Bulimia nervosa, also known as bulimia, is an eating disorder. It’s generally characterized by eating large amounts of food in a short period of time, followed by purging.

Purging can occur through forced vomiting, excessive exercise, or by taking laxatives or diuretics.

Bulimia is a serious condition that can be life threatening.

People living with bulimia may purge or display purge behaviors, as well as follow a binge-and-purge cycle. Purge behaviors can also include other strict methods to maintain weight like fasting, exercise, or extreme dieting.

Bulimia nervosa may also cause an obsession with achieving an unrealistic body size or shape. A person living with this eating disorder might be obsessed with their weight and can often be self-critical.

Read on to learn more about bulimia, as well as the ways you may help yourself or a loved one with this eating disorder.

The symptoms of bulimia include eating large amounts of food at once and purging, along with a lack of control over these behaviors. A person living with bulimia may also experience feelings of self-disgust after eating.

While the precise list of symptoms may vary between individuals, bulimia may include the following symptoms:

  • fear of gaining weight
  • making comments about being “fat”
  • a preoccupation with weight and body
  • a strongly negative self-image
  • binge eating, usually within a 2-hour period
  • self-induced vomiting
  • misuse of laxatives or diuretics
  • use of supplements or herbs for weight loss
  • excessive and compulsive exercise
  • stained teeth (from stomach acid)
  • acid reflux
  • calluses on the back of your hands
  • going to the bathroom immediately after meals
  • not eating in front of others
  • constipation
  • withdrawal from typical social activities

Complications from bulimia can include:

Bulimia can affect anyone at any age or body weight.

Research indicates that roughly 1.5 percent of women and 0.5 percent of men in the United States will experience bulimia at some point during their life. It’s more common in women, and the median age of onset is estimated to be around 12 years old.

Risk factors may include:

  • social factors
  • biological makeup
  • genetics
  • psychological well-being

Additionally, some people living with bulimia may also have a history of anorexia nervosa or another eating disorder.

If you suspect your loved one needs help, it’s important to let them know that you’re there for them without any judgment. They may need you to just listen, or they might need your help finding and going to appointments.

Any progress should also be addressed with further encouragement.

Try saying things like:

  • I’m here to listen.
  • Can I help you with finding a doctor or mental health professional?
  • Do you need help making an appointment? Can I drive you?
  • You are a great person because _______.
  • I appreciate you and I’m proud of you.

Avoid saying things like:

  • You need to stop eating so much at once.
  • Can’t you just stop purging?
  • You need to get help.
  • You look fine.
  • Why are you worried about how you look?
  • I don’t understand your behaviors.
  • It’s all in your head or you’re just stressed.
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Bulimia has no single known cause. However, it’s thought that a combination of certain factors can influence its development. These can include:

  • genes
  • family history
  • a past traumatic event
  • social or cultural influences

A 2019 review, as well as some older research, also suggests that bulimia may also be associated with serotonin deficiencies in the brain. This important neurotransmitter helps regulate mood, appetite, and sleep.

A doctor typically uses a variety of tests to diagnose bulimia. First, they may conduct a physical examination. They may also order blood or urine tests.

A psychological evaluation will help them understand your relationship with food and body image.

The doctor will also use criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The DSM-5 is a diagnostic tool that uses standard language and criteria to diagnose mental disorders.

The criteria used to diagnose bulimia include:

  • recurrent binge eating
  • regular purging through vomiting, excessive exercise, misuse of laxatives, or fasting
  • deriving self-worth from weight and body shape
  • binge eating and purging that happens, on average, at least once a week for 3 months
  • not having anorexia nervosa

The DSM-5 also categorizes bulimia from mild to extreme:

  • Mild: 1 to 3 episodes per week
  • Moderate: 4 to 7 episodes per week
  • Severe: 8 to 13 episodes per week
  • Extreme: 14 or more episodes per week

You may need further tests if you’ve had bulimia for a long period of time. These tests can check for complications that could include problems with your heart or other organs.

Treatment focuses on food and nutrition education as well as mental health treatment. It requires development of a healthy view of yourself and a healthy relationship with food.

Treatment options can include:

  • Antidepressants. Currently, fluoxetine (Prozac) is the only antidepressant approved by the Food and Drug Administration (FDA) to treat bulimia. This selective serotonin reuptake inhibitor may also help with depression and anxiety. Fluoxetine is only approved for treating bulimia in adults.
  • Psychotherapy. Also called talk therapy, this type of counseling can include cognitive behavioral therapy, family-based therapy, and interpersonal psychotherapy. The goal is to help you work through potentially harmful thoughts and behaviors that contribute to your condition. Group talk therapy may also be helpful.
  • Dietitian support and nutrition education. These can help you learn healthy eating habits and form nutritious meal plans. You may also learn to shift your attitudes toward food.
  • Treatment for complications. This may include hospitalization, especially for cases of severe dehydration, electrolyte imbalances, and organ damage.

Successful treatment usually involves a combination of the above treatments, along with a collaborative approach between your doctor, mental health professional, and family and friends.

Some eating disorder treatment facilities offer live-in or day treatment programs. Some live-in programs provide around-the-clock support and care.

If you don’t already have a therapist, you can browse doctors in your area through the Healthline FindCare tool.

Bulimia can be life threatening if it’s left untreated or if the treatment fails. Bulimia is both a physical and psychological condition, and it may be a lifelong challenge to manage it.

However, there are several treatment options available that can help. Often, the earlier bulimia is detected, the more effective treatment may be.

Effective treatments focus on:

  • food
  • self-esteem
  • problem solving
  • coping skills
  • mental health

These treatments can help you maintain healthy behaviors in the long term.

Bulimia is a type of eating disorder defined by eating large amounts of food in a short amount of time, followed by purging behaviors. While there are some known risk factors, there’s no single cause of bulimia.

It’s also important to know that this eating disorder can affect anyone.

If you suspect you or a loved one may be living with bulimia, it’s important to seek help from both a medical doctor and mental health professional.

Seeking prompt treatment may not only improve your quality of life, but it may also help prevent potentially life threatening complications.