Bulimia nervosa, more commonly known as bulimia, is an eating disorder that can damage a person’s health and relationships. A key behavioral feature of bulimia is what’s known as the binge-purge cycle.
Bulimia can have serious short- and long-term effects. If you suspect you or someone you know may have bulimia, speak to your healthcare provider to determine the best treatment options.
This article will cover:
- Bulimia signs and symptoms.
- Causes of bulimia.
- Short- and long-term effects.
- Co-occurring illnesses, such as depression.
- Facts and statistics.
- How to get help.
What Is Bulimia?
Bulimia is an eating disorder that is characterized by periods of binging – or overeating – followed by purging, or measures to control or mitigate any weight gain. These measures often include forced vomiting, laxatives, diuretics, and/or exercise. A person with bulimia can be normal weight, but they fear gaining weight or want to lose weight. 6
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Bulimia is commonly diagnosed in females, especially teenage girls and young women. 2 However, males are also affected, particularly those who are involved in sports or careers where body image is considered a crucial aspect of their success (diving, running, wrestling, ballet, and modeling). Males with bulimia are also more likely to have muscle dysmorphia, a type of body disorder that is commonly associated with eating disorders. 3
Bulimia can be categorized into two types. A person can demonstrate both or alternate between the two types over time.
- Purging – The person uses excessive means to rid themselves of food intake through self-induced vomiting, abusing laxatives, diuretics, or enemas.
- Non-purging – The person uses other means to prevent or to control weight gain, such as excessive exercise or avoiding or restricting foods (i.e., fasting or strict dieting).
Signs and Symptoms
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), bulimia nervosa is defined as recurrent episodes of binge eating, or overeating, followed by inappropriate or excessive behaviors to rid oneself of the caloric intake. Binging and purging behaviors must occur at least once a week for 3 months. 5
Bulimia symptoms can vary and include: 2, 6
- Forced vomiting.
- Excessive exercise.
- Misusing or abusing laxatives, diuretics, and/or enemas.
- Social withdrawal or avoiding situations in which food will be a component.
- Defensiveness or guilt about behavior.
- Distorted body image.
If you’re worried that a loved one may have bulimia, below is a list of potential bulimia signs that you can look for. 2, 6
- Constantly worrying about or obsessed with weight
- Distorted body image (i.e., the person believes they are fat when they’re not)
- Buying large amounts of food that disappear or are consumed immediately
- Consuming large quantities of food in short periods of time
- Going to the bathroom immediately after meals
- Excessive exercising
- Sores on the knuckles or hands that could indicate forced vomiting
- Damaged teeth or gums
Don’t ignore these signs. If you believe you or someone you know is suffering from bulimia, call our helpline at .
What Causes Bulimia?
Eating disorders are complex, and there is usually more than one contributing factor. Varying degrees of genetic, familial, societal, and cultural issues can all lead someone to develop bulimia or other eating disorders. 2
- Genetic or familial. Genes can play a role. Studies have shown that those who have another family member with bulimia are more likely to develop the eating disorder themselves. Whether this is passed on through genetics or from family pressures (i.e., parents who focus on looks or criticize the appearance of others), is unknown, though one study showed that heritability of bulimia can range anywhere from 30% to 80%. 7
- Psychological. Stressful or traumatic events can cause someone to develop the symptoms of bulimia or another eating disorder. 6 People often use food as a means to cope with stressful situations and may overeat or under-eat to handle that stress.
- Societal or cultural pressures. Particularly in the U.S., women are inundated with images of thin females on TV, in the movies, and on magazine covers. Fad diets and diet drinks that encourage people to lose weight can also have an impact. A person can develop an unrealistic body image and, in turn, an eating disorder.
Substance use is also often associated with eating disorders, including bulimia. Some studies suggest that 50% of those with an eating disorder are also abusing drugs or alcohol. 8
Other risk factors include:
- Low self-esteem.
- Peer pressure.
Short-Term and Long-Term Effects
Bulimia side effects can be both short- and long-term. Many of these side effects are reversible, however, with appropriate treatment and recovery.
- Weight loss / gain
- Shame about behavior
- Social withdrawal and loss of friends or other relationships
- Rigid exercise regime
- Depression 6
- Severe dehydration and electrolyte imbalance
- Sore throat, particularly from excessive and regular vomiting
- Tooth decay, cavities, or gum disease, particularly from excessive vomiting
- Gastrointestinal tract (e.g., duodenal, stomach) ulcers.
- Irregular period or amenorrhea
- Constipation or irregular bowel movements
- Kidney problems from diuretic abuse
- Irregular heart beat
- Weakened heart muscle
- Heart failure
- Low pulse or blood pressure
- Chronic fatigue 6
Bulimia affects fertility and can increase the chances of pregnancy-related complications, including miscarriage and birth defects. For example, if a woman takes laxatives or diuretics while pregnant, vital nutrients needed for the growth of the baby can be lost and can contribute to congenital abnormalities and other fetal development issues.
A woman who has recovered from bulimia can become pregnant. However, talk to your healthcare provider if you are having difficulty conceiving. 6
If you or someone you know is ready to take the first step toward recovery from bulimia, call one of our treatment support specialists at .
Depression and Bulimia
Several studies indicate that major depressive disorder is the most common comorbid diagnosis in individuals who suffer from an eating disorder. 10 One study found that those with bulimia were about 10 times more likely to report major depression. 11
Another study found that adolescents with bulimia also had high rates of suicidal ideation. Fifty-three percent had suicidal ideation, 26% had suicidal plans, and 35% had made suicidal attempts. 15
A healthcare provider can help identify any underlying mental illnesses, as well as assist with treatment planning to make sure that any plan covers all symptoms and causes.
Bulimia Facts and Statistics
The following are some facts and statistics about how many people are affected by bulimia and who is most affected.
- About 0.9% of individuals in the U.S. suffer from the disorder. 13
- Approximately 1-2% of adolescent females and 0.5% of males meet the DSM-V criteria for bulimia. 15
- The estimated male-to-female ratio is 1:10. Some estimates are as high as 1:3. 15
- Bulimia typically begins between the ages of 14 and 22 years of age, 14 with an average onset of 20 years of age. 13
- Adolescent and young women are most likely to develop the eating disorder. 2
- Those with bulimia have a mortality rate of 3.9%. 16
- One study showed that bulimia rates tripled between 1988 and 1993 among women aged 10 to 39. 12
Getting Help for Bulimia
If you or someone you know is suffering from bulimia, there is help. Please call us today at . We’re available 24/7.
You’ll be connected to a 100% confidential and free helpline with trained, caring advisors who can help guide you to the best local treatment options for bulimia.
Read next: Where to Get Help for Bulimia
. U.S. Department of Health and Human Services. (2016). Bulimia.
. U.S. National Library of Medicine. (2016). Bulimia.
. National Institute of Health. (2016). Eating Disorders.
. U.S. National Library of Medicine. (2016). Anorexia.
. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
. U.S. Department of Health and Human Services. (2012). Bulimia nervosa fact sheet.
. Hay, P. J., & Claudino, A. M. (2010). Bulimia nervosa. BMJ Clinical Evidence, 1009.
. National Eating Disorders Association. Substance Abuse and Eating Disorders.
. Fichter, M. M., & Quadflieg, N. (2004). Twelve-year course and outcome of bulimia nervosa. Psychological medicine 34(08): 1395-1406.
. Kaye, W. H., Bulik, C. M., Plotnicov, K., Thornton, L., Devlin, B., Fichter, M. M., Treasure, J., Kaplan, A., Woodside, D. B., Johnson, C. L., Halmi, K., Brandt, H. A., Crawford, S., Mitchell, J. E., Strober, M., Berrettini, W. and Jones, I. (2008). The genetics of anorexia nervosa collaborative study: Methods and sample description. Int. J. Eat. Disord. 41: 289–300.
. Hoste RR, Labuschagne Z, Le Grange D. Adolescent bulimia nervosa. Current psychiatry reports. 2012 Aug 1;14(4):391-7.
. Hoek, H. W., & van Hoeken, D. (2003). Review of the prevalence and incidence of eating disorders. International Journal of Eating Disorders 34(4): 383-396
. Hudson, J. I., Hiripi, E., Pope, H. G., & Kessler, R. C. (2007). The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biological psychiatry 61(3): 348-358.
. National Eating Disorders Association. Bulimia Nervosa.
. Lock, J. & La Via, M.C. (2015). Practice Parameter for The Assessment and Treatment of Children and Adolescents with Eating Disorders. Journal of The American Academy of Child & Adolescent Psychiatry, 54(5): 412-425.
. Crow, S.J. et al. (2009). Increased mortality in bulimia nervosa and other eating disorders. The American Journal of Psychiatry. 166(12):1342-1346.