All About Bulimia Nervosa

Bulimia is a type of eating disorder that involves extreme and harmful eating behaviors.

Bulimia is often characterized by episodes of bingeing (eating large amounts of food) and purging (getting rid of the food in some way). Many people with bulimia will eat large amounts of food in a short time, during which they feel out of control — like they can’t stop eating until the food is gone.

After bingeing comes an overwhelming sense of guilt and shame, leading to purging to get rid of the food.

But there are actually two types of bulimia: purging and non-purging.

• Purging bulimia. This is the most common type of bulimia, which typically involves making yourself vomit or using diuretics and laxatives to purge.
• Non-purging bulimia. This type typically involves fasting or excessively exercising after binge eating.

Some people may have behaviors of both purging and non-purging bulimia.

Behaviors of bulimia are often done in private, so many people who live with the condition feel alone and isolated. But if you have bulimia, you’re not alone.

Approximately 28.8 million Americans will have an eating disorder in their lifetime. Of those people, at least 288,000 – about 1% – will have bulimia nervosa.

Do you have more questions about bulimia? You can read some FAQ here.

Despite what’s been previously believed and highlighted in the media, bulimia isn’t only a condition that affects young, white women. It affects people of every age, gender identity, sexual orientation, race, and size.

Let’s take a quick look at some statistics of bulimia and all those it affects:

• About 1% of people in the United States will have bulimia at some point in their lives.
• Bulimia affects females (0.5%) 5 times more often than males (0.1%).
• Females with bulimia are more likely to seek treatment for their eating disorder than males.
• The median age of onset (when the condition begins) is 18 years old.
• Of the number of adolescents with bulimia, 41.3% report purging behaviors, while the remainder engage in non-purging behaviors.
• Black teenagers are 50% more likely to engage in bulimia-related behaviors, such as bingeing and purging, than white teenagers.
• Hispanic people are much more likely to have bulimia than non-Hispanic peers.
• Asian American college students report higher rates of bulimia-related behaviors like purging than their non-Asian peers.
• Gay men are 7 times more likely to binge eat and 12 times more likely to purge than heterosexual men.
• Gay and bisexual boys are more likely to engage in purging behaviors, such as vomiting, fasting, or using laxatives or diet pills to control their weight.
• Between 35 to 57% of adolescent girls engage in bulimia-related behavior, such as self-induced vomiting and using diet pills or laxatives.
• Bulimia is the most common type of eating disorder among military members.

It’s not always easy to tell if someone has bulimia just by looking at them. Someone with bulimia may be thin, an average weight, or overweight.

Some common physical signs of bulimia include:

• swelling of the cheeks or jaws
• severe dehydration
• calluses or scrapes on the knuckles or the backs of hands
• gastrointestinal problems, such as constipation or acid reflux
• broken blood vessels in the eyes
• stained or discolored teeth

People with bulimia are usually very careful about hiding their symptoms. However, these are some behaviors you might notice that can signal a problem.

Common behaviors or changes can include:

• They go to the bathroom right after eating.
• You find empty food wrappers in unexpected places.
• They’re exercising a lot, even in bad weather or when they’re tired or hurt.
• They hoard food in strange places.
• You find empty packages of laxatives, diuretics, or diet pills.
• They skip meals or eat much smaller portions.
• They’re excessively using mouthwash, mints, or gums.

If you want to learn more about the signs and symptoms of bulimia, you can read more here.

The exact cause of bulimia isn’t fully known, but experts believe there are several factors that can increase a person’s chances of developing this eating disorder.

Factors include:

• genetics
• emotional distress
• mental health conditions
• societal and cultural experiences
• stressful life events
• bullying and weight shaming
• traumatic events

There’s still more to learn about what causes someone to develop bulimia. For instance, researchers have been studying the connection between structural changes in the brain and eating.

Want to know more? You can find out all about causes and risk factors of bulimia here.

If you think you might have bulimia or another eating disorder, you can start by talking with a healthcare professional who can provide you with an evaluation, diagnosis, or referral to an eating disorder specialist.

Your doctor will likely start with a physical exam. They may look closely at your weight and height to determine your body mass index (BMI). Your past medical history will also be reviewed to look for any extreme changes in weight over time.

You’ll also be asked questions about your eating and exercising habits, and will probably be asked to complete a mental health questionnaire.

A blood test may be done to rule out any other conditions that may be causing or related to your symptoms.

Ultimately, a bulimia diagnosis is usually based off fitting the criteria found in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

But diagnosing bulimia isn’t always easy. Many people who have bulimia-related behaviors don’t meet the strict criteria for diagnosis.

A study in 2018 noted that the number of people who have eating disorder behaviors is much higher — 14 to 22% — than the people who fit the strict diagnostic guidelines (less than 2%).

In addition, Black, Indigenous, and People of Color are less likely to be diagnosed with an eating disorder than white people.

Even if you don’t meet the strict criteria for diagnosis, you still deserve to seek and receive support if you need it.

There are several ways bulimia can be treated and managed.

Each treatment plan will be unique to you. No two treatment plans will look alike because each person with bulimia is different.

Typically, a treatment plan will include at least one or two of the following:

• individual, group, or family psychotherapy
• cognitive behavioral therapy
• inpatient or outpatient rehabilitation
• nutritional therapy
• medications
• nutritional counseling
• support groups

For many, bulimia is a life-long condition. Some people with bulimia are able to develop a healthy relationship with food and exercise after the first treatment. Others may have a relapse and need treatment again.

You can check out our deep dive into treatments for bulimia here.

Over time, the continuous cycle of bingeing and purging can cause damage to the entire body, leading to complications affecting the heart and other bodily functions.

Some common complications of bulimia include:

• a damaged or inflamed esophagus
• ulcers
• inflammation of the pancreas
• tooth decay
• inflamed or damaged glands in the jaw and cheeks
• anemia
• irregular heartbeat
• heart failure
• kidney failure
• malnutrition

In some cases, severe complications — such as heart or organ failure — can lead to death.

People with eating disorders often have coexisting mental health conditions.

According to the National Institute of Mental Health, 94.5% of people with bulimia also have at least one other mental health condition.

Common coexisting mental health conditions include:

• anxiety
• depression
• obsessive-compulsive disorder (OCD)
• substance use
• a personality disorder

Research also suggests that 30–40% of people with bulimia are more likely to engage in self-harming behaviors, such as cutting.

Living with bulimia can be hard work. Returning to healthy eating habits and using coping skills when needed isn’t always easy.

It can take many months or even years to fully recover. And often, people experience bumps along this journey.

Recovery can’t fully begin until you’ve experienced:

• Physical recovery: Having a good overall physical condition, including maintaining a healthy weight for your body.
• Behavioral recovery: Reducing or eliminating bulimia-related behaviors, such as bingeing and purging or non-purging.
• Psychological recovery: Having a realistic image of your body weight and shape, and having healthy goals.

A strong support system is also key. Parents, partners, friends, and more can help encourage positive eating behaviors and offer an ear when you need it.

Even if you don’t feel like you’ve completely recovered, treatment can still greatly reduce symptoms. Over time with continued management, you may be able to eliminate all your symptoms.

You can find out more about living with bulimia here.

It can be scary for some people to admit they have bulimia — but it’s important to seek help as soon as possible. Bulimia can cause a lot of damage to the body if left untreated.

Help is available. You can start by speaking with a healthcare professional or eating disorder specialist. Talk with them about your symptoms, thoughts, and feelings.

If you’re concerned about a loved one, your support and encouragement can go a long way. While you can’t force someone with bulimia to seek help, being there for them and letting them know how much you care can be invaluable.

If you want to connect with others who are also living with bulimia, you can find community forums and more at the National Eating Disorders Association.

If you want to find a local treatment center near you, you can find that information here.

Other organizations where you can find help include:

• National Association of Anorexia Nervosa and Associated Disorders (ANAD)
• Academy for Eating Disorders
• The Alliance for Eating Disorders Awareness
• Eating Disorder Hope