What is Bulimia?
Bulimia nervosa, usually referred to as just bulimia, is an eating disorder where someone repeatedly eats large amounts of food (known as a bingeing), and then tries to “get rid of” the food through different harmful behaviors (known as purging). Purging can take a number of different forms, including vomiting, compulsive exercise, or misuse of laxatives or diuretics.
Bulimia is not a choice or a vanity issue. Like all eating disorders, bulimia has complex neurological and biological underpinnings, which is why we refer to it as a brain disorder. While environmental and social factors play a role in eating disorder development, they are never the singular cause (nor is anything else). Rather, eating disorders emerge out of a “perfect storm” of factors.
Bulimia has serious short- and long-term health consequences, and can be fatal if left untreated. But with the right support, lasting recovery is possible for everyone struggling.
Signs and symptoms of bulimia
When people think about bulimia, they generally think of the two most commonly known behaviors: binge eating (uncontrollably consuming a large amount of food in a short amount of time), and purging through self-induced vomiting. However, bulimia doesn’t always show up that way, and there are other symptoms and behaviors a person might experience. Additionally, bingeing and purging almost always happen in secret, so it’s important to be aware of other red flags.
Signs and symptoms of bulimia can be physical, psychological, or behavioral, and touch many different aspects of a person’s life.
Physical symptoms
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Psychological and mood-related symptoms
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Food-related symptoms
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Body image symptoms
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What is bingeing?
Bingeing, or binge eating, is when a person eats an objectively large amount of food in a short amount of time. Eating an extra slice of cake or going back for a third serving of pasta isn’t a binge—binges are distinct psychological events with specific characteristics.
Someone who’s engaging in a binge may feel like they’re unable to control how much they’re eating, and even have the sense that they’re outside their body while the binge is occurring. During a binge, a person typically continues to eat after they feel full, often to the point of extreme physical discomfort. Episodes of binge eating are almost always followed by intense feelings of shame or guilt and significant emotional distress.
- Within a 2-hour period, eating an amount of food that is definitely larger than most people would eat under similar circumstances
- Feeling a lack of control over eating during the episode
- Eating much more rapidly than normal
- Eating until feeling uncomfortably full
- Eating large amounts of food when not feeling physically hungry
- Eating alone because of being embarrassed by how much one is eating
- Feeling disgusted with oneself, depressed, or very guilty after overeating
How does binge eating affect the body?
For people struggling with bulimia or binge eating disorder, binges can provide a temporary sense of relief, helping people to numb tough feelings. However, that relief is quickly and inevitably replaced by emotional and psychological distress, often in the form of shame, guilt, embarrassment, disgust, or other distressing emotions.
In addition to these mental health consequences, bingeing can also take a toll on your body.
- Abdominal bloating
- Abdominal cramping
- Nausea
- Vomiting
- Acid reflux
- Diarrhea
- Constipation
- Lethargy
- Insulin resistance
- Sleep apnea
- Metabolic syndrome
- Heart disease
- Type 2 diabetes
- High blood pressure
- Musculoskeletal problems
What is purging?
Purging is a term used to describe any behavior meant to “get rid of” or “make up for” food a person has eaten. People with bulimia or anorexia binge-purge subtype will purge after a binge, while people with purging disorder will purge without having binged beforehand.
When people think of the purging associated with bulimia, they tend to think of vomiting. And while this is a common purging behavior, purging can also take several other forms, including excessively exercising, abusing laxatives or diuretics, or fasting.
Levels of severity
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Mild
Purges occur 1-3 times per week
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Moderate
Purges occur 4-7 times per week
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Severe
Purges occur 8-13 times per week
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Extreme
Purges occur 14 or more times per week
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These different levels of severity can be helpful for clinicians looking to understand and treat someone who purges—but they do not suggest who should and shouldn’t get treatment. Regardless of how frequently someone is purging, they’re at risk for serious mental and physical health complications. Plus, “mild” purging behaviors can easily and quickly escalate to “extreme” forms.
Getting help early is always the best approach, not only to prevent serious health issues, but also to set someone up for an easier recovery journey.
How does purging affect the body?
As with binge eating, purging is a coping behavior that can provide a sense of temporary relief for someone struggling with an eating disorder. But this relief, just like the relief associated with binge eating, is always overshadowed by distressing emotions.
Purging also carries physical health risks, some of which can be extremely serious and potentially deadly.
Some of the most common physical effects of purging include:
- Discoloration and decay of the teeth
- Sore throat and temporary loss of voice
- Bleeding from the mouth
- Low blood pressure
- Heart arrhythmia
- Low heart rate
- Feeling cold often
- Chronic acid reflux
- Chronic diarrhea
- Chronic pain in the stomach
- Chronic cough
- Kidney failure
- Infertility
- Hormone disruptions
- Electrolyte imbalance
Common questions about bulimia
What does bulimia treatment look like?
The initial focus of treatment for bulimia nervosa is normalizing eating habits, stopping eating disorder behaviors, and weight restoration if necessary. Treatment may include identifying what triggers put the patient at risk of engaging in eating disorder behaviors and learning tools and skills to stop behaviors. We also work to identify how others in the patient's life might be able to support eating and recovery goals. Once the patient has made progress with eating behaviors and weight, if needed, treatment then shifts to other areas like working on interpersonal relationships, learning to handle triggers, or understanding potential root causes of the eating disorder.
Our clinicians use a variety of different evidence-based treatment modalities, including CBT-E (a form of cognitive behavioral therapy designed specifically for eating disorders), DBT (dialectical behavioral therapy), and ERP (exposure and response prevention). For younger patients who live with their family, we generally use FBT (family-based treatment).
What are the causes of bulimia?
As frustrating as it is, there is rarely one identifiable cause of an eating disorder, and bulimia is no different. More often than not, it's a constellation of neurobiological and environmental factors: in other words, someone has a genetic predisposition to developing an eating disorder, and then the eating disorder is “turned on” by environmental factors. Some factors that have been associated with the development of bulimia include impulsivity, childhood trauma, and history of dieting. You can learn more about the causes of eating disorders on our blog.
What defines bingeing and purging?
Though the specifics of a binge or a purge will look different from person to person and circumstance to circumstance, there are some defining criteria. A binge is defined as an episode of eating in which a person eats a large quantity of food while feeling a lack of control. This often involves eating past the point of fullness until uncomfortable, eating extremely quickly, eating in secret, and feeling shame after eating. A purge is defined as a compensatory behavior meant explicitly to “make up for” or “get rid of” food eaten. In bulimia, this often takes the form of self-induced vomiting, or abuse of laxatives or diuretics.