Bulimia Nervosa, commonly referred to as bulimia, is an eating disorder characterized by a cycle of binge eating followed by purging. Binge eating refers to the action of consuming large quantities of food in a very short period of time, even when not hungry and often past the point of overindulgence. Purging is described as engaging in behaviors to compensate for the effects of binge eating, such as vomiting, taking laxatives, taking diuretics, fasting, and exercising. 

It is important to remember, bulimia is a mental health condition where people become trapped engaging in a dangerous cycle of attempting to control their body image while losing control of their daily nourishment habits. Here are some symptoms of bulimia often reported or experienced:

✅ preoccupation with body shape and weight
✅ living in fear of gaining weight
✅ repeated binge eating episodes
✅ sensing a loss of control during binging
✅ forcing oneself to undo the effects of binging through purging

Causes of Bulimia

There is no known cause of bulimia; instead, a series of risk factors influencing the development of the distorted eating disorder. 

A common blame for the development of bulimia is the increase in technological advances and the accessibility of social media. Social media’s average generalized users tend to be those of younger generations usually in the stages of critical self exploration and development. Some find teenagers to act as sponges during this time, absorbing the content presented to them on social media and comparing themselves to what is missing. 

Though it is important to consider, the media cannot solely be blamed for the unhealthy representations of body image. Instead, the consistent upholding of body image standards within a person’s family, friends, and community groups followed by the media’s perceptions can create dysfunctional thinking. Bulimia is not caused by a single event or interaction, rather from a combination of life experiences.  

Listed below- outlines the genetic, cultural, and physiological factors increasing the risk of developing bulimia and some common misconceptions:

💡 family history of bulimia                           ❌ someone’s enjoyment of food
💡  physical or emotional trauma               ❌ solely by parental upbringing
💡  unhealthy relationship with food           ❌ unhealthy body image
💡  having poor body image issues         
💡  extreme diet culture 

💡 family history of bulimia
💡  physical or emotional trauma
💡  unhealthy relationship with food 
💡  having poor body image issues         
💡  extreme diet culture 

❌ someone’s enjoyment of food
❌ solely by parental upbringing
❌ unhealthy body image

Misconceptions About Bulimia

Bulimia carries many misconceptions. Eating disorders, along with many other mental health conditions, are still considered taboo and simply “make believe”in many cultures. Due to the stigmas, it can be hard to obtain the facts with the blending of societal stereotypes and biases, creating a barrier in education and awareness. Below are a few misconceptions about bulimia to help sort through the truth. Bulimia is not:

🚫 a choice 
🚫 attention seeking
🚫 an adolescent developmental stage 

anorexia with purging behaviors
🚫 fat phobia with an eating disorder
🚫 about food
🚫 harmless

🚫 affecting women only 
🚫 visible in person’s appearance
🚫 not dangerous unless physical signs


🚫 anorexia with purging behaviors
🚫 a choice 
🚫 fat phobia with an eating disorder
🚫 harmless
🚫 about food
🚫 attention seeking
🚫 affecting women only
🚫 an adolescent developmental stage 
🚫 visible in person’s appearance
🚫 not dangerous unless physical signs

Signs and Symptoms of Bulimia

The symptoms of bulimia are considered fairly easy to hide. Therefore the warning signs can often go unnoticed for years. There are various signs and symptoms that are both true to the diagnosis and individualized to a person’s experience as well. If you’re concerned about bulimia, this is not a comprehensive list but some of the warning signs:

🚩  self-induced vomiting
🚩  edema
🚩  misuse of laxatives and diuretics
🚩  puffy cheeks
🚩  complaints about body image
🚩  significant weight fluctuation
🚩  depression
🚩  discomfort eating around others
🚩  irritability
🚩  hiding food
🚩  withdrawal after eating
🚩  drinking excessive amounts of water
🚩  guilt or shame about eating
🚩  self harm and negative self talk
🚩  scars on knuckles or hands specifically in purging habits

Diagnosing Bulimia

Provided below are symptoms from the Diagnostic and Statistical Manual of Mental Disorders (DSM) used by mental health providers to diagnose bulimia. The DSM serves as a guide for mental health providers to destigmatize labels that can arise upon diagnosis. 

It is important to recognize that an individual does not have to exhibit all of these criteria for a diagnosis of bulimia. There are four key diagnosable features of bulimia: 

                                   1. recurrent episodes of binge eating

                                   2. repeated purging behaviors

                                   3. high influence of body shape and weight on self worth

                                   4. behaviors occur on average at least once a week for three months

For the final diagnosis of bulimia nervosa, these behaviors must have continued for at least once per week for three months. Below, we have detailed the terms of each diagnosable symptom. 

⚠️ recurrent binge eating episodes characterized by:

        • eating a larger than average amount of food during a short period of time
        • uncontrolled eating during each episodes

⚠️ repeated purging behaviors to reverse binge eating effects

        • compensatory purging behavior examples: self-induced vomiting, misuse of laxatives, diuretics, or other medications, fasting, and excessive exercise. 

⚠️ heavy influence of body image on self worth

⚠️ binge eating and purging behaviors both occur at least once a week for three months (on average)

Conditions Commonly Mistaken for Bulimia

Bulimia nervosa is often confused with other eating disorders, such as anorexia nervosa, binge eating disorder (BED), and avoidant restrictive food intake disorder (ARFID). However, these disorders are characteristically different from bulimia. 

✳️ anorexia nervosa is characterized by a distorted perception of body image, causing the restriction of food and the development of abnormally low body weight due to an intense fear of gaining weight. Usually people with anorexia severely limit their food intake and often obsessively exercise to control potential weight gain. Anorexia is diagnosed in people who have reported or shown behaviors of obsessively staying  underweight and restricting food, while people with bulimia often appear to be of average weight for their age. 

✳️  binge eating disorder (BED) is similar to bulimia, though does not involve purging after overconsumption. During binge eating episodes, individuals eat  abnormally large amounts of food with the inability to control. They may eat even when not hungry and will often eat past the point of feeling full. Similar to people with bulimia, people with BED experience intense distress towards their behavior, though never compensate through purging behaviors. 

✳️ avoidant restrictive food intake disorder (ARFID) is characterized by highly selective eating habits and/or disturbed feeding patterns. Although both bulimia and ARFID diagnoses indicate severe changes to eating patterns, bulimia involves uncontrolled eating while ARFID is intentionally controlled.

Treating Bulimia

The most common and effective treatment for bulimia is a combination of psychotherapy and medication. The following is a list of commonly recommended treatments:

🧬 individual, group and/or family psychotherapy 
🧬 behavioral therapy – focuses on analysis of behaviors and ways to change them, so patients will follow specific instructions between sessions. 
🧬 cognitive behavioral therapy – focuses on identifying and countering the thoughts that influence these destructive habits.
🧬 medication management – antidepressants are used in combination with psychological therapies in order to treat the whole person. 
🧬 mind/body exercises – to help change body image perceptions body exercises such as yoga, tai chi, and dance are recommended

Healthcare Professionals Who Treat Bulimia

For the best results in a successful treatment of bulimia, seek providers that have specialties in the assessment, treatment, diagnosis, and continuing support of patients diagnosed with bulimia. 

Many medical and mental health providers are familiar with the diagnosis of bulimia.  However if your chosen provider is not, they should always provide a knowledgeable referral source. Specialized providers will have the capabilities to diagnose using various testing methods to decrease the likelihood of misdiagnoses and unnecessary treatments. 

If you choose to utilize medication, psychotherapy should always be incorporated in treatment planning. 

The following are professionals involved in the treatment of bulimia:

🧠 general practitioners
🧠 psychologists
🧠 social workers
🧠 family doctors
🧠 psychiatrists
🧠 rehab therapists
🧠 pediatricians
🧠 dietitians
🧠 nurses

Recognizing Immediate Need for Bulimia Treatment

Eating disorders can be fatal. If you or someone around you starts to show symptoms, please seek support immediately. As soon there are concerns related to wellbeing, consider contacting a health professional for support. Bulimia can affect all portions of life, often with relationships being the first to change. You may sense a change in not only your relationship with food and your body, but also with friends and family. When things in life start to feel “uneasy” or “not right,” please seek support.

🚨 obsession with body shape and weight
🚨 feeling a lack of self control when eating
🚨 severe changes in weight
🚨 increase in untruths when discussing food
🚨 changes in mood and behavior
🚨 sense of pulling away from your family and friends
🚨 negative thinking
🚨 inability to change eating behaviors

Bulimia Professional Organizations

Provided are some resources to help the start of seeking support for bulimia. Though these are national links, consider narrowing options down by searching in your current location.