Bulimia Nervosa




Bulimia Nervosa is a type of eating disorder characterized by a cycle of binge eating followed by purging at least 1 time a week for the last 3 months. Purging behaviors can include self-induced vomiting, laxative abuse, excessive exercise, fasting, diuretics, weight-loss supplements, and enemas. Those with bulimia also struggle with negative self-image and fear of gaining weight. The term bulimia comes from the Greek word for ‘ravenous hunger’. Many report feeling they have little control over their hunger and a loss of control when they eat, feeling like it’s impossible to stop the binge once it begins.

Binges are often precipitated by a period of dieting or restriction where the individual tries to limit what or how much they are eating. It is common to experience extreme levels of hunger after a period of restriction. This makes it difficult to detect and honor natural fullness cues from the body and often results in eating past comfortable fullness or a binge. When a binge occurs, it can be followed by intense feelings of guilt and discomfort leading to purging behaviors to relieve the distress. Purging often gives the individual feelings of well being, comfort, euphoria or instant relief, making it feel difficult to stop.

As with all eating disorders, we can’t tell if someone has bulimia by just looking at them or knowing their weight. Many people who have bulimia are not classified as ‘underweight’. This is a mental health disorder that is often held as a secret from others. If someone shares with you that they struggle with eating, body image, or an eating disorder, it is important to take them seriously and support them in entering treatment as soon as possible.

Signs and Symptoms

  • Binge eating
  • Secretive eating (eating in the car, eating in the middle of the night, food missing)
  • Bathroom visits after eating (in order to purge)
  • Vomiting/purging
  • Laxative, diet pill or diuretic abuse
  • Weight fluctuations (usually with 10-15 lb range)
  • Swollen glands
  • Broken blood vessels
  • Rigid and/or excessive exercise regimens
  • Fasting or avoiding eating after a purge
  • Mood swings
  • Depression
  • Severe self-criticism
  • Self-worth determined by weight
  • Fear of not being able to stop eating voluntarily
  • Self-deprecating thoughts following eating
  • Fatigue
  • Muscle weakness
  • Tooth decay
  • Irregular heartbeats
  • Avoidance of restaurants, planned meals or social events
  • Complains of sore throat
  • Need for approval from others
  • Substance abuse
  • Ipecac abuse – this can be particularly dangerous. Ipecac is a medicine used to induce vomiting; long-term misuse of ipecac can actually be deadly as it can lead to cardiac arrest.

Physical/Medical Complications

  • Fatigue and lack of energy
  • Amenorrhea (loss of menstruation) and irregular menstruation
  • Dizziness
  • Headaches
  • Dehydration
  • Constipation and diarrhea
  • Shortness of breath
  • Irregular heartbeats
  • Depression
  • Tears of esophagus
  • Hair loss
  • Stomach pain and bloating
  • Erosion of teeth enamel
  • Chronic sore throat
  • Kidney and liver damage
  • Parotid gland enlargement
  • Electrolyte imbalances
  • Cathartic colon (caused from laxative abuse)
  • Edema (swelling of hands and feet)
  • Low blood pressure
  • Chest pains
  • Development of peptic ulcers and pancreatitis (inflammation of the pancreas)
  • Gastric dilation and rupture
  • Abrasions on back of hands and knuckles
  • Anemias
  • Cardiac arrest and death
  • More on the dangers of bulimia


There are no single factors that contribute to the development of an eating disorder. It is usually a combination of biological, social, and psychological factors. It is common for people with eating disorders to also experience symptoms of anxiety, depression, substance use disorder, perfectionism, impulsivity, and a history of trauma, dieting, or another eating disorder. There may be a higher likelihood of developing an eating disorder if one or both parents, a sibling, or a child suffers from an eating disorder; suggesting a genetic link.

Here is more on the causes of eating disorders.


Bulimia is a serious eating disorder that can come with sudden medical complications. If you suspect that you or someone you know may be suffering from bulimia, it is important to seek professional treatment with a medical doctor. A treatment team approach is usually recommended to recover from an eating disorder including nutritional therapy with a registered dietitian, and mental health therapy with a licensed therapist.

While eating disorders are thought of as the “problem” to address, we need to dig further and consider how it is the “solution” to a deeper issue. It is difficult to recover without addressing the underlying core issues that lead to the individual using eating disorder behaviors (restricting, binging, purging). These behaviors help the individual cope with difficult emotions, life transitions, negative beliefs, and challenging experiences. Working with a therapist, dietitian, doctor, and possibly psychiatrist, can help provide the support and resources needed to recover.


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Additional Reading:

Bulimia Signs and Symptoms and Dental Issues.
Family-Based Treatment For Adolescent Bulimia Nervosa – How it works, effectiveness, resources.
Treatment For Eating Disorders – Information about treatment, what to expect, resources.
Investigational Pharmacological Treatments for Bulimia Nervosa – Research Updates from King’s College London.
Medication Choices to Assist in the Treatment of Eating Disorders
Teenage Bulimia – How bulimia affects teens. Symptoms, physical effects, getting help.
Chewing and Spitting Food – Causes, side effects, treatment.
The Connection Between Bulimia and Self-Harm



Help Your Teenager Beat an Eating Disorder – By James Lock

Bulimia: A Guide to Recovery – By Lindsey Hall

The 8 Keys To Recovery From An Eating Disorder – By Carolyn Costin

Sick Enough – By Dr. Jennifer Gaudiani

Updated by Molly Bahr –  12/2019
Written by: Colleen Thompson