Bulimia Nervosa

This article provides a comprehensive overview of bulimia nervosa, including the symptoms, causes, treatments, and at-home management options.

Key Takeaways:

• Bulimia nervosa is an eating disorder that involves specific periods of binge eating, followed by compensatory behaviors to either get rid of food or help lose weight (e.g. vomiting, excessive exercise)
• Bulimia can lead to several mental and physical consequences, such as shame, guilt, digestive distress, and electrolyte imbalances. It is also highly correlated with low self-esteem, anxiety, and poorer mental health.
• Early treatment is essential for recovery. Treatment may include therapy, medication, and nutritional counseling, along with support and home management strategies.

Understanding Bulimia Nervosa

Bulimia nervosa is one of the primary eating disorders listed in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). It is characterized by frequent episodes of excessive eating, followed by compensatory behaviors to remove the food and/or lose weight. ^{[1] [2]}

There are two types of bulimia, which differ based on the specific compensatory behaviors involved: ^{[1] [2]}

• Purging Type: This involves specific methods to remove food from the system, such as vomiting or use of laxatives.
• Non-Purging: This involves specific non-purging methods to lose weight, such as excessive exercise or a strict diet.

Individuals with bulimia nervosa also typically worry a lot about their weight and body image, which leads them to engage in these behaviors. They may feel shame, guilt, and low self-esteem. Moreover, individuals with bulimia often binge and purge in private, so others may not be aware of their issues. ^{[1] [2]}

How Common is It?

Bulimia nervosa is more common in women than men, with women making up 90% of all bulimia nervosa diagnoses. In general, prevalence rates are between 0.1 to 1.3% among males and 0.5 to 2.0% among females. ^{[1] [3]}

It more often affects adolescents than adults, although anyone can be affected. It has a mean onset at around 12 years old. ^[1]

Is it the Same as Binge Eating Disorder?

Bulimia nervosa is not the same as binge eating disorder. Both conditions involve similar periods of excessive/binge eating, but bulimia nervosa also involves compensatory mechanisms, which are not (or rarely) present in binge eating disorder.

Symptoms

Bulimia typically involves several symptoms, although they may differ slightly from person to person. The most common symptoms of bulimia nervosa are: ^{[1] [2] [3] [4]}

• Eating excessive amounts of food in one sitting (binging)
• Specific purging methods to get rid of food:
• Use of laxatives
• Self-induced vomiting
• Use of diuretics
• Specific methods to lose weight, especially:
• Over-exercising
• Fasting
• Strict diet
• Fear of gaining weight
• Intense worry/preoccupation about weight and/or body image
• Low self-esteem or self-confidence
• Feeling unable to control eating behaviors
• Extreme mood swings

Family and friends are often unaware that someone is bulimic. Some signs that may indicate bulimia nervosa for others to look out for include:^{[2] [4]}

• Fatigue
• Constipation
• Mood changes
• Going to the bathroom right after eating
• Declining to go out to eat or eat in public
• Light-headedness
• Weakness

Bulimia and Body Dysmorphia

Bulimia is commonly associated with body dysmorphia, which is characterized by intense ridicule about certain aspects of one’s appearance. In the case of bulimia, individuals feel very unsatisfied with their body. For example, they may think they are fat or that they have an ugly body shape. This causes a lot of distress and often is a key driver behind their binging and compensatory behaviors.

Other Conditions Linked to Bulimia

Bulimia is associated with several other mental health conditions, especially anxiety, depression, and alcohol and substance use disorders. Even individuals without clinical anxiety or depression often experience general symptoms of anxiety, depressed mood, or low self-esteem. ^{[3] [4]}

Causes

The exact causes of bulimia aren’t completely identified, but it’s thought to result from a combination of factors, including biology, genetics, social/cultural influence, and personality.

Regarding biological factors, individuals with bulimia may have abnormal functioning in brain areas associated with emotional processing, appetite regulation, and taste reward processing. These can all influence binging behaviors. ^[1]

Childhood obesity and having a first-degree family member with bulimia also increases the risk. ^{[2] [4]}

Social and cultural factors may also influence bulimia. This is especially true for cultures that place a high priority on a thin body shape. ^{[2] [4] [5]}

Other causes or risk factors for bulimia include: ^{[2] [4]}

• Family/personal stress
• Anxiety, depression, or substance use
• Past or present dieting
• High stress
• Childhood abuse
• Low self-esteem

Diagnosing Assessments and Tests

Diagnosing bulimia nervosa involves several important steps. This includes a physical exam, mental health assessment, and possible testing for related complications.

The first step in diagnosing bulimia nervosa is a physical exam by your primary care doctor. He or she will complete a comprehensive physical, while going over your personal and medical history. They may pay special attention to your skin, mouth, and abdomen, since these are areas associated with issues in bulimia. ^[1]

The physical exam will also include a neurological exam, and possibly the following tests: ^{[1] [2]}

• Comprehensive metabolic panel
• Complete blood count
• Urinalysis
• Electrocardiogram and serum magnesium and phosphorus (for severe instances)
• Lab tests for stool or urine laxatives

The next step is a psychological evaluation, typically by a psychiatrist or psychologist. In this evaluation, your doctor will ask questions about your eating behaviors and habits. It might be uncomfortable to discuss this information, but it’s important to be as honest as possible. They are there to help, not judge.

Specific assessments that can aid in diagnosis of bulimia nervosa include: ^[6]

• Short Evaluation of Eating Disorders (SEED): This is a 5-question assessment to quickly evaluate eating behaviors and thought processes related to bulimia.
• Body Shape Questionnaire (BSQ): This is a 34-item scale that measures body shape concerns and factors related to body image.
• Disordered Eating Attitude Scale (DEAS): This is a 25-item questionnaire that assesses one’s thoughts, feelings, beliefs, behaviors, and relationship with food. It has five subscales.

After the evaluation, symptoms are compared to the diagnostic criteria found in the DSM-5, which are:

• Recurrent episodes of binge eating, which are characterized by
• Eating an excessive amount of food within a discrete time period (e.g. 2 hours or less)
• Feeling like one has no control over their eating behaviors
• Recurrent, inappropriate compensatory behaviors in order to prevent weight gain
• Binge eating and compensatory behaviors occur, on average, at least once a week for 3 months
• Self-image/evaluation is excessively influenced by body shape or weight
• Symptoms don’t occur exclusively during anorexia nervosa

Risks and Complications

Disordered eating patterns in bulimia nervosa increase the likelihood of health risks and other complications. These include: ^{[1] [2] [4] [5]}

• Stomach damage
• Other gastrointestinal issues (e.g. heartburn, irritable bowel syndrome [IBS], constipation)
• Diabetes
• Heart rhythm issues
• Muscle fatigue and weakness
• Headache
• Tooth erosion or decay
• Malnutrition and dehydration

Individuals with bulimia also have a higher risk of depression, anxiety, substance use, and suicidal thoughts or actions. ^{[1] [2] [4]}

Treatment Approaches

Common treatment approaches for bulimia nervosa include medication, therapy, and addressing any resulting health consequences. Nutritional counseling and support groups may also be included.

Medication

The most commonly used medications for bulimia are a group of antidepressants called selective-serotonin reuptake inhibitors (SSRIs). Examples of these include fluoxetine, citalopram and sertraline. ^{[1] [3]}

Other medications that may be used include:

• Other antidepressants, such as trazodone
• Antiepileptics, such as topiramate

Therapy

Therapy is typically an essential component of bulimia treatment. Two of the most effective forms of psychotherapy are cognitive behavioral therapy (CBT) and interpersonal therapy (IPT). ^{[1] [3]}

CBT addresses underlying negative or dysfunctional thoughts and maladaptive behaviors. Specific to bulimia, it can help individuals develop greater self-esteem, reduce self-criticism, manage cravings and distressing thoughts, and adopt healthier eating patterns.

IPT focuses on any interpersonal deficits that may be contributing to symptoms. The main goals of IPT are to improve one’s relationships and social interaction, reduce isolation, and promote greater confidence and overall feelings of connectedness and well-being.

Family-based therapy (FBT) may also be used, particularly when dealing with children or teenagers. It helps improve the child’s behaviors, while also helping parents or caregivers to learn ways to handle their child’s behaviors more effectively and to promote healthier eating. ^[7]

Additional Approaches

Nutritional counseling can also help individuals with bulimia to adopt a healthier relationship with food. These sessions may also be focused on nutritional education, so individuals can better understand the importance of food and nutrition in overall health and wellness, as well as the negative impacts of binging, purging, and overly restrictive diets. ^[7]

Home Management and Self-Care

In addition to professional treatments, there are several steps you can take to manage symptoms at home, which may in turn lead to improved function and well-being. The following tips may help: ^[7]

• Maintain relationships with trusted family and friends
• Talk openly with them, especially when you’re feeling stressed or down
• Eat a well-balanced, nutrient-rich diet
• Eat at consistent and regular intervals
• Set limits on how often you weigh yourself or check your appearance
• (once or twice weekly is a reasonable amount to stick to)
• Practice self-compassion, especially when you think you’ve messed up
• One setback doesn’t define you; zoom out and consider the larger journey
• Use relaxation strategies, such as deep breathing, meditation, and spending time outside
• Engage in enjoyable activities and hobbies, especially to take your mind off of cravings or related symptoms

Parents of children with bulimia can help by: ^[7]

• Allowing the child to talk, without judgment or criticism
• Scheduling meals at regular times
• Making healthy, nutrient-rich meals as often as possible
• Watching out for warning signs
• Staying in touch with the child’s doctor and healthcare team

Author

Jack Cincotta

Jack Cincotta holds a M.S. degree in Psychology. He is also a board-certified holistic health practitioner through AADP and an AFPA-certified holistic health coach and nutritionist.

Activity History - Last updated: March 19, 2026, Published date: March 19, 2026

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Reviewer

Jennifer Brown

Dr. Jennifer Brown is dual board-certified in family medicine and obesity medicine. She currently works for Amwell Medical Group, providing virtual primary care services, including mental health treatment.

Activity History - Medically reviewed on April 10, 2026 and last checked on March 19, 2026