What is bulimia nervosa?

Bulimia nervosa is an eating disorder that is potentially life threatening. It is defined as episodes of binge eating followed by inappropriate response behaviors such as self-induced vomiting; fasting; misuse of laxatives, diuretics or other medicines; or excessive exercise. Individuals with bulimia nervosa judge themselves overly harshly based on perceived body shape and/or weight.

Who gets bulimia nervosa?

Bulimia nervosa tends to peak in late in adolescence or in early adulthood, but has been diagnosed in children as young as 5 years old and during the geriatric years. It can occur in people of any age, sex, race, gender, ethnicity, economic status, as well as individuals of all body weights, shapes and sizes. Bulimia tends to affect females more often than males. Between 1% and 4% of people will experience bulimia sometime during their lifetime.

People with bulimia may be of low weight, normal weight, or overweight. In all cases, they are dissatisfied with their weight or shape.

What’s the difference between bulimia nervosa and other eating disorders?

People with bulimia often perform their binge-purge behaviors in secret, feeling ashamed of their binges and purges. They are aware they have a problem. This shame and guilt may lead individuals not to seek medical care. In contrast, people with anorexia nervosa may deny or not recognize that they have a problem. Someone may have anorexia nervosa and still binge and/or purge. The difference is that with bulimia nervosa, the behaviors are recognized as a problem and restricting food is not the main behavior. Bulimia nervosa is defined by the binges followed by some form of purge. Binge eating disorder, on the other hand, is limited to the binge behavior.

What causes bulimia nervosa?

The exact cause of bulimia is not known. However, research suggests that it may be a combination of genetic or biologic factors (inherited; runs in families) combined with learned behaviors and thought patterns.

What are the signs and symptoms of bulimia nervosa?

Behavioral and emotional symptoms of bulimia include:

  • Eating more than an expected amount.
  • Frequent visits to the bathroom, particularly after meals.
  • Vomiting or abusing laxatives, diuretics or other medicines in an attempt to prevent weight gain.
  • Excessive exercising or extreme physical training.
  • Preoccupation with body image.
  • An intense fear of gaining weight.
  • Depression or mood swings.
  • Feeling out of control.
  • Feeling guilty or shameful about eating.
  • Withdrawing socially from friends and family.
  • Lack of awareness of the seriousness of the condition.

Physical symptoms of bulimia nervosa include:

  • Facial swelling or swollen parotid glands visible at the jawline or cheeks (parotitis).
  • Heartburn, indigestion, bloating.
  • Irregular menstrual periods.
  • Weakness, exhaustion.
  • Bloodshot eyes.
  • Dental problems, including erosion of tooth enamel.
  • Sore throat.
  • Petechiaie (pinpoint bruising) on the back of the pharyngeal wall (back of throat).
  • Bleeding gums.
  • Thickening (callus) or scratches (excoriations) on the back of the knuckles (Russell sign).
  • Sores at the angle of the mouth on either side.

What complications are associated with bulimia nervosa?

Last reviewed by a Cleveland Clinic medical professional on 12/12/2019.

References

  • Rome ES, Strandjord SE. Eating Disorders. Pediatrics in Review 2016;37(8);323-336. Accessed 10/12/2019.
  • Dickstein LP. Franco KN, Rome ES, Auron M. Recognizing, managing medical consequences of eating disorders in primary care. Cleve Clinic J Med 2014;81(4):255-263. Accessed 10/12/2019.
  • National Alliance on Mental Illness. Eating Disorders. Accessed 10/12/2019.
  • National Eating Disorders Association. Bulimia Nervosa. Accessed 10/12/2019.
  • Academy for Eating Disorders. Eating Disorders. A Guide to Medical Care. AED Report 2016. 3rd edition. Accessed 10/12/2019.
  • Hay PJ Claudino AM. Bulimia nervosa. BMJ Clin Evid 2010; July 19:1009. Accessed 10/12/2019.
  • American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA, American Psychiatric Association, 2013. Accessed 10/12/2019.
  • Gwirtsman HE, Mitchell JE, Ebert MH. Chapter 26. Eating Disorders. In: Ebert MH, Loosen PT, Nurcombe B, Leckman JF. eds. CURRENT Diagnosis & Treatment: Psychiatry, 2e. New York: McGraw-Hill; 2008. Accessed 10/12/2019.
  • Mehler PS. Medical complications of bulimia nervosa and their treatments. Int J Eat Disord. 2011 Mar; 44(2):95–104. Accessed 10/12/2019.

Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy