Understanding Bulimia Nervosa

By Lauren Krouse

Bulimia (also called bulimia nervosa) is a serious but treatable eating disorder in which a person goes through cycles of binge eating followed by purging. Researchers are still sorting out exactly what causes bulimia, but it seems to be linked to many factors including family history, childhood trauma, brain chemistry, struggles to cope with intense emotions, and feeling unsatisfied with your body. Changes in your relationship to eating—such as dieting—can also lead to disordered eating behaviors like binging and purging. 

• Binge-eating is defined as an intense experience during which you eat a significantly larger amount of food than your body needs in a short period of time, such as a single sitting. You feel out of control, like you can’t stop. It’s common for a binge to be physically painful and to be followed by waves of guilt and shame and efforts to keep it a secret. 
• Purging, or what’s known as compensatory behavior, is an attempt to make up for or get rid of what you just ate, such as making yourself throw up, fasting, exercising excessively, or misusing medications like laxatives or diuretics.

Bulimia is a dangerous cycle that can cause serious harm to your body and ultimately become life-threatening. It’s super important to take warning signs seriously and get professional help as soon as possible if you’re concerned for yourself or someone else.

Watch: The Secretive Eating Disorder: Bulimia Nervosa

Who Can Get Bulimia?

Bulimia can affect anyone. It doesn’t matter what you look like, how much you weigh, or your sexuality, race, age, ethnicity, background, or income. Bulimia typically starts in teens and young adults, but left untreated it can continue long into adulthood. Girls and women of color have a 50 percent higher rate of bulimia than their white peers, but they’re also far less likely to get diagnosed and treated due to stereotypes and racism.

What Causes Bulimia?

We don’t yet know exactly what causes bulimia, but many factors play a role.

• Having a close family member, such as a parent or sibling, with an eating disorder is linked to an increased risk of developing an eating disorder like bulimia. 
• Differences in brain chemicals such as serotonin and dopamine have been linked with bulimia, and they may fuel binge eating, irritability, impulsivity, and depression. 
• Dieting doubles your risk of developing an eating disorder.
• Feeling unsatisfied with your body image and struggling with social pressures to tie your value to your body weight or shape can lead to disordered eating and bulimia. 
• Difficulty coping with intense emotions can lead to disordered eating, in an attempt to self-soothe and find temporary relief or escape from distress.
• Experiences of sexual abuse or neglect during childhood are linked to a higher risk of developing bulimia. 
• Weight stigma, such as being bullied, teased, and judged because of your weight, can also increase the risk of developing bulimia.

What Are the Signs Someone May Have Bulimia?

There are many warning signs and symptoms of bulimia.

• Focusing excessively on body-image concerns, weight loss, or dieting.
• An unusual number of food wrappers or containers, or large amounts of food missing from where you usually keep them.
• Going to the bathroom during or after meals.
• Sounds or smells of throwing up after eating.
• Packages or wrappers of laxatives or diuretics that are not prescribed by a doctor.
• Drinking excessive amounts of water or zero-calorie drinks.
• Using a lot of mouthwash, mints, or gum.
• Puffy lips and cheeks, or calluses on the backs of hands and knuckles from using hands to cause vomiting.
• Dental problems such as sensitive teeth or the wearing away of enamel.
• Pulling away from friends, family, and activities you typically enjoy.
• Irritability, anxiety, or low mood.
• Self-harm or suicidal thoughts.

People with bulimia are more likely to struggle with self-harm and suicidal thoughts. If you or someone you know needs help: 

• Text HEALING to 741-741 for a free, confidential conversation with a trained counselor any time of day. 
• Text or call 988 or use the chat function at 988lifeline.org. 

If this is a medical emergency or there is immediate danger of harm, call 911 and explain that you need support for a mental health crisis.

How Can Bulimia Impact Your Physical Health?

Along with the profound emotional toll, bulimia can also have serious, irreversible effects on your body. The binging-and-purging cycle can lead to electrolyte and chemical imbalances that can hurt major organs, including your heart, and even lead to sudden cardiac arrest and death—even when someone looks or seems OK. Other health consequences include: 

• Long-lasting digestive issues, especially in the upper digestive tract, from damage associated with vomiting and stomach acid (acid reflux and inflammation or irritation of the esophagus, which may increase the risk of esophageal cancer).
• Irregular periods or difficulty getting pregnant.
• Tooth decay and gum disease from repeated exposure to stomach acid.
• Dehydration and kidney problems.
• Dry skin, brittle nails, and hair loss.

How to Get Help for Bulimia

• When you have bulimia, it’s common to work overtime to hide signs of binge eating and purging, which can make it really hard for the people who love you to know what’s going on. You may believe you can stop or get over it by yourself, but bulimia is a serious medical condition that—like others—needs treatment from a professional as soon as possible to prevent long-term consequences. If you notice any signs of bulimia in yourself or someone you care about, don’t let doubt or concerns about not being sick enough stop you. Now is the time to reach out and let yourself get the care and compassion everyone deserves.  Learn how you can ask for help with an eating disorder. Contact the National Alliance for Eating Disorders helpline, which is run by licensed therapists who specialize in eating disorders and can help connect you to the resources and care you need. 
  • Call 866-662-1235 or email info@allianceforeatingdisorders.com to get referrals to all levels of care. The helpline is open from 9 a.m. to 5:30 p.m. EST Monday through Friday. If help is not immediately available, your call will be returned as soon as possible. 

Learn more about body image, eating disorders, and how to get help, check out:

• What Is an Eating Disorder?
• What are the Signs and Symptoms of an Eating Disorder?
• Body Image and Eating Disorders: What’s the Connection? 
• Struggling With Body Image? Body Positivity and Body Neutrality Can Help
• What Is Anorexia Nervosa and How Can I Get Help for It?
• What is Binge Eating Disorder?
• How to Help Someone with an Eating Disorder
• Do Eating Disorders Increase the Risk of Suicide?

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