliance for Eating Disorders Awareness This organization is a national, nonprofit dedicated to providing programs and activities aimed at outreach, education, early intervention, and advocacy for eating disorders. Office on Women’s Health This government-run site provides a wealth of information about bulimia and treatment options. Academy for Eating Disorders (AED) The AED is a professional organization that promotes excellence in research, treatment, and prevention of eating disorders.

Favorite Online Support Network

ANAD ANAD is an organization committed to providing free services that are accessible to all. We love their recovery mentor program, which matches you with an individual who has recovered from an eating disorder and can help support you. Eating Disorder Hope Eating Disorder Hope offers online support groups dedicated to providing assistance and encouragement. The groups are led by licensed professional counselors.

Favorite App

Recovery Record: Eating Disorder Management This app is designed to help you manage your recovery from eating disorders. It lets you track your mood and meals. You can also connect with your therapist or dietitian and receive feedback.

Favorite Blogs

National Eating Disorders Association Blog The NEDA’s blog features personal accounts of people who’ve battled eating disorders and recovered. There are also entries that provide educational information about eating disorders.

Favorite Resource for Becoming an Advocate

Eating Disorders Coalition (EDC) The EDC’s mission is to advance the federal recognition of eating disorders as a public health priority. They build relationships with Congress, federal agencies, and national and local organizations to advocate for awareness.

Favorite Annual Meetings

International Conference on Eating Disorders (ICED) The AED hosts this annual scientific conference, which highlights research and education related to eating disorders. Experts from around the world attend to learn about emerging breakthroughs in the field.

Favorite Retreats

The Meadows Ranch This 50-acre property located in Arizona provides a relaxing retreat so you can focus on regaining your health. Their experts specialize in combining approaches to treat a range of eating disorders, including bulimia. Representatives work with your health insurance company to make your treatment as affordable as possible.

Editorial Sources and Fact-Checking

Bulimia Nervosa: Symptoms and Causes. Mayo Clinic. May 10, 2018.Bulimia Nervosa: Signs, Symptoms, Treatment, and Self-Help. HelpGuide. September 2020.Bulimia Nervosa. U.S. Department of Health and Human Services Office on Women's Health. August 28, 2018.Bulimia Nervosa. National Eating Disorders Association.Bulimia Nervosa: Outlook/Prognosis. Cleveland Clinic. December 12, 2019.Smith K. The Aftermath of Eating Disorders: Long-Term Effects of Bulimia. Psycom. November 25, 2018.Eating Disorders. Mayo Clinic. February 22, 2018.Prevention. National Eating Disorders Association.Bulimia Nervosa. National Eating Disorders Collaboration.People of Color and Eating Disorders. National Eating Disorders Association.Franco KN, et al. Eating Disorders. Cleveland Clinic. July 2017.Show LessNEWSLETTERS

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