Bulimia is an eating disorder characterized by binge eating followed by behavior to compensate for excess caloric intake. These behaviors are often harmful to various body systems and include self-induced vomiting, fasting, excessive exercise, and the abuse of laxatives or diuretics.
What Is Bulimia?
Bulimia is an eating disorder characterized by recurrent episodes of binge eating followed by compensatory behavior, such as self-induced vomiting, fasting, excessive exercise, or abuse of laxatives or diuretics.
Despite typically having a normal weight, people with bulimia are often persistently concerned with their weight. The compensatory behaviors associated with bulimia can result in a number of dangerous medical complications.
Treatment of bulimia typically requires collaboration between a patient, family members, primary care physicians, mental health professionals, and nutritionists and consists of psychotherapy, nutrition, and medication.
You should speak with your primary care physician, psychiatrist, or therapist.
- Binges — Episodes of rapid consumption of food, in amounts larger than most people would eat, sometimes thousands of calories, coupled with feeling a loss of control. Binges may be triggered by psychosocial stressors and are often carried out in secret.
- Compensatory behaviors to avoid weight gain, often resulting in a sense of relief
- Self-induced vomiting
- Excessive exercise
- Negative self-evaluation: People with bulimia are often a normal weight, but are often dissatisfied with their bodies and feel compelled to lose weight or afraid of gaining weight.
- Growth stunting or weight loss in adolescence: Youth should be gaining weight as they grow. Weight loss, failure to gain weight, delayed puberty, or stunted growth can be .
- Secretive behaviors such as spending a long time in the bathroom after meals, hiding food, or hiding laxatives.
- Oral health problems: This includes tooth decay, gum disease, swollen parotid (salivary) glands, and dry mouth.
- Kidney injury: This occurs from dehydration.
- Heart problems: Vomiting and diuretic use in bulimia can lead to abnormal levels of electrolytes in the blood, which can predispose the heart to irregular rhythms (arrhythmias) and heart failure.
- Hormonal: Bulimia can lead to absent or irregular periods (amenorrhea) in women and delayed growth in both genders, due to abnormal hormone levels.
- Gastrointestinal problems: Recurrent vomiting can lead to tears or irritation of the esophagus. Delayed emptying of the stomach and constipation can also result.
- Mental health problems: These are common in bulimia, and may include anxiety (13 to 65%), mood disorders (50 to 70%), substance use disorders (25%), problems with relationships and social functioning, self-injury, and suicide.
The exact cause of bulimia is not well understood. A combination of neurobiological, genetic, psychological, environmental, social, and cultural factors likely play a role in the of the condition. Possible include:
- Abnormal neurotransmitter systems: This includes those involving serotonin and dopamine.
- Psychological factors: This includes perfectionism, poor impulse control, and limited adaptability to developmental stressors.
- Socially idealized body shapes and weight
Not likely causes
Contrary to prior beliefs, the current clinical evidence does not consider eating disorders to be caused by families or chosen by people with them.
Who is most likely to be affected
Bulimia is likely to affect the following groups.
- One to three percent of the population over the lifetime
- Age of onset: It most often occurs at age 16 to 17.
- Females: Females are more commonly affected than males.
- Family members: Family members of people with eating disorders are seven to 12 times more likely to develop an eating disorder.
- Adolescents with chronic illnesses: Especially those with diabetes, are at higher risk.
Treatment Options and Prevention for Bulimia
Effective eating disorder treatment usually involves a team consisting of the individual in need, their family, a primary care doctor, a mental health professional, and a nutritionist. Treatment usually consists of a combination of psychotherapy, nutrition, and medication. Indicators of physical, nutritional, behavioral, and psychological health are all monitored to assess progress and recovery.
Methods of psychotherapy (talk therapy) include the following.
- Cognitive behavioral therapy (CBT): Sixteen to 20 sessions over several months aim to increase motivation for change, decrease concern about body shape and weight, replace dysfunctional eating with healthy patterns, and prevent relapse. CBT has been found to eliminate binging and purging in up to half of people, with improvements maintained over the .
- Family-based therapy (FBT): For youth with eating disorders, FBT that focuses on restoring a healthy weight, reducing blame, and empowering caregivers has been found most effective. It is typically conducted over six to 12 months and 50 to 60 percent of patients achieve full remission within one year.
Nutrition is considered important to improve cognition in eating disorders. In growing youth, weight restoration, often involving high-calorie diets, is used to allow continued growth and development and is a mainstay of treatment. Nutritionists can help you learn how to eat a healthy, nutrient-rich diet, without excessive focus on calorie counting.
Antidepressants, such as fluoxetine (Prozac) are approved for the treatment of bulimia in adults. In addition to reducing comorbid anxiety and depression symptoms, selective serotonin reuptake inhibitors (SSRIs) seem to help reduce the frequency of binging and vomiting.
The American Academy of Pediatrics suggests hospitalization if any of the following occur in the course of bulimia:
- Passing out: Also known as syncope.
- Very low potassium or chloride: Meaning the concentration of these in the blood.
- Esophageal tears: These occur from vomiting.
- Abnormal heart rhythms (arrhythmias)
- Low body temperature (hypothermia)
- Suicide risk
- Vomiting blood: Known as hematemesis.
- Vomiting that won't stop
- Failure to improve with outpatient treatment
Methods of preventing bulimia include the following. In addition, it is important for overall health to establish a support system among friends and family as well as medical providers.
- Avoid frequent weighing
- Control urges to look in the mirror more than necessary
- Discourage or avoid dieting and weight-control behaviors in youth: Instead, encourage healthy eating, including nutritious foods, and activity that can be sustained over time.
- Foster a healthy body image in youth, regardless of shape or size: Build confidence via attributes other than appearance.
- Do not use body dissatisfaction as a motivator for change:Instead, encourage nurturing the body through healthy eating, moderate activity, and positive self-talk.
- Do not use diet or weight loss drugs without first consulting your physician: Even "natural" weight loss products may be unsafe.
When to Seek Further Consultation for Bulimia
If food dominates your life
If you are concerned that you worry excessively about how much you eat, what you look like, or feel you have lost control over how much you eat, then you should seek help from a medical professional.
If you are concerned that you or your child may have an eating disorder
If your child is not gaining weight, frequently expresses concerns about their body or weight, has unusual rituals around eating, or engages in excessive behaviors to control their weight, consider seeking help from a medical professional. These may be signs of eating disorders, which can lead to dangerous consequences if not detected and treated.
If you or your child expresses a desire to end life
Suicidal thinking is more common in people with eating disorders. If you or someone you know engage in self-injurious behavior, such as cutting, or feel life is not worth living, seek immediate help.
Questions Your Doctor May Ask to Determine Bulimia
- Have you been feeling more tired than usual, lethargic or fatigued despite sleeping a normal amount?
- Do you have trouble sleeping?
- Are you feeling irritable (easily made upset)?
- Are you having difficulty concentrating or thinking through daily activities?
- Any fever today or during the last week?
Self-diagnose with our free if you answer yes on any of these questions.
- Campbell K, Peebles R. Eating disorders in children and adolescents: State of the art review. Pediatrics. 2014;134(3):582-592.
- Bulimia nervosa: Diagnosis & treatment. Mayo Clinic. Published May 10, 2018.
- Harrington BC, Haxton C, Jimerson DC. Initial evaluation, diagnosis, and treatment of anorexia nervosa and bulimia nervosa. Am Fam Physician. 2015;91(1):46-52.
- Mcgilley BM, Pryor TL. Assessment and treatment of bulimia nervosa. Am Fam Physician. 1998;57(11):2743-2750.
- Attia E, Walsh BT. Bulimia nervosa. Merck Manual Professional Version. Updated March 2018.