Bulimia nervosa is a serious mental illness and eating disorder. Without treatment, it can be life-threatening.
A note about gender and gender
and gender exist in spectra. In this article, the terms “male,” “female,” or both are used to refer to the gender assigned at birth. Click here to find out more
A person with bulimia nervosa eats large amounts in short periods of time and then tries to make up for this by overtraining, fasting or cleansing, for example. Rinsing may include vomiting or the use of laxatives or diuretics.
Statistics suggest that bulimia nervosa affects 1% of women and 0.1% of men at the same time. On average, it develops in a person’s late teens or early 20s, but it can do so at any time.
Below, you’ll learn more about complications, treatment options, resources for recovery, and more.
What is bulimia nervosa?
This condition has two main symptoms. The first is to eat plenty of food regularly over short periods of time, usually 2-hour windows.
This is sometimes referred to as bingeing, and during these periods, a person may feel unable to stop eating.
The second symptom is taking steps to make up for overeating, such as rinsing, fasting, or lots of exercise.
People with bulimia nervosa often have what doctors think is a healthy body mass index (BMI). This can make it difficult to tell if a person has bulimia.
Someone with bulimia eats large amounts of food over short periods of time. They then take steps to make up for it, such as fasting, overtraining, vomiting, or using laxatives or diuretics.
They may also worry about gaining weight and experience mood swings and social withdrawal.
Malnutrition, chemical imbalances, and effects on the digestive system can lead to physical signs and symptoms. These can develop over time and include:
- brittle nails
- dry hair and
- skin weakness
- , dental problems due to the influence of stomach acid on the teeth
- irregular menstruation
- swollen lymph nodes
- constipation and other bowel problems,
- a persistently inflamed sore throat
- swollen salivary glands in the neck and jaw
- acid reflux
- kidney problems
- muscle cramps
Bulimia often brings with it another mental health problem, such as anxiety or depression. Without treatment, these too can lead to complications.
The National Eating Disorders Association (NEDA) lists a number of signs that could indicate to another person that a person has bulimia. Here are a few of them:
- excessive concern about weight loss, dieting, and food control,
- disappearing foods
- that occur in unusual places
- Signs of mysterious food, such as empty food packaging in the trash
- regular visits to the bathroom right after a meal
- Signs of frequent vomiting
- Better to eat alone or with others
- Rituals around eating or eating, decisions such as excessive chewing or just one food group
The person may be aware that they have a problem but feel unable to talk to anyone about it.
Anyone who suspects that a loved one has bulimia can contact a doctor or mental health provider first. NEDA also provides a “How to Help” guide with resources and information about the recovery phases.
Treatment for bulimia may be long-term. It addresses the person’s mental health and any underlying physical issues. The approach includes nutritional advice and possibly medication.
Before you start, the person must recognize that the problem exists. The earlier treatment starts, the less likely the person is to develop long-term complications.
Many people recover from eating disorders. It’s important to know that recovery can take time and be challenging. Stressful life events can trigger relapses.
Relatives can help by learning as much as they can about bulimia and other eating disorders and offering empathy and support. Helplines and resources are available for the person and their friends and family.
Treatment could include:
Cognitive behavioral therapy, sometimes referred to as CBT, can help a person identify and address the thought patterns that lead to unhealthy eating habits.
Interpersonal therapy places bulimia in a social and interpersonal context. It addresses underlying issues such as grief and interpersonal conflict.
Supporting family and friends can play a key role in recovery. The Maudsley Method is a form of therapy that focuses on how family members can help their loved ones establish healthy eating habits.
Antidepressants, antipsychotics, and mood stabilizers can help treat eating disorders as well as anxiety and depression.
The Food and Drug Administration (FDA) has approved fluoxetine (Prozac) to treat bulimia nervosa, but experts are calling for the development of more targeted therapies.
In some cases, the person may need to spend time in hospital. This may be necessary if the physical complications of bulimia have become severe or if there is a risk of self-harm or suicide.
Find resources to support people with eating disorders and other mental health conditions.
If you know someone who is at imminent risk of self-harm, suicide, or harm, another person:
- Ask the tough question: “Are you considering suicide?
- Listen to the person without judgement.
- Call 911 or the local emergency number, or send TALK to 741741 to communicate with a trained crisis counselor.
- Stay with the person until professional help arrives.
- Try to remove weapons, medicines, or other potentially harmful objects.
If you or someone you know is having suicidal thoughts, a prevention hotline can help. The 988 Suicide and Crisis Lifeline is available 24 hours a day at 988. During a crisis, people who are hard of hearing can use their preferred relay service or dial 711 and then 988.
Click here for more links and local resources.
Causes and risk factors
Doctors are not sure why bulimia develops. It can come from a combination of genetic, biological, psychological, social, and behavioral factors.
It is clear that bulimia nervosa is a mental illness — the person’s behavior is one way of dealing with emotional stress.
The National Institute of Mental Health is observing that eating disorders occur in families, suggesting that genetic factors may play a role.
A 2013 study using brain imaging technology reported differences in brain responses between women with bulimia and women without bulimia, who were shown pictures of slim women. The results suggest that there is different brain processing in people with bulimia.
Eating disorders also often occur during puberty, a period of major hormonal changes and a growing awareness of the body. The results of a 2007 study suggest that changes in ovarian hormones may increase the risk.
People who experience sexual abuse or criticism of their bodies or eating habits may be more likely to develop bulimia.
Other environmental factors may include social pressure to strive for specific physical norms, which are often unnatural and unrealistic. The pressure of sports and other activities can also play a role, particularly those that emphasize weight.
Conditions associated with bulimia include:
- personality disorders
- , anxiety disorders
- , OCD, or
, post-traumatic stress disorder, or PTSD
These conditions can occur at the same time as an eating disorder or before or after it. They may result from or contribute to bulimia.
Early diagnosis can improve the chances of a full recovery. The diagnosis can be difficult because the person’s BMI may be within the normal or overweight range and they may be careful to hide their eating habits.
If someone is seeking medical help for bulimia, the doctor will likely:
- Ask about his mental and physical health
- Take into account his personal and family medical history
- Perform a physical exam
Diagnostic tests can also help rule out other underlying conditions or conditions.
If the doctor suspects that the person has bulimia nervosa, he can refer them to a mental health specialist.
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition lists diagnostic criteria that doctors use to determine whether a person has bulimia.
To obtain the diagnosis, the person must:
- experience recurring episodes of binge eating that they don’t control
- Use compensatory strategies to prevent weight gain, such as vomiting, fasting, overtraining, or misuse of enemas, laxatives, diuretics, or other medications
Bingeing and purging at least once a week in the last 3 months
It is important to note that a person may have an eating disorder, even if they don’t meet these criteria.
With treatment, many people recover from eating disorders. However, recovery can take months or years, and relapses are common.
Some research shows that 55% of people who were treated for bulimia had recovered 5 years later.
The earlier a person seeks treatment, the more likely they are to recover and avoid complications. Support from family and friends can be crucial.
Bulimia nervosa is an eating disorder and mental health condition that can be serious.
Help is available for anyone who may have bulimia, as well as for their loved ones. Early treatment and support can improve the chances of a full recovery without complications.