What is bulimia?

Bulimia nervosa, commonly known as bulimia, is an eating disorder characterized by periods of eating large amounts of food in a short period of time, called bingeing. These binges are followed by compensatory behavior, such as forced vomiting or laxative use, called purging, to prevent weight gain.

Bulimia can cause serious health problems and even be life-threatening. If you think you or someone you know may be suffering from this condition, it's important to be aware of bulimia symptoms and understand how treatments can offer a chance for recovery.

About 6 million people in the U.S. struggle with bulimia, affecting 1.5% of the female population and 0.5% of the male population. While bulimia most commonly appears in teenage girls and young women, it can arise later and many men struggle too.

While the exact causes of bulimia are unknown, many risk factors influence the development of this disorder. These include:

• Gender. Females are at higher risk of suffering from bulimia than males.
• Other mental health conditions. Those who struggle with mental health conditions, such as substance-use disorders, personality disorders, depression and anxiety are at higher risk of developing bulimia.
• Social and environmental factors. Social stigmas around weight and body image, bullying and stressful life events can all contribute to the development of bulimia.
• Genetics. Those with a family history of eating disorders and other mental health problems can have a higher risk of developing bulimia.

Bulimia may be hard to recognize. A person with bulimia will often binge and purge in secret and attempt to hide these behaviors from others. Also, because most people with bulimia are usually of a normal weight or are slightly overweight, even family members and close friends may have trouble detecting the signs of bulimia in someone they know.

Signs and symptoms of bulimia may include:

• Being preoccupied with body shape and weight
• Repeated episodes of eating abnormally large amounts of food over a short period
• Feeling a lack of control during bingeing episodes
• Frequent use of the bathroom after eating
• Exercising too much
• Withdrawing from normal activities with friends or family, especially activities that involve eating
• Feelings of guilt or shame regarding eating
• Hoarding food

Physical effects of bulimia may include:

• Broken blood vessels in the eyes
• Damaged or decayed teeth and gums
• Swelling of the cheeks
• Irregular or absent menstrual periods
• Digestive problems
• Thinning hair and dry or brittle nails
• Electrolyte imbalances (having levels of sodium, potassium or other minerals that are too high or too low, which can lead to irregular heartbeats and possibly heart failure)

Anorexia nervosa, commonly called anorexia, is another eating disorder that is sometimes confused with bulimia. Those battling anorexia severely restrict their food intake and have an extreme fear of weight gain. People with anorexia and bulimia may both suffer from a distorted body image. The key difference between anorexia and bulimia is that people with anorexia often have an abnormally low body weight.

Yes, there are treatments for bulimia. Treatments will vary based on individual need and should be discussed with your healthcare provider. As with most mental health conditions, it is worth considering a holistic approach to treatment with a focus on:

• Physical health (medical doctors, nutritionists)
• Mental health (individual, family and group psychotherapy, as well as psychiatry for medication management)
• Support from loved ones

If you suspect you may have bulimia or you’re concerned about a friend or family member, consult with a doctor or mental health professional on how to proceed with treatment.

Bulimia can become a serious physical and mental health risk. It can leave people feeling isolated, frustrated and confused due to the shame associated with periods of bingeing and purging. It's important to ask for help and seek medical treatment if you or someone you know has bulimia. With therapy and support, it is possible to recover from this condition.

Clinically reviewed and updated by Julie McDaniel, MSN, RN, CRNI October 2023.