Bulimia nervosa is an eating disorder marked by uncontrollable binge-eating and subsequent purging by vomiting or using laxatives or diuretics. Other compensatory behaviors after binging include fasting and overexercising. People with bulimia tend to struggle with body dissatisfaction and low self-esteem. Anxiety, depression, and substance use can overlap with the disorder as well.
Bulimia tends to emerge in adolescence, although it can go undetected for years. It occurs far more frequently in women than in men.
It can take time for people with bulimia to accept or seek help, but treatment can address underlying challenges and allow them to make a successful recovery.
For more on causes, symptoms, and treatments, see our Diagnosis Dictionary.
There is no way to tell by looks alone whether a person is bulimic, and both bingeing and purging are done secretly. People with bulimia often describe the experience as out of control, and intense shame can prevent them from seeking help.
Bulimia involves recurrent episodes of binge eating, in which someone consumes an abnormally large amount of food in a short time, as well as subsequent compensatory behaviors to prevent weight gain such as vomiting, laxatives, diuretics, or overexercise. If this pattern occurs at least once a week for three months, and if the person is concerned about their body image, they may be diagnosed with bulimia.
Many people with bulimia are normal or slightly overweight and they tend to hide their binging and purging, which has led some to call bulimia “the secretive syndrome.” But learning to identify the signs of the disorder can help understand and support someone who is struggling.
Signs of bulimia can include:
• Going to the bathroom after meals
• Exercising excessively
• Eating in private or in unexpected places
• Withdrawing socially or developing greater anger, anxiety, or depression
Due to the same surrounding it and its role as a coping mechanism, people with bulimia often hide the disorder. For example, parents often don’t realize that their teenager has bulimia. The child might hide food in their room to binge later, run the shower to cover the sound of vomiting, or lie when asked directly about their eating. Similarly, patients in therapy often need to work through other issues and develop coping skills before they feel ready to discuss disordered eating.
Complications often result from excessive purging. People who have bulimia may experience dehydration, electrolyte imbalances, gastrointestinal problems such as inflammation of the stomach or esophagus, enlarged salivary glands from eating excessive carbohydrates that stimulate saliva production, and eroded dental enamel or cavities due to the acid in vomit.
The median age of onset for bulimia is 18 years old, according to the National Institute of Mental Health. The disorder most commonly emerges in the late teens and early 20s, but it can sometimes go undetected until a person’s 30s or 40s.
Around 1 percent of people in the United States will have bulimia in their lifetime, and 0.3 percent of adults have bulimia at any given time, according to the National Institute of Mental Health. The prevalence of bulimia is five times higher among women than it is among men. And women of all ethnic backgrounds develop eating disorders at very similar rates, research suggests.
We still don’t understand exactly what causes bulimia. As with most disorders, genetics plays a role, and the interaction between genetics and complex life experiences ultimately gives rise to the condition. It can be triggered by dieting, trauma, stress, or uncomfortable emotions such as anger and anxiety; purging and other actions to prevent weight gain can lead people with bulimia to release stress and feel more in control of their lives. Personality traits such as low self-esteem or compulsive tendencies play a role as well.
There is no way to definitively prevent bulimia, given that it’s still unclear exactly what causes it. But becoming aware of the disorder and recognizing signs in yourself or others can put people on the right track. Research suggests that programs that diminish the need for dieting and increase the emphasis on good nutrition and healthy eating patterns may help prevent bulimia. Improving emotion regulation skills and reducing the value assigned to body image and thinness for young children might help as well.
Those with bulimia often share certain traits, so those traits may influence the development of the disorder. They include perfectionism, compulsive behavior (the need for control, exactness, and order), impulsivity (associated with abrupt and, at times poor decision-making), and high neuroticism (more frequent and intense negative emotions). Bulimia involves body dissatisfaction and low self-esteem as well.
Traumatic events and stressful transitions are known to trigger eating disorders; trying to control one’s body when the world feels uncontrollable can become a coping mechanism. Events that lead to anxiety and depression can similarly influence the development of bulimia. Restriction and purging can seem to control anxiety by acting as an emotional buoy and a release of stress. Beauty ideals in the culture and in the media may play a role, but alone they do not lead to the development of an eating disorder.
The road to recovery is long and difficult; it often involves setbacks and relapses. But those who commit to treatment can overcome their past patterns and make a successful recovery.
Therapy can help people with bulimia work through underlying challenges that lead to disordered eating. The primary therapies for bulimia are cognitive-behavioral therapy, which shifts beliefs about oneself and one’s eating patterns, and family therapy, in which a patient’s parents help change eating patterns at home. Medications such as antidepressants may help diminish binging and purging episodes as well; fluoxetine (Prozac) is approved by the FDA to treat bulimia. The therapist will work together with the primary care physician to monitor the patient’s medical status and a nutritionist to create a healthy eating plan.
Bulimia can be treated in an outpatient setting, meaning that the patient lives at home and attends medical and mental health appointments as needed, or an inpatient setting, meaning that the patient stays at the hospital or an eating disorder treatment facility for a sustained period of time. Cases of bulimia with severe medical or psychological risk, such as dangerous weight loss or suicidal thoughts, require hospitalization to stabilize the patient’s condition.
Many people overcome bulimia, but it can be difficult to banish the behavior altogether; people often encounter recurrences at various points in their life. But a few practices can help ensure that these are small bumps rather than overwhelming setbacks. People in recovery can recognize what specifically triggers a relapse, develop and implement healthy coping mechanisms, and continue working with a therapist to maintain a strong relationship.