Bulimia Nervosa

Overview

What is bulimia nervosa?

Bulimia nervosa, also called bulimia, is an eating disorder. Eating disorders are mental health conditions that can be potentially life-threatening. If you have an eating disorder, you may have an obsession with food and weight. This obsession can harm your physical and emotional well-being.

Bulimia nervosa can be defined as a pattern of eating characterized by:

  1. Consuming an unusually large amount of food in a short period of time (binge eating).
  2. Getting rid of the food (purging). Purging may involve making yourself throw up (vomiting) or taking laxatives. Laxatives are medications that speed up the movement of food through your body.

Other characteristics of bulimia nervosa may include:

  • Misuse of water pills (diuretics) or diet pills.
  • Eating very little or not at all (fasting).
  • Excessively exercising.
  • Hiding food to binge and purge later.

People with bulimia are usually at a normal, healthy weight. But they judge themselves harshly based on their view of their body shape and/or weight. They usually have self-esteem issues closely linked to their body image.

Who does bulimia nervosa affect?

Bulimia nervosa affects people assigned female at birth more often than people assigned male at birth. It typically develops during adolescence or early adulthood. But it can affect people of all ages. Between 1% and 2% of people will experience bulimia during any given year. Bulimia can occur in people of any sex, gender, age, race, ethnicity or body type.

What’s the difference between bulimia nervosa and anorexia nervosa?

People with bulimia nervosa usually have a normal weight. They engage in a cycle of binging and purging. People with anorexia nervosa are usually underweight. They engage in self-starvation, extreme diets and extreme exercise to lose weight. People with anorexia nervosa think they’re fat even though they’re very thin. They may get so thin they look sick.

What’s the difference between bulimia nervosa and binge eating disorder?

People with bulimia nervosa binge eat and then purge, or try to get rid of the food or weight. People with binge eating disorder binge but they don’t purge. Also, people with bulimia are usually at a weight that's healthy for them. People with binge eating disorder typically have overweight/obesity.

Symptoms and Causes

The symptoms of bulimia nervosa can be behavioral, such as finding empty food wrappers. The physical signs can include dental issues.
The signs and symptoms of bulimia nervosa can be behavioral, emotional and physical.

What are the signs and symptoms of bulimia nervosa?

Bulimia nervosa can be hard to spot. People with the condition often binge and purge privately. But empty food wrappers and laxative packaging can be warning signs of bulimia. Other behavioral and emotional symptoms of bulimia nervosa include:

  • Frequent visits to the bathroom, particularly after meals.
  • Excessive exercising.
  • Preoccupation with body image.
  • Intense fear of gaining weight.
  • Depression, anxiety or substance abuse.
  • Feeling out of control.
  • Feeling guilty or shameful about eating.
  • Withdrawing socially from friends and family.

The physical symptoms of bulimia nervosa can include dental issues. Self-induced vomiting can cause erosion of your tooth enamel from your stomach acid. Your teeth may also appear clear instead of white and be more sensitive. Other physical symptoms of bulimia nervosa can include:

What causes bulimia nervosa?

The exact cause of bulimia nervosa isn’t known. But researchers think it may be a combination of genetics and learned behaviors. If you have a relative that has or had an eating disorder, you're at a higher risk of developing one yourself.

Popular culture and the media put pressure on people to have a certain body type. These outside influences can affect your body image and self-esteem. Also, feeling stressed, upset or out of control can all lead to bulimia.

What complications are associated with bulimia nervosa?

Bulimia can prevent your body from getting the nutrients it needs. Many different complications can occur due to bulimia nervosa including:

Diagnosis and Tests

How is bulimia nervosa diagnosed?

To diagnose bulimia nervosa, your healthcare provider will perform a physical examination. They’ll ask you about your medical history and symptoms. It’s OK to be nervous when talking with your healthcare provider. But they want to help you get better. So it’s important to be honest with your healthcare provider about your eating habits.

Your healthcare provider will diagnose bulimia nervosa if you meet the following criteria:

  • Do you have repeated episodes of binge eating?
  • Do you feel a lack of control over your eating during an episode?
  • Do you engage in inappropriate purging behaviors?
  • Have you experienced binge eating at least once a week for three months?
  • Does your body weight or shape have a strong influence on your self-image?

There aren’t any laboratory tests to specifically diagnose bulimia. Your healthcare provider may order tests to see how bulimia has affected your health. These tests include:

Management and Treatment

How is bulimia nervosa treated?

Your healthcare provider may treat bulimia nervosa using a variety of techniques. They may refer you to a team of specialists including dietitians and mental health professionals. Treatments may include:

  • Psychotherapy: Cognitive-behavioral therapy is a type of individual counseling. It focuses on changing your thinking (cognitive) and behavior (behavioral). Treatment includes techniques for developing healthy attitudes toward food and weight. It also includes approaches for changing the way you respond to difficult situations.
  • Nutritional counseling: Nutrition counseling involves learning healthier ways to eat. You'll work with a registered dietitian or counselor to get back on track.
  • Medication: Selective serotonin reuptake inhibitors are a type of antidepressant. They can reduce the frequency of binge eating and vomiting. But the long-term effectiveness of these drugs isn’t clear. They’re also effective at treating anxiety and depression. These conditions are common among people with bulimia nervosa.
  • Support groups: Support groups can be helpful when used with other forms of treatment. In support groups, people and their families meet and share their stories.

Prevention

How can I prevent bulimia nervosa?

If bulimia runs in your family, be aware of the warning signs so you can catch the problem early. Early treatment can break unhealthy eating patterns before they become harder to overcome.

You can reduce your risk of bulimia nervosa by getting treatment for other conditions like depression and anxiety disorders.

Educators and parents can also teach young people the “ideal” body type portrayed by the media isn't realistic. In fact, it can be unhealthy and even unsafe.

Outlook / Prognosis

What is the outlook for people with bulimia nervosa?

Many people with bulimia get better with treatment and go on to lead healthy lives. Some people improve at first but then relapse and need treatment again. Statistics show about half of people with bulimia fully recover with appropriate treatment.

Left untreated, people with bulimia nervosa may develop serious complications. Some people may need to receive additional medical care at a hospital or treatment center.

Living With

When should I seek help?

If your relationship with food causes you stress or gets in the way of your everyday life, you may have an eating disorder. You should seek immediate treatment if you also have any of the following symptoms:

A note from Cleveland Clinic

Many people worry about their weight. But people with bulimia nervosa have an obsession with food and weight. Bulimia nervosa is a serious condition that can affect your mental and physical health. If you think you have bulimia nervosa, don’t be embarrassed about seeking help. With proper medical care and mental health counseling, you can get better. Take the first step to protecting your well-being by talking to your healthcare provider.

Last reviewed by a Cleveland Clinic medical professional on 05/16/2022.

References

  • American Academy of Family Physicians. Eating Disorders. (https://familydoctor.org/condition/eating-disorders/) Accessed 5/16/2022.
  • American Psychiatric Association. Feeding and Eating Disorders. In: Diagnostic and Statistical Manual of Mental Disorders, 5th ed. Arlington, VA.: American Psychiatric Association; 2013.
  • Merck Manual. Bulimia Nervosa. (http://www.merckmanuals.com/professional/psychiatric-disorders/eating-disorders/bulimia-nervosa) Accessed 5/16/2022.
  • National Alliance on Mental Illness. Eating Disorders. (https://www.nami.org/About-Mental-Illness/Mental-Health-Conditions/Eating-Disorders) 5/16/2022.
  • U.S. Department of Health & Human Services, Office on Women’s Health. Bulimia nervosa. (https://www.womenshealth.gov/mental-health/mental-health-conditions/eating-disorders/bulimia-nervosa) Accessed 5/16/2022.

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