Bulimia Nervosa

According to Johns Hopkins Medicine, bulimia can present itself in two ways: purging type and non-purging type. The symptoms a person experiences typically depend on which type they have. Purging is when the individual uses self-induced vomiting, laxatives, diuretics, or enemas to clear out the digestive system. Non-purging individuals typically use other means of controlling calorie levels, such as excessive exercise, weight loss pills, or fasting. 

Symptoms of bulimia can be divided into physiological and psychological/behavioral symptoms. The psychological and behavioral symptoms may include:

• Signs of purging behaviors, such as frequent bathroom visits after meals, evidence of vomiting, or boxes of laxatives or diuretics noticed around the house
• Disappearance of large amounts of food at a time, food wrappers hidden around the house, or any other indicator of someone eating large amounts of food
• Behaviors and beliefs that indicate that weight loss, control of food, and dieting are becoming an obsession in the individual’s life
• A tendency to be overly focused on diet fads
• Reluctance to eat in public or with other people
• Reliance on breath mints, gum, or mouthwash
• An excessive, rigid exercise routine
• Presence of food rituals
• A tendency of a person to hide their body with baggy clothing
• A preoccupation with body image and an intense fear of gaining weight
• Depression, anxiety, and/or social withdrawal
• Risky behaviors, such as drug or alcohol use

Physiological symptoms of bulimia can include:

• Fatigue and decreased energy
• Dental problems due to the erosion of enamel caused by frequent vomiting
• Continually inflamed or sore throat
• Heart arrhythmia
• Throat and stomach ulcers
• Dry and brittle nails
• Poor wound healing
• Irregular menstrual periods
• Swollen jawline or cheeks
• Fainting
• Bloodshot eyes
• Calluses or scars on knuckles (from forced vomiting)

According to the American Society for Nutrition, eating disorders (like anorexia nervosa¹ and bulimia) have a high risk of death—second only to addiction to opioids. The medical complications from starvation can be extremely dangerous, and yet difficult to detect until it’s too late. A secondary cause of death with eating disorders tends to be suicide.* It is highly recommended that you get help if you suspect you have an eating disorder or if you suspect it in a loved one. 

There is no single known cause of bulimia, but researchers believe that it can stem from a combination of genetics and learned behaviors. Those who have family members with bulimia may be at greater risk for developing the disorder themselves. It tends to show up most often in teenage girls but can affect people of all genders. 

Risk factors

There are some risk factors that may indicate a greater chance of experiencing bulimia, including the following:

• Age and gender (teenage girls—although people of all genders can have bulimia, it tends to be more prevalent in women)
• Low self-image or self-worth
• Other mental disorders, such as depression or anxiety
• Substance use disorder
• Excess weight as a child or teen
• Excessive stress or boredom
• Family members with eating disorders

Treatment for bulimia may involve a combination of therapeutic approaches. A strong inter-professional approach with medical and mental health professionals can be most effective for long-term success in treating bulimia and other eating disorders. 

Medication

Medication is not generally used in the treatment of eating disorders like bulimia. However, in some cases, antidepressant medications may be prescribed to alleviate symptoms of bulimia. The only medication currently approved for bulimia by the U.S. Food and Drug Administration (FDA) is fluoxetine (Prozac). Do not start, stop, or change a medication without consulting with a healthcare professional.

Other treatment options

Any severe physical symptoms may be treated by a medical professional in a hospital or outpatient setting. These include symptoms like electrolyte imbalance, ulcers, dental problems, or any other challenges that may have been caused by purging behaviors. 

A therapist may work with family members to educate them on bulimia and appropriate interactions with food and exercise. A strong support system can be helpful for those who experience eating disorders. 

Self-care

As a part of the therapeutic process, a therapist may work with individuals on learning and implementing self-care practices to help manage stress and build self-esteem. This can include mindfulness or relaxation techniques like deep breathing or meditation, positive self-talk, social support systems, and healthy lifestyle habits that are not centered on food.

Cognitive-behavioral therapy (CBT) is considered the first-line therapeutic treatment for bulimia. CBT is designed to replace negative patterns of thought and behavior. Licensed therapists who practice CBT may be able to help you identify the source of negative thoughts and beliefs and guide you toward a more positive body image and better mental health. 

For those who may have difficulty finding a therapist in their geographical area, online therapy offers a variety of choices. With an online therapy platform like BetterHelp, you can fill out a simple questionnaire and be matched with a licensed therapist who meets your needs. Sessions are held online through audio, videoconferencing, or live chat. 

Below are some other resources you can use to find out more about bulimia or reach out for help:

• National Eating Disorders Association (NEDA)
• Bulimia Guide
• Eating Disorder Foundation
• Johns Hopkins Medicine

For those with thoughts of suicide, contact 988 Suicide & Crisis Lifeline at 988. Please also see our Get Help Now page for more immediate resources.

Research shows that cognitive behavioral therapy specialized on the treatment of eating disorders is the most effective form of therapy, when compared to other psychological interventions. 

A recent study has suggested that there is a brain response that reinforces behaviors in binge eating. Researchers believe that continued study into the neurobiological aspect of eating disorders can help in discovering more effective avenues of treatment.

40% to 60% of individuals with bulimia achieve remission after therapy

40% to 60% of all people with bulimia nervosa were found to achieve remission of eating disorder symptoms after participating in recommended treatments for eating disorders, such as cognitive-behavioral therapy (CBT) and focal psychodynamic psychotherapy. ¹

¹Neuroscience & Biobehavioral Reviews

Here are more key statistics on bulimia nervosa, anorexia, and binge eating disorder:

• The standard onset of bulimia nervosa (as well as anorexia nervosa) is between 12 and 25 years old.
• The one-year prevalence of bulimia nervosa is 0.32% for females and 0.05% for males. 
• Around 94.5% of individuals with bulimia met criteria for at least one other core DSM-IV mental health disorder in the National Comorbidity Survey Replication.