Frequently Asked Questions About Bulimia Nervosa

Bulimia nervosa, often referred to as bulimia, is one of the most common eating disorders. It’s usually characterized by its most classic symptoms of bingeing and purging.

But bulimia is a complex condition. Some people with bulimia fast or don’t eat for long periods of time. It’s common for people with bulimia to also obsessively exercise, sometimes for several hours a day.

If you think you may have bulimia, you’re not alone. According to recent figures from a 2018 study, 1–1.5% of adults and 0.1–2% of young people have been diagnosed with bulimia.

The actual number of people with bulimia may be even higher than reported, especially for young people.

However, these numbers were even greater (14–22%) for those who engaged in disordered eating but didn’t meet the strict criteria for a bulimia diagnosis.

People with bulimia often find comfort in consuming large amounts of food. Then, after feeling an immense sense of guilt over eating too much, they purge. Purging might be done by vomiting or by using laxatives or diuretics.

For many, the effects of this condition can be felt for years. Some people even go through cycles of recovery and relapse.

But there is hope. Bulimia and other eating disorders are treatable. Treatments often include a combo of medications, therapy, and coping strategies.

Whichever path you choose is your choice. So make the one that’s right for you.

Want to know more? You can learn more about bulimia here.

A. Both disorders have a key similarity — people with these conditions are intensely preoccupied with food and body weight. The main difference is the food-related behaviors in each condition.

People with anorexia nervosa often engage in self-starvation, by either not eating or severely limiting the amount of food they eat. On the other hand, people with bulimia often eat an excessive amount of food in a short time, then purge to get rid of the food or prevent weight gain.

In some cases, people with anorexia will also purge by either vomiting or using laxatives and diuretics.

While both conditions affect all types of people and body types, people with anorexia may weigh 15% or more below a clinically ideal body weight, while those with bulimia may be more likely to maintain body weight or even appear overweight.

Excessive exercise is another similarity between anorexia and bulimia.

A. Movies and media make it seem like bulimia only affects a certain population — specifically, young white women. But it has a much wider impact than that.

The idea that only young white women get eating disorders is one of the most common misconceptions.

Yes, it’s true that bulimia is more commonly diagnosed in women (about 1.5% of U.S. women), but it affects other genders as well. In fact, nearly 1.5 million (0.5%) U.S. men experience bulimia.

Bulimia, like other eating disorders, can affect all types of people.

According to the National Association of Anorexia Nervosa and Associated Disorders (ANAD):

• 50% of Black teens are more likely to engage in bulimia-related behaviors (such as binge eating and purging) than white teens. But, they’re less likely to be diagnosed.
• Hispanic people are more likely to have bulimia than their non-Hispanic peers.
• Asian American college students restrict their eating and purge more than their white or non-Asian peers.
• Gay men are 7 times more likely to binge eat and 12 times more likely to purge than heterosexual men. Bisexual males are also more likely to binge and purge.

Bulimia doesn’t just affect younger people, either.

Though the condition appears more likely to occur among adolescents and college students, one study found that 13% of American women over age 50 had eating disorder-related behaviors like bingeing and purging.

Like other eating disorders, bulimia occurs in all races, ethnicities, genders, ages, and sexual orientations.

A. There’s no known cause of bulimia. But researchers have identified some risk factors that may increase a person’s chances of developing the condition.

These risk factors include:

• genetics
• bullying and weight shaming
• societal and cultural pressures
• emotional and psychological health
• stressful life events
• traumatic events

There’s still a lot to be learned about what causes bulimia. Researchers continue to explore the reasons why some people develop bulimia and others don’t, including looking at the possibility of a connection between brain activity and eating.

Factors vary, but you can find out more about bulimia causes here.

A. It’s often difficult (if not impossible) to tell whether a person has bulimia just by the way they look. People with bulimia may be underweight, overweight, or an average weight.

Some common symptoms of bulimia include:

• severe dehydration
• calluses or scrapes on the knuckles or backs of hands
• stained or discolored teeth
• unusual swelling of the cheeks or jaws
• stomach cramps and other gastrointestinal issues (such as constipation and acid reflux)
• dizziness and fainting, or syncope

Bingeing and purging is often done in secret, so it’s not easy for family and friends to realize what’s going on. Some of these signs may mean a loved one is engaging in this behavior:

• They go to the bathroom right after eating.
• You find empty food wrappers in unexpected places.
• They seem unusually moody or sad.
• They skip regular meals or eat small portions.
• You find packages of laxatives, diet pills, or diuretics.
• They have an intense concern about food, weight, and body image.
• You hear, see, or smell signs of vomiting.
• They hoard food in strange places.
• They’re exercising a lot, even in bad weather or when they’re tired or hurt.

You can read more about symptoms of bulimia here.

A. If your doctor believes you may have an eating disorder, or you go in to get checked out for one, they’ll often start by running several tests. These can help them figure out if you need to be referred to a specialist for diagnosis.

Your doctor will likely start with a physical exam, looking at your weight and height to calculate body mass index (BMI). They’ll also review your medical history to see if there have been changes in your weight over time.

While a healthcare professional may use this information as a starting point, it doesn’t give full insight into your health.

To get a better understanding of your overall health, your doctor will ask questions about your eating and exercise habits. And you may be asked to complete a mental health questionnaire.

Depending on your symptoms, they may also order blood tests to rule out other causes.

If you’re honest with your doctor, this will help them figure out if you need to see an eating disorder specialist or therapist — who will likely be able to make the most accurate diagnosis and treatment plan.

A. There’s no “cure” or quick fix for bulimia. But there are a number of options available to treat the condition and help you recover.

Your doctor may recommend a combination of medication, therapy, and rehabilitation to treat bulimia.

The primary goal of treatment is to:

• improve your relationship with food
• address any underlying medical or mental health issues
• challenge any unhealthy eating behaviors and thoughts

Treatment may include:

• psychotherapy, aka talk therapy
• nutrition therapy
• medications
• nutritional counseling
• support groups
• rehabilitation (inpatient or outpatient)

While some people with bulimia are able to go back to eating and exercising in healthy ways after the first treatment, there are others who may relapse and need treatment again.

Part of your treatment plan will likely include developing strategies to help prevent relapse.

Want to know more about treatments for bulimia? You can find it here.

A. Not only can bulimia make it more difficult to become pregnant, it can also cause issues during pregnancy.

Bingeing and purging can change your menstrual cycle, which may cause irregular ovulation.

Someone with bulimia may miss their periods for several months, or have periods off and on — some months, but not others. This means you don’t ovulate (release an egg from the ovary) every month like usual, making it harder to get pregnant.

Bulimia and its behaviors may also increase your chances of having problems during pregnancy, including:

• miscarriage (pregnancy loss)
• having a baby with low birth weight
• postpartum depression
• preterm or premature birth
• needing a cesarean section (C-section) delivery
• developmental issues or irregularities in the fetus

If you’re living with bulimia and become pregnant, consider speaking with a doctor about managing your condition throughout pregnancy to prevent possible complications. For instance, you can discuss ideal weight gain.

A. Like most eating disorders, bulimia can affect every organ in the body. The ongoing cycle of bingeing and purging can lead to gastrointestinal issues and cause chemical imbalances that can affect the heart and other bodily functions.

Some common complications of bulimia include:

• tooth decay
• inflamed glands under the jaw and in the cheeks
• damaged or inflamed esophagus
• anemia
• inflammation of the pancreas (pancreatitis)
• ulcers
• heart failure
• irregular heartbeat (arrhythmia)
• slowed digestion (gastroparesis)
• kidney failure

In severe cases, certain complications — like organ or heart failure — can lead to death.

A. If you suspect someone you know has bulimia, talk with them about your concerns.

It might be challenging to get them to talk about it, and they may even deny having a problem, but just offering to support and listen may be all the encouragement they need to open up.

Consider these tips when you decide to approach the subject:

Pick a good time and place

Choose a private location so you can both talk openly without distractions. The last thing you want when discussing a sensitive topic is to be stopped mid-conversation because of interruptions.

Don’t be confrontational

Be careful to avoid using an accusatory tone and language. This will only make the person feel defensive, and possibly even angry.

If they do get angry, try to remain calm and respectful. Don’t take it personally. Remember: This is a hard subject to discuss.

Listen, don’t judge

Ask open-ended questions and practice listening with a nonjudgmental attitude.

You’re not there to judge. Your only goal is to offer support and express your concerns about their health and your desire to help.

Be prepared with resources

Before your talk, do your research. Find out if there are support groups or programs in your area where they can connect with others who are having similar problems.

Have this list of resources with you, and be ready to provide them if needed.

A couple of resources that may be helpful include:

• National Eating Disorders Association
• National Association of Anorexia Nervosa and Associated Disorders
• Recovery Road (an eating disorder treatment app)
• Academy for Eating Disorders
• The Alliance for Eating Disorder Awareness

Be patient and supportive

It can take some time before someone is willing to talk about bulimia openly and honestly.

Don’t give up — even if they get angry or shut down.

The important thing is you’ve opened the lines of communication. When they’re willing to talk, you can make it clear you’ll be there whenever and however they need.

If you want to connect with other people living with eating disorders, NEDA has forums that may help. You can also find information on local treatment centers near you.