Bulimia: What It Is And How To Move Past It

If you or a loved one is experiencing signs of an eating disorder, you can contact the National Eating Disorder Association Helpline for support and resources at 1-800-931-2237 (M–Th from 9AM–9PM EST and Fri 9AM–5PM EST).

Eating disorders like bulimia are a type of mental health disorder that can have very serious consequences for a person’s mental and physical well-being. However, recognizing the warning signs in yourself can sometimes be difficult, since this condition is typically characterized by distorted thinking about your own body and actions. It can be difficult to recognize in others as well, since many people with this type of illness feel shame around it and go to great lengths to hide their behaviors. That’s why gaining a deeper understanding of how a mental disorder like bulimia works can help us or our loved ones get the treatment that may be necessary.

In this article, we’ll discuss symptoms of bulimia nervosa, risk factors, and treatment options.

What is bulimia?

Bulimia, or bulimia nervosa, is a mental health condition that can take many different forms, but is usually marked by two key behaviors:

• Binge eating. This term refers to episodes of eating large amounts of food at once. A person with bulimia will often feel unable to resist or control their impulse to overeat, though they often engage in this behavior in secret because of feelings of shame. This compulsion tends to be triggered by negative feelings such as loneliness, self-loathing, or sadness and may be used to temporarily help soothe them.

• Compensation. People with bulimia typically feel extreme anxiety about their body weight as a result of their binge eating. As a result, they will take extreme, unhealthy measures in an attempt to “compensate” for their excessive food consumption. Contrary to popular belief, these behaviors do not always take the form of purging via self-induced vomiting or laxatives, though they can. There’s also another type of bulimia known as “non-purging,” which involves prolonged fasting or excessive exercise in order to “make up for” the food consumed.

Eating disorders similar to bulimia

It’s worth noting that there are other eating disorders that may be confused with bulimia. For example, one of the subtypes of anorexia nervosa may involve binging and purging from time to time, with extreme food restriction as is characteristic of classic anorexia the rest of the time. In addition, those with the traditional presentation of anorexia often engage in compensatory behaviors for the little food they do eat. 

Binge eating disorder (BED) is also similar to bulimia in that both are characterized by regular binge eating episodes. However, the difference is that those experiencing binge eating disorder typically do not engage in purging of any kind afterward. Seeing a healthcare provider to discuss your unique symptoms is typically the best way to get an accurate diagnosis and the most helpful treatment suggestions for you before your eating disorder becomes a life-threatening illness.

Recognizing bulimia: Common symptoms

Of course, the most common symptom of bulimia is a cycle of excessive eating followed by “compensation” for that eating, either by self-induced vomiting, laxatives, fasting, or excessive exercise. However, it may not always be easy to realize if your own eating habits have reached unhealthy extremes. That’s why looking out for these additional symptoms may help you recognize when it could be time to seek help:

• Intense worries and insecurity about body image or gaining weight

• Frequently feeling unable to stop eating

• Intentionally causing yourself to vomit to avoid weight gain

• Feeling shame about eating 

• Consuming large amounts of food in secret

• Obsessively counting calories or restricting food intake between binges

• Using laxatives when not constipated, or diuretics when you don’t have problems with fluid or salt retention

What if it’s a loved one you’re worried about instead? People with bulimia are often careful to conceal their binging and purging from the people around them, so you may need to look for other warning behaviors, such as:

• Strict dieting, food restriction, calorie counting, or fasting

• Frequent complaints about weight or body shape

• Avoiding eating in front of other people

• Hiding or hoarding food

• Stashing medicine that can cause vomiting, defecation, or urination

• Excessive use of breath-freshening products

• Heading straight to the bathroom after eating

• Exercising obsessively, even when tired, sick, or injured

Finally, you might also notice physical signs that could point to the presence of this disorder. Frequent vomiting can cause damage to the mouth and esophagus, while overuse of laxatives may negatively affect the stomach and intestines. A person with bulimia may undergo dramatic weight fluctuations, and they may also show signs of malnutrition. Potential effects related to these could include:

• Stomach cramps and digestive problems

• Dry skin

• Brittle hair and nails

• Damaged gums and teeth

• Dizziness

• Cuts, scars, or calluses on the backs of hands (from contact with teeth while inducing vomiting)

• Acid reflux

Who is at risk for bulimia?

The National Institute of Mental Health estimated that about 0.3% of the U.S. population is living with bulimia at any given time, but this was in 2003. Up-to-date statistics about how many people are currently affected by bulimia are not widely available, but it’s likely higher than this figure reflects. Though there’s a lack of broader details on this topic, various studies have been done over the last several years to focus on the incidence of eating disorders like bulimia among particular subsets of the population who tend to be more at risk for developing them.

Anyone of any age, race, gender, body size, or background can experience bulimia or any other eating disorder. However, statistics compiled by the National Association of Anorexia Nervosa and Associated Disorders (ANAD) suggest that some people may be at higher risk of developing eating disorders than others—which can largely be traced back to societal pressures and prejudices and systemic inequalities. For example:

• Adolescents experience eating disorders more frequently than those of other ages, and most people with bulimia develop the disorder in their teens

• Black and Hispanic teenagers are 50% more likely to display bulimia-related behaviors than white teens

• BIPOC (Black, Indigenous, and People of Color) are significantly less likely to be asked by a doctor about eating disorder symptoms than white individuals and are half as likely to be diagnosed with or receive treatment for them

• Gay and bisexual men are seven times more likely to report binge eating and twelve times more likely to report purging than heterosexual men

• Transgender college students report experiencing disordered eating at four times the rate of cisgender students

• Women with a physical disability are more likely to develop eating disorders

• Those with autism represent as many as 30% of those with eating disorders

• Those in larger bodies are half as likely to be diagnosed with an eating disorder as those at a “normal weight” or who are “underweight”

• Military veterans who experience an eating disorder are most likely to experience bulimia

Potential health impacts of bulimia

People with bulimia could experience a wide variety of health complications as a result of this illness. For example, they are at increased risk for health problems like chronic malnutrition, throat inflammation, and organ failure. Cardiac disease, in particular, appears to be more common among people with bulimia as well due to electrolyte disruption resulting from binging behavior. That’s part of the reason why people with this condition are at increased risk of mortality. Although, again, up-to-date statistics are unavailable, a 2011 review reported that one to two people out of every 1,000 with bulimia will die each year. 

Physical effects aren’t the only risk of this condition. Living with bulimia can take a serious toll on one’s interpersonal relationships and self-esteem as well. It may place a person under a great deal of psychological strain, likely impacting their daily functioning and overall well-being. Finally, people with bulimia are also at a substantially increased risk of self-harm. One study estimated that those with this disorder are almost eight times more likely to die by suicide those without—a chance that may be magnified for those with intersecting identities that are also associated with increased suicide risk as a result of their treatment in society, such as those who identify as LGBTQIA+.

If you or someone you know is experiencing suicidal thoughts or behaviors, seek help immediately. The National Suicide Prevention Lifeline can be reached 24/7 by dialing 988.

What can you do to support someone with bulimia?

If you think that someone close to you might be living with bulimia, your support could make a significant difference in helping them recover. They may not be willing to admit to themselves that they need to make a change, and the feelings of low self-worth that often accompany this condition could even make them feel that they don’t deserve help.

The National Eating Disorders Association suggests expressing your concerns to your loved one in a caring, non-accusatory, but firm manner. It may be helpful to do some research on bulimia and rehearse what you’re going to say beforehand, then find an appropriate time and place for a conversation. Remember that it’s often best to place the emphasis on your own concern for this person, and to bring up specific troubling behaviors you’ve observed to explain why you’re worried. 

Jumping to simplistic answers, like telling them to “just stop purging,” is rarely helpful. Instead, you might want to do some research on treatment options and offer to support them in practical ways, such as by helping them enter a support group and sitting in with them as they open up. Or you might help them find a therapist and perhaps accompany them to sessions if they would like you to. Emphasizing that you think they should seek professional help may be important.

How is bulimia treated?

Effective treatment for bulimia usually involves addressing both the underlying psychological factors and the immediate physical effects of binging and compensatory behaviors. If you’re trying to overcome bulimia, you may want to consult a nutrition professional for support in building healthier eating habits. It’s also often recommended that you connect with a compassionate therapist for help in working through feelings like shame, self-loathing, a lack of control, or past trauma that may be affecting your relationship with food. Some people also find participating in an eating disorder support group helpful, as it gives them the opportunity to connect with others who have the same experiences.

Many people carry intense shame related to their relationship to food and to feelings or traumas that may contribute to their behaviors. As a result, meeting with a therapist to discuss them in person can be intimidating and may even dissuade some people from seeking potentially life-saving help. In cases like these, online therapy may represent a more approachable option. With a platform like BetterHelp, you can get matched with a licensed therapist who you can meet with via phone, video call, and/or in-app messaging to address the challenges you may be facing. 

If you are experiencing trauma, support is available. Please see our Get Help Now page for more resources.

Multiple studies on the effectiveness of online therapy in recent years have suggested that it can be as effective as in-person treatment for a variety of conditions. This appears to be true for bulimia as well. For example, a 2017 randomized trial indicates that online treatment with cognitive behavioral therapy led to long-term reductions in bulimia symptoms, similar to face-to-face therapy. The researchers concluded that internet-based therapy had the potential to be an effective and affordable treatment for bulimia. In other words, you can generally feel confident in choosing whichever therapeutic format you may prefer when seeking treatment for this or another eating disorder.