What Is Bulimia? Symptoms, Causes, Diagnosis, Treatment, and Prevention

Bulimia is a serious eating disorder that involves both bingeing and purging.

“Bingeing” means you eat a large amount of food in a short period of time. “Purging” is an unhealthy way of ridding your body of those extra calories, per the Mayo Clinic. People with bulimia sometimes make themselves vomit to eliminate the calories they consume.

But that isn’t the only way to purge. Some may also follow a strict diet, fast, exercise excessively, or use laxatives, pills, or enemas. The harmful cycle of bingeing and purging can affect both physical and mental health, according to HelpGuide.

The bingeing and purging cycle isn’t even an effective way to lose weight. Indeed, many people with bulimia actually gain weight over time.

Your body starts absorbing calories from the moment you put food in your mouth. If you vomit right after a very large meal, you typically eliminate less than 50 percent of the calories you consumed. Laxatives get rid of 10 percent of the calories you eat.

While purging may make you weigh less temporarily, it’s most likely water loss and not true weight loss, per HelpGuide.

Signs and symptoms of bulimia can vary from person to person. Some common red flags, per the Mayo Clinic and HelpGuide, include:

• Eating large amounts of food in isolation
• Being unable to control how much you eat
• Vomiting after meals
• Using laxatives, diuretics, enemas, or other pills after eating when they’re not needed
• Exercising or dieting excessively
• Experiencing frequent weight changes
• Suffering from fainting or dizziness spells
• Displaying physical changes caused by vomiting, such as bad breath, damaged teeth, swelling around the cheeks, broken blood vessels in the eyes, or calluses on the knuckles (from gagging)
• Feeling constipated or bloated
• Feeling tired
• Experiencing menstrual period changes
• Engaging in repetitive, secretive, or antisocial behaviors related to food
• Being intensely concerned with body weight
• Using dietary supplements incorrectly

Doctors aren’t sure exactly what causes bulimia. Your genes, family history, mental health status, life experiences, self-esteem, and other factors may all play a role, according the U.S. Department of Health and Human Services (HHS).

Scientists are also studying whether certain chemical changes in the brain, such as changing levels of serotonin, may affect a person’s risk of developing eating disorders, per HHS. Researchers are also investigating the role of certain brain circuits involved in processing motivation and rewards.

Some factors may make you more likely to develop bulimia. Per Mayo Clinic and HelpGuide, those include:

• Having a poor body image or low self-esteem
• Experiencing stressful life changes
• Having a history of substance abuse
• Being diagnosed with depression, anxiety, or another mental health disorder
• Experiencing trauma or abuse or suffering from post-traumatic stress disorder (PTSD)

Your physician will likely use the criteria listed in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to diagnose your condition. Per the National Eating Disorders Association, the criteria in the DSM-5 are:

• Recurrent episodes of binge eating
• Recurrent inappropriate behavior designed to prevent weight gain, including using vomiting, laxatives, diuretics, or other medication
• Behavior occurs, on average, at least once a week for three months

When to See a Doctor About Your Condition

If you think you have bulimia, it’s important to be honest with your doctor about your eating habits and weight loss methods. This eating disorder can have dangerous effects on your body if it’s not treated.

Your healthcare provider may want to perform a physical exam, a blood or urine test, and a psychological evaluation, per HHS.

You may also need to have a blood test (including a particular blood test called a basic metabolic panel) or an electrocardiogram to see if the repeated bingeing and purging episodes have affected certain organs in your body.

A good first step is to consult your primary care physician. They can refer you to a more specialized doctor.

Additionally, the National Eating Disorders Association offers a toll-free hotline at 800-931-2237.

Prognosis of Bulimia

Many people with bulimia will improve with the right treatment, but some may get better and then relapse again.

Studies show that about 50 percent of those battling bulimia will completely recover with treatment, according to the Cleveland Clinic. Research also suggests that 30 percent will go on to experience a partial recovery, while up to 20 percent will still have symptoms.

The duration of bulimia varies from person to person. Roughly half of patients will fully recover from the condition within 10 years, but others won’t. For many, bulimia is a lifelong struggle. Symptoms may come and go or be constant, according to Psycom.

Several options are available to help people with bulimia. Sometimes the approaches are used together for better results. Common treatments, per Mayo Clinic and the National Eating Disorders Association, include:

• Psychotherapy Different forms of therapy and counseling can improve symptoms of bulimia. Talking to a mental health professional may help you identify your unhealthy behaviors and come up with ways to eliminate them. Sometimes family members are encouraged to participate in therapy sessions.
• Nutritional Counseling A dietitian can help you develop a healthy eating plan.
• Hospitalization If your condition is severe, you may need to be hospitalized until you get better.

You may relapse after treatment, but the good news is that you can still recover from bulimia. After proper treatment, most girls and women are able to eat and exercise in healthy ways, per HHS.

Medication Options

Antidepressant medications can be used along with therapy. The U.S. Food and Drug Administration has approved fluoxetine (Prozac), which is a selective serotonin reuptake inhibitor, to treat bulimia in adults, per the Mayo Clinic and HHS.

Alternative and Complementary Therapies

Some people with bulimia look to alternative therapies to help ease their symptoms and lower their stress levels.

Common approaches, per Mayo Clinic, include:

• Acupuncture
• Massage
• Meditation, tai chi, or yoga

Prevention of Bulimia

While there’s no surefire way to prevent bulimia, adopting healthy habits and seeking professional help early on can improve the outlook for you or someone you know who’s battling bulimia.

Here are some tips from Mayo Clinic and the National Eating Disorders Association:

• Try to avoid talking about your weight.
• Be mindful of your triggers and steer clear of them; examples may include social media or fashion magazines, certain interactions with highly critical people in your life, etc. It is different for everyone, but it is important to be mindful if certain experiences lead you to be more likely to binge or purge.
• Focus less on your weight and more on maintaining a healthy lifestyle.
• Avoid unhealthy weight-control measures, such as fasting, laxatives, or supplements.
• Talk to your doctor if you have any early signs or symptoms of bulimia.
• Seek treatment for underlying conditions, such as depression.
• Ask a loved one for support.
• Educate yourself about unrealistic body expectations portrayed by the media.
• Talk to friends or family members if you think they have food issues.

Bulimia can have dangerous effects on your body. In certain cases, the eating disorder can even lead to death.

Some risks that can develop from bulimia, per Mayo Clinic and the National Eating Disorders Collaboration, include:

• Severe dehydration
• Electrolyte imbalances, which can lead to heart or kidney failure
• Stomach damage or ulcers
• Irregular periods
• Tooth decay
• Chronic sore throat
• Indigestion, heartburn, or acid reflux
• Constipation, diarrhea, or other problems with bowel movements
• Osteoporosis
• Infertility in men and women

Anyone can suffer from bulimia. And while it may be underdiagnosed in men, it does tend to affect women more often. Up to 2 percent of women have this eating disorder, per HHS.

Girls and younger women are more likely to have bulimia than older women. Women usually develop bulimia around age 18 or 19. Still, researchers are finding that eating disorders are beginning to affect more older members of the population. According to a study cited by HHS, 13 percent of women over age 50 had some disordered eating pattern.

Historically, eating disorders have been portrayed as a problem primarily affecting young, heterosexual, white women. In fact they affect people of all races and ethnicities, per the National Eating Disorders Association.

Black and Hispanic Americans and Bulimia

One study found that Black teenagers were 50 percent more likely than white teens to exhibit symptoms of bulimia.

In another study, researchers found that Hispanic adolescents were significantly more apt to suffer from bulimia, compared with non-Hispanics.

Experts say eating disorders may be partially due to environmental stressors, such as abuse, poverty, or racism. Because women from Black, Indigenous, and People of Color (BIPOC) communities are exposed to more of these stressors, they may be more susceptible to disorders like bulimia, per the National Eating Disorders Association.

Sometimes people with bulimia have other eating disorders or medical problems.

Conditions that may be related to bulimia, according to Cleveland Clinic, include:

• Anorexia This disorder involves extreme calorie restriction.
• Exercise Bulimia People with this condition use physical activity along with other means, such as vomiting and diarrhea, to “pay” for overeating.
• Rumination Disorder This involves repeatedly regurgitating food after eating, but it’s not caused by an eating disorder.
• Binge Eating Disorder This means you regularly eat too much and feel a lack of control over your eating, but you don’t try to purge the food.
• Depression This mental health disorder is characterized by a depressed mood and/or loss of interest in activities.
• PTSD This condition happens when a person has a reaction to a traumatizing or upsetting event. 

Your journey with bulimia will require lots of support and resources. Here are Everyday Health’s top recommended organizations, articles, and websites with the information and support you may need.

Favorite Organizations for Essential Bulimia Info

National Eating Disorders Association (NEDA)

NEDA is the largest nonprofit organization dedicated to supporting individuals and families affected by eating disorders. They provide information and support to build a community of hope. We especially love their online screening tool, which can help you determine if you need to seek professional help.

National Alliance for Eating Disorders

This organization is a national nonprofit dedicated to providing programs and activities aimed at outreach, education, early intervention, and advocacy for those with eating disorders.

Office on Women’s Health

This government-run site provides a wealth of information about bulimia and treatment options.

Academy for Eating Disorders (AED)

The AED is a professional organization that promotes excellence in the research, treatment, and prevention of eating disorders.

Favorite Online Support Network

ANAD

ANAD is an organization committed to providing free services that are accessible to all. We love their recovery mentor program, which matches you with an individual who has recovered from an eating disorder and can help support you.

Eating Disorder Hope

Eating Disorder Hope offers online support groups dedicated to providing assistance and encouragement. The groups are led by licensed professional counselors.

Favorite App

Recovery Record: Eating Disorder Management

This app is designed to help you manage your recovery from eating disorders. It lets you track your mood and meals. You can also connect with your therapist or dietitian and receive feedback.

Favorite Blogs

National Eating Disorders Association Blog

NEDA’s blog features personal accounts of people who’ve battled eating disorders and recovered. There are also entries that provide educational information about eating disorders.

Favorite Resource for Becoming an Advocate

Eating Disorders Coalition (EDC)

The EDC’s mission is to advance the federal recognition of eating disorders as a public health priority. They build relationships with Congress, federal agencies, and national and local organizations to advocate for awareness.

Favorite Annual Meetings

International Conference on Eating Disorders (ICED)

The AED hosts this annual scientific conference that highlights research and education related to eating disorders. Experts from around the world attend to learn about emerging breakthroughs in the field.

Favorite Retreats

The Meadows Ranch

This 50-acre property located in Arizona provides a relaxing retreat where you can focus on regaining your health. Their experts specialize in combining approaches to treat a range of eating disorders, including bulimia. Representatives work with your health insurance company to make your treatment as affordable as possible.